Cutaneous Cysts Research Articles

A Rare Case of a Giant Pelvic Retroperitoneal Epidermoid Cyst

To The Editor: Epidermoid cyst is a frequent benign cutaneous tumor that could occur in any part of the human body. The pelvic cysts are uncommon and only a few cases are described in the literature. The following is a report of a rare case of a pelvic epidermoid cyst. A seventy year old multiparus lady presented with progressive swelling in the abdomen. Clinical examination confirmed a large mass in the abdomin. The ultrasound showed a giant 35 cm abdomino-pelvic echogene mass, extending from the pubis symphysis to the epigastric region, displacing the liver, spleen and the urinary bladder. The computed tomography showed similar finding (figure 1). A giant ovarian cyst was diagnosed. Median laparotomy was performed and a 30 cm retroperitoneal cyst was found. Ovaries and uterus were normal. Uneventful cyst cleavage was performed after liberation of some intestinal and epiploic adherences (figure 2). The cyst contained sebaceous matter and histological examination shows that the cystic wall was lined with flattened squamous epithelia with a distinguished granular layer. The cystic space was filled with a large amount of keratinized material. The histology was compatible with an epidermoid cyst. The post operative course was uneventful and the patient was doing well at the 5 months follow-up visit. Figure 1 Reconstruction of the image with CT scan, giant intra-abdominal mass. Figure 2 Image of the cyst after excision, size > 30cm Epidermoid cyst is a frequent benign cutaneous tumor, usually present in patients with an age range of 19 to 45 years. In children it is associated with a Gardner syndrome in 50% of cases [1]. It was described in various parts of the body including penis, spleen and brain [2–4]. It is the most frequent cutaneous cyst in the head and neck (49%) [5]. Only three cases of pelvic epidermoid cyst were reported in the literature, one was retroperitoneal [1] and the other two were retro-rectal [6, 7]. Concerning pathogenic theories, the epidermal cyst could be congenital, or post traumatic [8]. Epidermoid cysts are benign tumors with no risk of malignant transformation, but they may grow insidiously to reach a considerable sizes displacing or damaging other tissues and organs [9]. Pre-operatively, diagnosis of pelvic epidermoid cyst is difficult. Ultrasound and computed tomography often lead to a diagnosis of ovarian cyst. Magnetic resonance imaging (MRI) is more specific, as it shows epidermoid cyst as hypointense area on T1-weighted imaging and hyperintense on T2 weighted imaging without enhancement at contrast injection [10]. MRI could also help in confirming retroperitoneal localization; unfortunately it was not performed in our patient's case. The treatment of the pelvic epidermoid cyst is a surgical ablation using a cleavage to avoid any organ damage. However, in dealing with retroperitoneal space it could be difficult to avoid damaging iliac vessels and nerves [11] and if that is the case then the cyst must be punctured and drained before it is dissected. Precaution should be taken to avoid spillage of the contents out. A successful laparoscopic excision of a retro-rectal epidermoid cyst was described [7]. In conclusion, this report described a patient with a giant retroperitoneal pelvic epidermoid cyst which was successfully treated surgically. Although the pelvic epidermoid cysts are rare and difficult to diagnose pre-operatively, it should be considered in the differential diagnosis of ovarian tumors.

Cutaneous Cysts of the Head and Neck

A retrospective study on the features of cutaneous cysts of the head and neck as seen in a North Jordanian population. The records of the Department of Pathology at Jordan University of Science and Technology were reviewed for patients with cutaneous cysts of the head and neck during the 12-year period extending between 1991 and 2002. Applicable records were retrieved, reviewed, and analyzed. Primary analysis outcome measures included patient age, gender, location of the cyst, type, clinical presentation, and treatment. The records of 488 patients were available for analysis. Epidermoid cyst was the most frequent lesion (49%) followed by pilar cysts (27%), and dermoid cysts (22%). The site affected most frequently was the scalp (34%), predominantly with pilar cysts (96%). Epidermoid cyst was the most frequent lesion in the neck (68%), cheeks (77%), periauricular area (70%), and the nasal area (55%). Dermoid cyst was the most frequent lesion in the periorbital area (52%). Females represented 51% of the patients and males accounted for 49%. The peak of age distribution for patients with dermoid cysts was at the first decade, and both of epidermoid and pilar cysts peaked at the third decade. Infection presented in 2.5% of cases. All cysts were enucleated surgically. Maxillofacial surgeons often encounter cutaneous cysts of the head and neck, and they must be familiar with the clinicopathologic characteristics of these lesions.

