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Case 1: histopathologic view of the fibrovascular cystic wall lined with squamous epithelium. (H & E; Â200).
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Epidermoid cysts are benign epithelial cysts that occur rarely in the neck. In contrast to dermoid cysts, epidermoid cysts do not include dermal attachments such as hair, hair follicles, sebaceous glands and sweat glands. They may be congenital or acquired. Acquired epidermoid cysts are either post-traumatic or iatrogenic. They rarely enlarge marke...
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Citations
... Since they are categorized under dermoid cysts, no data is available about their incidence alone. Together, epidermoid and dermoid cysts comprise between 1.6 and 6.9 percent of all head and neck cysts [1]. They mostly occur in the third or fourth decade of life and show a slightly higher male predilection [2]. ...
... Ectodermal entrapment during early foetal life has been most widely accepted, however, some consider these cysts to develop from pluripotent cells which get trapped during early embryonic life [5][6][7]. Acquired processes including traumatic or surgical implantation of epithelial tissues have also been linked with the development of these lesions [1]. Meyer first advocated the use of the term dermoid cyst for all developmental cysts on the floor of the mouth. ...
... Epidermoid cysts are often tough to diagnose clinically because of their rare occurrence in this anatomic site and a close clinico-radiological resemblance with the more common differentials including ranulas and dermoid cysts. Fine needle aspiration cytology (FNAC) is often helpful in differentiating ranulas from dermoids based on the presence of mucoid content in ranulas versus keratinous material in dermoids [1,4]. ...
Dermoid cysts are benign ectodermal-derived epithelial cysts rarely found on the floor of the neck. They may be congenital or acquired. They comprise three histological variants according to their contents and include dermoid, epidermoid, and teratoma. Epidermoid cysts are lined by epithelium but do not contain skin appendages like hair follicles and sebaceous glands, as seen in dermoid cysts. Teratoma on the other hand contain mesodermal element. They reveal either a supra-myelohyiod or infra-myelohyiod floor-of-mouth location and can be clinically confused with various close differentials including infections, tumours, mucous extravasation phenomena, and embryonic abnormalities. A 28-year-old female presented with a complaint of painless large swelling beneath the chin. Computed tomography (CT) scan with contrast revealed a right para-median thick-walled cystic lesion located in the sublingual space. A plunging ranula was suspected on radiological assessment. Aspiration cytology revealed keratin-containing fluid and pointed towards a tentative diagnosis of dermoid/epidermoid cystic lesion. The mass lesion was explored via a transcutaneous neck approach. The final histopathological evaluation of the excised cystic lesion eventually confirmed a diagnosis of epidermoid cyst. Consider epidermoid cyst as a possible differential for any floor-of-mouth swelling. They can be clinically and radiologically confused with close differential including ranula, dentoalveolar cyst and lipoma. Aspiration cytology examination is sometimes helpful in equivocal cases. Cyst excision with histological examination allows for a confirmatory diagnosis and is possibly the only means of distinguishing between specific histological variants of dermoids.
... Epidermoid cysts are the commonest of head and neck cutaneous cysts Golden BA, et al. [18] found in various regions [19]. In contrast to dermoid, epidermoid cysts do not include skin appendages within their wall [20]. Ren D, et al. [21] reported a huge epidermoid cyst in the maxillary sinus with sinus cavity expansion and sinus wall thinning [21]. ...
... Epidermoid cysts are the commonest of head and neck cutaneous cysts Golden BA, et al. [18] found in various regions [19]. In contrast to dermoid, epidermoid cysts do not include skin appendages within their wall [20]. Ren D, et al. [21] reported a huge epidermoid cyst in the maxillary sinus with sinus cavity expansion and sinus wall thinning [21]. ...
... 4 Histologically, they can be divided into three types: epidermoids, dermoids and teratoids 5,6 with epidermoid cysts being the most common and teratoids being the least common. 7 Epidermoid cysts are composed of a stratified squamous epithelium membrane without dermal components; dermoid cysts are composed of a stratified squamous epithelium membrane with dermal components inside including sebaceous glands, sweat glands and hair follicles; and teratoid cysts are composed of a stratified squamous epithelium membrane with elements from the three germ layers (ectoderm, mesoderm and endoderm) inside. 6 In terms of demographic distribution, there is no gender predilection and they are usually diagnosed in the second and third decades of life, although there are cases described from 7 months to 77 years of age. ...
... Differential diagnoses of mouth or neck swellings7 ...
