Congenital peristernal dermal sinuses: a new entity?

Abstract

Conflicts of interest: none declared. Sir, Congenital dermal sinuses, including periauricular sinuses, spinal dermal sinuses and nasal dermoid sinuses, are sometimes encountered. Dermal sinuses have also been described in every region of the scalp, including the occipital region1, 2 and the frontotemporal region.3 However, congenital peristernal dermal sinuses are extremely rare. To the best of our knowledge they have not been reported in the English language literature. We present seven patients with congenital dermal sinuses in the peristernal region (Table 1, Fig. 1). All the lesions were detected at birth. Probing of all cases revealed a subcutaneous tract. In five of the seven cases, the lesions were extirpated and surgical exploration showed a blind‐ended tract ending at the fascial layer of the pectoralis major muscle. We describe a representative case. A 10‐year‐old Japanese girl (patient 4 in Table 1) with a punctum in her left anterior thoracic wall was referred to our department (Fig. 2a). Her parents noticed the punctum at birth. The punctum was located at the intersection of the left parasternal line and the left first intercostal space. She was clinically well and asymptomatic. Ultrasonography revealed a subcutaneous tract extending toward the pectoralis major muscle (Fig. 2b). Therefore, we diagnosed it as a sinus and excised it after staining with a blue dye. Surgical exploration disclosed a blind‐ended sinus ending at the fascia of the pectoralis major muscle (Fig. 2c,d). Histopathological examination showed that the lesion was lined by keratinized squamous epithelium. Numerous hair follicles, in varying stages of development, were observed in the sinus wall (Fig. 2e,f). The lesion was diagnosed histologically as a dermal sinus. The postoperative course was uneventful.