A rare suprasternal cystic neck mass in a pediatric patient: Epidermoid cyst

Abstract

Epidermoid and dermoid cysts are benign lesions encountered throughout the body; 7% occur in the head and neck area and 1.6% within the oral cavity. The cysts can be defined as epidermoid when the lining presents only epithelium, dermoid cysts when skin adnexa are found, and teratoid cysts when other tissue such as muscle, cartilage, and bone are present. Epidermoid cysts that originate from the suprasternal notch have not been reported previously in the literature. To our knowledge, we are reporting the first case of epidermoid cyst of the suprasternal notch in this study. A 10-year-old girl presented with a lower anterior midline neck mass that had been present for 1 year and that appeared only during coughing. The swelling usually occurred coincident with an intercurrent illness. She had no dysphagia, hoarseness of voice, or shortness of breath. Her medical history revealed acute bronchitis one month before admission. On admission, a physical examination revealed a tense swelling at the suprasternal notch that became apparent only during coughing and Valsalva’s maneuver (Fig 1). The lower border of the mass was not palpable. The mass was immobile during swallowing and was painless; passive pulling on the tongue did not cause a change in the position of the mass. The overlying skin was intact with no discoloration or ulceration. No other neck mass or cervical lymphadenopathy was detected. The remainder of the physical examination was normal. Laboratory examinations, including complete blood count, serum electrolytes, and liver function tests were all within normal limits. Sonography of the neck with the patient performing Valsalva’s maneuver showed a well-circumscribed, capsuled, cystic, hypoechoic mass that measured 2 2 2 cm at the suprasternal notch anterior to the cervical trachea. Magnetic resonance imaging of the neck revealed a well-circumscribed, cystic mass with no relationship to any other tissue at the suprasternal notch measuring 2 2 2 cm. We do not have an IRB; however, informed consent was taken from the patient’s family. The mass was removed by simple excision with the patient under general anesthesia. The wound was closed primarily. The postoperative period