Multiple cutaneous myxoid cysts with transepidermal elimination

Multiple cutaneous myxoid cysts with transepidermal elimination

An Unusual Midline Swelling – Case Report of a Cutaneous Bronchogenic Cyst

Cutaneous bronchogenic cyst remains a very rare cause of a midline swelling in children. The authors report a case of a 14-month-old boy who presented with a sternal sinus and consequent abscess. Histopathological analysis revealed this to be a cutaneous bronchogenic cyst. This is a very rare lesion with only 65 cases reported in the literature. It is caused by an abnormal development in the distal tracheobronchial tree, and diagnosis is confirmed by ciliated and mucin-producing pseudostratified columnar epithelium of respiratory type on histopathological analysis. It is managed by resection of the cyst, as these cysts are often foci for subsequent infections and malignant potential has been reported.

Cutaneous Metaplastic Synovial Cyst in Ehlers-Danlos Syndrome: Report of a Second Case

A cutaneous metaplastic synovial cyst is a rare entity that is probably caused by trauma or surgery. We report the second case of cutaneous metaplastic synovial cyst in a child with Ehlers-Danlos syndrome. His father is also affected with Ehlers-Danlos syndrome, and his diagnosis is substantiated by the demonstration of reduced synthesis of collagen type V.

Cisto epidermóide: relato de caso

Os cistos epidermóides, também denominados cistos cutâneos, são tumores muito freqüentes, que podem requere cuidados cirúrgicos. Na maioria das vezes, em razão da apresentação clínica patognomônica e de curso indolente, são simplesmente removidos. Habitualmente, o diagnóstico clínico é de fácil confirmação na cirurgia devido ao aspecto típico de formação cística preenchida com um fluido cremoso. Comumente tais lesões “típicas” não sofrem investigação histológica após a remoção. Entretanto, este relato de caso de um cisto epidérmico em couro cabeludo vai mais além, produzindo, por meio de técnicas laboratoriais de rotina, uma análise histopatológica, que revelou a existência de um cisto típico, esférico e esbranquiçado, preenchido, predominantemente, pro lâminas de queratina, delimitado por um epitélio estratificado e envolvido por uma cápsula de tecido conjuntivo denso modelado.

Quiste cutáneo ciliado en piel escrotal. descripción de un caso con discusión patogénica de la entidad

Cutaneous ciliated cyst of the scrotal skin. A case report with discussion of pathogenesisCutaneous ciliated cyst (CCC) is a rare benign lesion predominantly occurring in the lower limbs of young women and exceedingly rare in males. Here, we report a case involving a previously unreported site (i.e., scrotal skin) in a 15-year-old male. We also describe pathologic and immunonohistochemical findings, review the pertinent literature and discuss their pathogenetic mechanisms. We propose that CCC could represent a morphologic pattern encompassing several pathogenetically different entities. Data we provide support the hypothesis that at least a part of CCC, specially those occurring in males, could have their origin in ciliated metaplasia of apocrine sweat glands

Scapular bronchogenic cyst

We report a rare case of a 3-year-old male child with scapular bronchogenic cyst. The cyst was excised because of associated pain and discharge from the swelling. Till date, 64 cases of cutaneous bronchogenic cyst have been reported in the literature. Only 12 of these patients had lesion located in periscapular area. The treatment is surgical as it can undergo malignant transformation.

Ciliated Cyst of the Vulva: Oestrogen and Progesterone Receptors

Sir, Cases of cutaneous cysts lined by ciliated epithelium have rarely been documented, and only a few cases of such cysts in the vulvar vestibulae have been reported (1–3). The origin of the cysts is controversial because the location is so anatomically specific. In this report, we describe a 14-year-old girl with a ciliated cyst of the vulva (CCV), the lining cells of which were positive for oestrogen and progesterone receptors, and discuss the pathogenesis of ciliated epithelium.