Dermoid and epidermoid cysts are rare in the head and neck, specially in the oral cavity, accounting for 1.6 %. It represents an even smaller percentage of all the oral cysts, less than 0.01%. Usually asymptomatic, however, occasionally, obstructive symptoms like dysphagia or speech difficulties are found. We present a case of a 32 years old female patient with a sublingual epidermoid cyst. The patient was referred to our ENT department with complaints of an oral mass, speech difficulties and solid food dysphagia for 1 month. Physical examination revealed a well circumscribed symmetrical mass on the floor of the mouth with no inflammatory signs, tender and fluctuant on palpation. Computed tomography (CT) was requested. CT scan showed a sublingual cystic mass inferiorly limited by the mylohyoid muscle. Aspiration was performed to improve symptoms until surgery. The liquid that resulted from aspiration showed a granulated white cheesy material. Enucleation of the cyst was performed intraorally in the operating room. Histopathologic investigation confirmed the diagnosis of epidermoid cyst. The patient fully recovered and there was no recurrence. Although rare, cases like this exist. There are several differential diagnoses and a high level of suspicion is necessary for a correct workup, diagnosis and follow-up. Surgical excision is usually necessary and curative.
... DCs and ECs are uncommon lesions in the head and neck region, corresponding to 7% of all cases, presenting even less frequently in the oral cavity, representing between only 0.01% and 1.6% of all oral cysts (3,4,(9)(10)(11). Yilmaz et al. (11) report that ECs are more common when compared to DCs. ...
... DCs and ECs are uncommon lesions in the head and neck region, corresponding to 7% of all cases, presenting even less frequently in the oral cavity, representing between only 0.01% and 1.6% of all oral cysts (3,4,(9)(10)(11). Yilmaz et al. (11) report that ECs are more common when compared to DCs. This retrospective study was performed at an oral diagnosis reference center in the sweat glands, salivary glands, melanin pigments, and Pacini corpuscles, were also noted, observed in 28.6%, 14.3%, 14.0%, 7.1% e 7.1% of the cases, respectively. ...
Background:
Dermoid and epidermoid cysts are slow-growing, benign developmental cysts that arise from ectodermal tissue and can occur anywhere in the body. Less than 7% of these cysts involve the head and neck region, with only 1.6% of cases presenting in the oral cavity. To evaluate the clinical and histopathological features of dermoid (DCs) and epidermoid (ECs) cysts stored in the archives of a referred Oral Pathology Service over a 48-year-period, and to review current concepts about these cysts.
Material and methods:
All DCs and ECs were reviewed, and clinical data were obtained from the patient records. Fourteen cases of DCs and thirteen cases of ECs were re-evaluated microscopically by 2 oral pathologists.
Results:
Among 15.387 cases, 14 (0.09%) had a histopathological diagnosis of DCs and 13 (0.08%) of ECs. For DCs, ten (71.4%) patients were women, with the mean age of 37.2 years. All DCs were lined by a stratified squamous epithelium (100%), with gut and respiratory epithelium observed in 1 (7.1%) and 2 (14.3%) cases, respectively. Chronic inflammatory cells, melanin, multinucleated giant cell reaction, and Pacini bodies were also observed. For ECs, eight (61.5%) cases were in women, and the mean age was 38.2 years. All ECs were lined by a stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, and adipose tissue were observed in the fibrous capsule.
Conclusion:
Our results suggest that stratified squamous epithelium is the predominant epithelial lining of these cystic lesions. Also, we may find some unusual findings in DCs, such as Pacini bodies.
... Ultrasonografi hızlı ve ucuz bir görüntüleme yöntemidir. Ultrasonografi ile kistik, solid ve vasküler ayrımı yapılırken, kitlenin sınırı ve çevre dokular ile ilişkisi de değerlendirilebilir. [9,10] Bilgisayarlı tomografi ve MRG ile lezyonu kesin yerleşim yeri ve çevre dokularla ilişkisi ortaya konulur. [7] Bizim olgumuzda yapılan MRG'de sağ submandibüler bölgede T1A sekanslarda ara intensitede, T2A sekanslarda hafif hiperintens kistik kitle raporlandı. ...
... literatürdeki 195 ağız tabanı dermoid kist olgusunu gözden geçirdiklerinde, cerrahi uygulanan 120 olgunun %58'inde intraoral, %31'inde servikal ve % 11'inde her iki yaklaşımın birlikte kullanıldığını belirlemişlerdir [8]. Dev kistlerde marsupializasyon alternatif bir yöntem olarak kullanılabilmektedir [9]. Dermoid kistlerde, komplikasyon olağan değildir. ...
... Tüm benign lezyonlarda olduğu gibi dermoid kistlerin de prognozu çok iyidir. Kist ve ilgili fistül yollarının total eksize edildiği olgularda nüks görülmez [9]. ...
