A diagnostic dilemma: unusual case report of a dermoid cyst embellished with a tattoo in the midline of neck

Abstract

Dermoid cysts are benign congenital tumours of ectoderm origin usually arising from the midline where the fusion of embryonic structures of both sides occurs. They are true hamartomas focal malformations that can resemble neoplasms grossly and even microscopically. We hereby presented a case of a 25 year old male presented with complaints of a midline neck swelling for 5 years which was found just beneath a symbol tattooed in the skin overlying the swelling. The USG, fine needle aspiration cytology and multislice CT scan reports strongly suggested findings of a dermoid cyst. However, there was a diagnostic challenge faced when chest CT suggested old granulomatous changes around the swelling region. After thorough history taking, physical examination and radiological investigations, the swelling was successfully excised with a complete margin which was sent for histo-pathological examination, results of which correlated with the initial diagnosis of it being a dermoid cyst with foreign-body reactions.