Figure 2 - uploaded by Georgi Tchernev
Content may be subject to copyright.
Surgery of a large epidermoid cyst of the glabella. (a) Clinical presentation; (b) Preparation of the cyst after mobilisation. (c) Surgical specimen
Source publication
Epidermoid cysts are common benign lesions of hair-bearing, and less often glabrous skin. They can also occur in oral mucosa and internal organs. In case of cutaneous lesions, an epidermal punctum is a clinical diagnostic hallmark. The clinical presentation is variable leading to some differential diagnoses. Diagnosis of epidermoid cysts needs hist...
Context in source publication
Similar publications
A case report of a big lateral branchial cyst growing for one year and presented as sixty three year old female is described. The diagnosis was based on ultrasonography with aspiration biopsy, computed tomography and histopathological findings. Successful surgical treatment was performed in Al-Karama teaching hospital. There is no recurrence after...
Citations
... The keratinous cysts are divided into epidermoid and trichilemmal cysts [3]. It occurs at the head, face, neck, trunk, extremities, and genitals [1,[4][5][6][7][8]. The keratinous cysts and epidermoid cystic lesions of the umbilicus are rare clinical findings [9]. ...
... Keratinous cysts are one of the most common cutaneous problems and occur most frequently on the face, head/scalp, neck, trunk, extremities, and genitals [1,[4][5][6][7][8]. The keratinous cysts and epidermoid cystic lesions of the umbilicus are rare clinical findings [9]. ...
Keratinous cysts, the most common kind of epidermal cysts, are filled with keratin originating from the epidermis, most often from the hair follicle. Keratinous cyst is one of the most common skin lesions and occurs most commonly in the face, head, trunk, extremities, and genitals. A 7-year-old girl reported to the pediatric surgery department with a painless, small tumor arising from her umbilicus. There was no history of trauma, and it has been slowly growing for the past many years. Clinical examination revealed a 3-cm-long skin tag with three small interconnected tumors from the umbilicus. It was soft, and the parts of the tumors looked like they contained whitish material inside. Her general and other systems, including the abdominal examinations, were within the normal limits. The tumor was resected through a sub-umbilical skin incision. She made an uninterrupted recovery. The excised specimens subjected to histology were reported as superficial keratinous cysts. Keratinous cysts are one of the most common benign skin lesions, but not the most common, at the umbilicus. Clinicians need to be aware of such pathology during the evaluation of the umbilical swellings and tumors, especially in children.
... 16,17 If multiple cysts are present, associated syndromes such as Gardner syndrome, pachyonychia congenita, and Lowe syndrome should be considered. 18 When partially calcified, these lesions may mimic pilomatrixoma on physical and ultrasound examination. 19 Symptomatic cysts are treated by surgical excision including the hair follicle of origin. ...
Introduction: Pilomatrixomas are benign neoplasms derived from hair follicle matrix cells. They are among the most common soft tissue head and neck tumors of childhood. Pilomatrixomas are typically isolated, slow-growing, firm, nontender masses that are adherent to the epidermis but mobile in the subcutaneous plane. This clinical presentation is so characteristic that many experienced surgeons will excise suspected pilomatrixomas without prior imaging. We reviewed the results of this approach to determine whether physical examination alone differentiates pilomatrixomas from other similar soft tissue lesions of the pediatric head and neck. Methods: Computerized review of all pilomatrixomas over a 20-year period in a single academic pediatric otolaryngology practice. Results: 18 patients presented to our pediatric otolaryngology practice between 2001 and 2021 with historical and physical findings consistent with pilomatrixoma. Of the 18 patients, 7 were male and 11 were female. Ages ranged from 1.5 to 14 years, with a mean of 7.5 years. Most of the lesions (12) were located in the head and face, while the rest (6) were found in the neck. All patients were treated with complete surgical excision. Pathology confirmed pilomatrixoma in 15 patients. The remaining 3 children were found to have an epidermal inclusion cyst, a ruptured trichilemmal cyst, and a giant molluscum contagiosum lesion, respectively. One additional patient presented with a small lesion of the auricular helix that was thought to be a dermoid cyst, but proved to be a pilomatrixoma on histologic examination. Discussion: As pilomatrixomas are common and have a very characteristic presentation, surgical excision without prior diagnostic imaging will lead to correct treatment in the majority of cases. High resolution ultrasonography can help to confirm the diagnosis preoperatively, but is not definitive in large case series. Most of the cystic lesions that imitate pilomatrixoma will ultimately require surgical excision.