The role of anaerobic bacteria in cutaneous and soft tissue abscesses and infected cysts

This review presents the aerobic and anaerobic microbiological aspects and management of cutaneous and soft tissue abscesses, paronychia, anorectal, pilonidal, and perirectal abscesses, infected epidermal cysts, hidradenitis suppurativa, and pustular acne lesions. These infections often occur in different body sites or in areas that have been compromised or injured by foreign body, trauma, ischemia, malignancy or surgery. In addition to group A beta-hemolytic streptococci and Staphylococcus aureus, the indigenous aerobic and anaerobic cutaneous and mucous membranes local microflora usually is responsible for these generally polymicrobial infections. These infections may occasionally lead to serious potentially life-threatening local and systemic complications. The infections can progress rapidly and early recognition and proper medical and surgical management is the cornerstone of therapy.

Intraosseous pilomatricoma: a possible rare skeletal manifestation of Gardner syndrome

Here we report a case of intraosseous pilomatricoma in a patient with Gardner syndrome. A 17-year-old boy with a family history of Gardner syndrome and multiple cutaneous epidermoid cysts presented with pain in the region below the knee of the left leg. Plain radiographs displayed a well-circumscribed eccentric lesion of mixed radiolucent and radiopaque density within the diaphysis of the left proximal tibia. By magnetic resonance (MR) imaging, the lesion appeared as a low intensity lesion in T1-weighted images and a heterogeneous high intensity lesion with a low-signal radiation pattern on T2-weighted images. Gadolinium enhancement was observed partially within the lesion and intensely in the lesion rim. After curettage, histological examination revealed a massive accumulation of keratinous material with epithelial nests that displayed both epidermal and trichilemmal keratinization with basaloid and shadow cells and with metaplastic ossification. These features confirmed a pathological diagnosis of intraosseous counterpart of pilomatricoma. In the context of this patient's skin lesions, intraosseous pilomatricoma may be a rare skeletal manifestation of Gardner syndrome.

A Case of a Follicular Hybrid Cyst

Various cutaneous cysts such as epidermal cysts, trichilemmal cysts, vellus hair cysts, steatocystoma, or pilomatricoma can arise from a different part of the pilosebaceous unit, namely the infundibulum, isthmus, sebaceous ducts, and bulbar or inferior portion. Rarely, a hybrid cyst that includes two or more components of a cystic lesion arising from the pilosebaceous unit can develop. The pathogenesis of this unusual disease is not yet known. We report a case of a follicular hybrid cyst which showed combined histologic features of both an epidermal cyst and pilomatricoma, and discuss the possible pathomechanism of the development of this hybrid cyst with a review of the literature. (Ann Dermatol (Seoul) 19(4) 153~156, 2007)

The Vein Hook Successfully Used for Eradication of Steatocystoma Multiplex

Steatocystoma multiplex is characterized by the formation of the numerous cutaneous cysts in the exposed area leaving some cosmetic problems for the patients. Only surgical excision has been effective, and its several variations were done with limited success. Because the patients usually have many cysts, excision of cysts was tedious for the doctors and left scars on the patients. Five patients agreeing to participate in this experiments were selected. The vein hook used for ambulatory phlebectomy was employed to eradicate the cysts. The skin was incised approximately 2 to 3 mm in length. Then the mosquito forceps removed the cysts by gently squeezing or hooking the inner or outer cyst wall. By completely removing tissue around the cyst, recurrence was able to be prevented. It took approximately 1 minute to excise one cyst completely, it left no hypertrophic scars except for transient postinflammatory hyperpigmentation, and it had no recurrences for 14 to 30 months on five patients. The use of this instrument is very simple and time-saving, providing excellent success rate with favorable cosmetic results. It can be a good alternative for eradication of the cysts in steatocystma multiplex. The authors have indicated no significant interest with commercial supporters.

Radiological findings in Birt–Hogg–Dubé syndrome: a rare differential for pulmonary cysts and renal tumors

Birt-Hogg-Dubé syndrome is a rare disorder characterized by cutaneous hair follicle tumors, pulmonary cysts, and renal tumors. We report a case of a 63-year-old male patient with this syndrome. The radiological findings seen with this syndrome are described. Radiologists should be aware of and able to recognize this syndrome.