SUBLİNGUAL EPİDERMOİD KİST Epidermoid kistler oral kavite bölgesinde çok nadir görülen, benign, ağrısız, ektodermal kökenli kitleler olup, vücudun herhangi bir yerinde görülebilirler. Etyolojide en kabul gören teori 1. ve 2. brankial arkların orta hatta kapanmaması sonucunda kistin, etrafı sarılan epitel doku artıklarından oluşması düşüncesidir. Epidermoid kistler oral kavitede en sık ağız tabanında, boyunda ise orta hatta en sık submental bölgede yerleşirler. Genellikle hayatın 2. ve 3. dekatında görülürler. Nadiren 5 cm boyutunu geçerler. En sık şikâyet ağrısız şişliktir. Dili geriye itmelerinden ötürü konuşma bozukluklarına, yemek yemede zorlanmaya ve boyut olarak çok büyük olgularda ise solunum sıkıntılarına sebep olabilirler. Tanıda ultrasonografi (USG) ve manyetik rezonans görüntüleme (MRG) yardımcı olur. Kesin tanısı histopatolojik inceleme ile konur. Tedavi seçeneği intraoral, ekstraoral veya kombine yaklaşımla cerrahi olarak kistin tüm duvarı ile birlikte total eksizyonudur. Bu olguda 35 yaşında bayan hastada nadir görülen sublingual yerleşimli 6 cm'lik dev bir epidermoid keratinöz kist klinik, histopatolojik, ayırıcı tanı ve tedavi özellikleri ile literatür eşliğinde tartışıldı.
SUBLINGUAL EPIDERMOID CYST Epidermoid cysts are rare, benign, painless ectodermal masses in the oral cavity and can be seen anywhere in the body. The most accepted theory in the etiology is that the first and second branchal arches are not covered in the midline, and that the cyst is composed of wrapped epithelial tissue residues. Epidermoid cysts are most commonly seen on the oral base in the oral cavity and they are most commonly located in the submental region on the midline. It is usually seen in the second and third decades of life. They rarely pass the size of 5 cm. The most common complaint is painless swelling. They may cause speech disorders, difficulty in eating, and respiratory distress in very large cases because they push back the tongue. Ultrasonography (USG) and magnetic resonance imaging (MRI) are helpful in the diagnosis. The definitive diagnosis is made by histopathological examination. The treatment option is a total excision of the entire wall of the cyst by means of an intraoral, extraoral or combined approach. In this case, a giant 6-cm epidermoid keratinous cyst which is rarely seen in a 35-year-old female patient was discussed with clinical, histopathological, differential diagnosis and treatment features.
... Its occurrence in the oral cavity is rare as epidermoid along with dermoid cysts comprises only 0.01% of all the oral cysts. In the oral cavity dermoid cyst is twice common than epidermoid cyst [1]. We report a rare sublingual epidermoid cyst in a young girl. ...
An epidermoid cyst is a benign cyst that can occur in any part of the body. The most common age group for this cyst is 20–40 years. It's extremely rare in oral cavity accounting for only 1.6%. The cyst develops from the ectodermal tissue. It represents the most common cutaneous cysts. A 6 years old female patient presented with a complaint of swelling in the floor of the mouth. It measured 4 × 5 cm in size. Surgical excision with primary closure was performed. We present this case because of its rare location, mistaken for other entities, like a ranula and its occurrence at an early age. After excision, an oval-shaped mass of 4 × 5 cm has been described in this case. The histopathological report confirms the diagnosis of epidermoid cyst. The epidermoid cyst commonly occurs in middle-aged adult group, especially over the face, scalp & trunk area. Surgical excision is the treatment of choice in such case. Epidermoid cyst of the oral cavity is an uncommon entity. Although it's common in middle-aged adult but sometimes it may occur in pediatrics age group.
... Congenital cysts are considered to develop from epithelial tissue remnants surrounded during midline closure of fi rst and second branchial arcs. Acquired epidermoid cysts are post-traumatic or iatrogeic [14]. ...
... Based on clinical presentation and behavior of the cyst without advanced investigation. Follow up is mandatory as there are cases reported with recurrence after excision and up to 5% of dermoid cysts undergo malignant changes in teratoid type [19][20][21][22][23]. ...
A dermoid cysts are benign congenital lesions of ectodermal origin not commonly seen in the mouth, however when
presents as a swelling in the middle of the mouth floor and its developmental lesion usually due to retention of germinal
epithelium during growth of branchial arches and Lower jaw. Usually diagnosed during the 2nd and 3rd decade of life and
rarely seen in children.
This is a case of 13 years old boy was presented with firm painless swelling in the floor of mouth extending into the
submental space, dermoid cyst should be considered in the differential diagnosis as one of the lesions presented in any
midline swelling.
The main treatment is surgical excision using an intraoral approach to avoid scar extra-orally