... While both cysts are lined by stratified squamous epithelium, only dermoid cysts contain other ectodermal elements such as hair, sebaceous glands, or sweat glands [1]. Presence or absence of these skin adnexa distinguishes these two entities pathologically; however, the distinction can often be made prior to histopathologic analysis based on location, mobility, and imaging characteristics [1][2][3]. Dermoid cysts are congenital malformations and consequently are most frequently identified during infancy or adolescence, whereas epidermoid cysts may be acquired and are most commonly seen in young males [2,3]. Patients or caretakers typically present with concerns over a growing subcutaneous nodule, seeking either reassurance of a benign nature of the nodule, or removal for cosmetic purposes [4]. ...
... Presence or absence of these skin adnexa distinguishes these two entities pathologically; however, the distinction can often be made prior to histopathologic analysis based on location, mobility, and imaging characteristics [1][2][3]. Dermoid cysts are congenital malformations and consequently are most frequently identified during infancy or adolescence, whereas epidermoid cysts may be acquired and are most commonly seen in young males [2,3]. Patients or caretakers typically present with concerns over a growing subcutaneous nodule, seeking either reassurance of a benign nature of the nodule, or removal for cosmetic purposes [4]. ...
... The additional presence of the left leg cyst in this patient raises the potential for a genetic syndrome. Both Gardner and Lowe syndrome have previously been linked to multiple epidermoid cysts, however the patient presented in this case did not have any other clinical features consistent with either syndrome [2]. Ultimately, the most important consideration in this case is management. ...
Dermoid and epidermoid cysts are benign lesions of ectodermal origin which are pathologically distinct entities, although often clinically indistinguishable. Cyst location, mobility, and appearance on MRI can help distinguish the two, however the distinction is mostly academic since both types have similar management. Co-occurrence of dermoid and epidermoid cysts together in the same patient has not been observed in the literature, however one case of an epidermoid cyst evolving into a dermoid cyst has been documented. In this case report, we identify a 16-year-old male with three separate cysts of the scalp and leg which, after histopathological analysis following surgical resection, were found to represent both dermoid and epidermoid cysts. We offer potential explanations for this rare occurrence in the absence of a genetic syndrome and highlight the importance of performing a thorough work-up of patients with multiple cysts.
... Furthermore, an atheromatous keratinous substance is found in the area corresponding to the stratum corneum. 5 Epidermoid cysts are often asymptomatic; rupture and secondary infection have been reported. 5 Here, we report two rare cases of intrascrotal epidermoid cysts penetrating the penile corpora cavernosa. ...
... 5 Epidermoid cysts are often asymptomatic; rupture and secondary infection have been reported. 5 Here, we report two rare cases of intrascrotal epidermoid cysts penetrating the penile corpora cavernosa. ...
Introduction
Epidermoid cysts are tumors and that rarely occur in intrascrotal extratesticular tissues. It is extremely rare for the tumors to penetrate the penile corpora cavernosa.
Case presentation
We encountered a 4‐year‐old and a 6‐year‐old boy with intrascrotal tumors that penetrated the penile corpora cavernosa. Both the patients underwent tumor resection. In the former case, some of the tumor within the corpora cavernosa was left behind, while in the latter case, the tumor was completely resected. Pathological examination in both cases confirmed the diagnosis of epidermoid cysts.
Conclusion
We should consider the possibility of epidermoid cysts in children presenting with intrascrotal tumors. Moreover, care should be taken when handling the corpora cavernosa during surgery.