Where in Europe should we look for sources of the cutaneous trematode Collyriclum faba infections in migrating birds?

Cutaneous cysts with trematodes of Collyriclum faba have been found in birds during their spring and post-breeding migrations in the Czech Republic. During spring migrations, C. faba was found in one dunnock Prunella modularis, two European robins Erithacus rubecula, three common nightingales Luscinia megarhynchos, one song thrush Turdus philomelos and one great reed warbler Acrocephalus arundinaceus. During post-breeding migration, the same parasite was found in one garden warbler Sylvia borin, one whitehroat S. communis, three goldcrests Regulus regulus and one Eurasian treecreeper Certhia familiaris. The newly identified hosts of C. faba are dunnock, common nightingale, song thrush, great reed warbler and Eurasian treecreeper. Geographical areas of the birds' infection were identified from an analysis of reports on ringed birds of the same species, the time necessary for the development of cutaneous cysts with C. faba and the time of their survival, and hitherto known geographical areas of endemic occurrence of C. faba. It is presumed that birds trapped during spring migrations were infected in some montane and submontane regions in south-western Europe (the Alps, the Apennines). Birds infected during autumn migration or post-breeding vagrancy could have been infected in the Central European Carpathians, the region of C. faba endemic occurrence. For migrating birds, the impact of C. faba infections has not been hitherto assessed.

Cutaneous ciliated cyst in a 16-year-old girl

A 16-year-old girl was seen for a painless subcutaneous mass of 1 year's duration. On excisional biopsy, a collapsed cystic structure lined by stratified, ciliated, columnar epithelium was noted; findings were consistent with cutaneous ciliated cyst. Immunohistochemical staining for progesterone receptor and epithelial membrane antigen were positive, whereas it was negative for carcinoembryonic antigen, which supports the theory of heteropia of the ciliated epithelium from the Müllerian epithelium in its histopathogenesis.

A case of cutaneous ciliated cyst on the umbilicus mimicking omphalomesenteric duct cyst and urachal cyst

A case of cutaneous ciliated cyst on the umbilicus mimicking omphalomesenteric duct cyst and urachal cyst

Cutaneous dermoid cyst: Cytokeratin and filaggrin expression suggesting differentiation towards follicular infundibulum and mature sebaceous gland

We experienced two cases of cutaneous dermoid cysts (DC). To elucidate the histogenesis of DC, we have studied cytokeratin (CK) expression in DC using ten different anti-keratin antibodies against CK1, 7, 8, 10, 14, 15, 16, 17, 18 and 19, and anti-filaggrin (filament aggregating protein) antibody. In the cyst wall of DC, CK1 and 10 were expressed in suprabasal layer, and CK14 was limited to the basal layer. In sebaceous gland-like structures, CK14 was detected in sebaceous acinus, and CK17 was detected in sebaceous duct. The other CKs were not detected. Filaggrin was intensely detected in the granular layer in the cyst wall of DC. CK expression profile of DC was similar to follicular infundibulum and sebaceous gland. These results suggested that DC differentiates towards follicular infundibulum and mature sebaceous gland.

Recurrent cutaneous metaplastic synovial cyst

Reported here is the first case of a recurrent cutaneous metaplastic synovial cyst (CMSC). The CMSC is a recently described lesion that is histologically characterized by a cystic cavity lined by cells resembling metaplastic synovium overlying villous connective tissue cores. The lesion clinically appears as a tender subcutaneous nodule and may often be misdiagnosed as a suture granuloma. Although the actual cause is unclear, a history of trauma usually precedes its onset. Here we present a case of CMSC in a 34-year-old white male, which recurred at the same site following excision of an epidermoid cyst. CMSCs are unique lesions that should be included in the differential diagnosis of tender subcutaneous swellings following surgical trauma.

Cutaneous ciliated cyst of the inguinal area in a man

Cutaneous ciliated cysts are rare, predominantly occurring on the lower extremities of young women. Most of them have been regarded as müllerian remnants. Cases in men are rarely reported. We report a case of a cutaneous ciliated cyst involving the inguinal area of a 56-year-old man and briefly review the published work.