... Only 7% of epidermoid cysts found throughout the body are in the head and neck region, and only 1.6% are in the oral cavity [1]. Epidermoid cysts and cervical lymphadenopathy have never been documented together. ...
... 28 In addition, carbon dioxide laser and erbium-YAG laser can be used to treat small epidermal cysts. 24,[29][30][31] Conclusion According to our case report and literature review, we considered trauma as one of the main causes of epidermoid cysts. The epidemiological data we provided proved that epidermoid cysts are prevalent in young and middle-aged people, with the face and trunk as the majority sites. ...
Background
Epidermal cysts are common benign epithelial tumors. They are known to result from penetrating-type injuries or infection of human papillomavirus. The differential diagnosis commonly includes multiplex steatocystoma, lipoma, and neurofibroma. Pathological examination is essential for diagnosis, and surgical excision is the recommended treatment.
Objective
We report a case in a man who presented with a cystic lesion on the scalp over 22 years to provide clinical evidence for mechanism of epidermal cysts. We conducted epidemiological analysis of 3949 patients with epidermal cysts to clarify the epidemiological characteristics and clinical features of epidermal cysts.
Patients and Methods
A total of 3949 individuals with confirmed epidermal cysts were collected for analysis. Data were expressed as mean ± SEM and analyzed using Student’s t-test.
Results
Our data showed that the mean age of diagnosis of males was statistically earlier than that of females (P<0.001), but no significant difference in sex predilection was observed (P=0.55). The high incidence age of males and females was in the young and middle stage. Lesion locations were a bit different among age groups, but the face was the most common site of epidermal cyst at all age stages.
Conclusion
Our case offers clinical evidence to the theory which refers trauma as one of the main causes of epidermal cysts in hair-bearing area. According to analysis of large number of samples, we can further support the idea that epidermal cyst has equal sex predilection and mainly occurs on the young and middle-aged adults. It is usually solitary and most likely to be found on face and trunk.
... The first is that effective management through excision is available, as stated previously. Another is due to the fact that, although rare, malignant transformation is possible [12]. Possible transformations include squamous cell carcinoma, basal cell carcinoma, and Merkel cell carcinoma [12]. ...
... Another is due to the fact that, although rare, malignant transformation is possible [12]. Possible transformations include squamous cell carcinoma, basal cell carcinoma, and Merkel cell carcinoma [12]. Each of these malignancies carry its own set of risks, so identification of these cysts is important for effective management of patients with Lowe syndrome. ...
Patient: Male, 9-year-old
Final Diagnosis: Epidermoid cyst
Symptoms: Perianal lesions • perianal pain
Clinical Procedure: —
Specialty: Pediatrics and Neonatology • Surgery
Objective
Rare disease
Background
Lowe syndrome, also known as oculocerebrorenal syndrome, is a rare genetic condition caused by an X-linked mutation of the OCRL1 gene, with an estimated prevalence in the general population of approximately 1 in 500 000. It is a multisystem disorder most commonly affecting the eyes, central nervous system, and kidneys. These commonly manifest as congenital cataracts, intellectual disability, and proximal renal dysfunction (Fanconi-type). Epidermal lesions are an uncommon manifestation of this condition, and the association is not completely understood.
Case Report
Here we present a case of a 9-year-old boy with Lowe syndrome who presented with multiple cystic masses found in the perianal region. An excision was then performed to remove the masses and found that the lesions were epidermal cysts, which are infrequently found in Lowe syndrome. After excision, the patient recovered uneventfully without complications.
Conclusions
While epidermal cysts are an uncommon manifestation that have been documented, our case remains unique given the location and associated symptoms of the lesions. At presentation, the constellation of pain and peri-anal masses was concerning for a malignant etiology. However, after diagnostic imaging was performed, these lesions were found to be epidermal cysts, an infrequent manifestation of Lowe syndrome. Few previous case reports described cystic lesions in association with Lowe syndrome, and none, to our knowledge, have described multiple symptomatic perianal lesions. This case is important to consider because epidermal cystic lesions can be found with this presentation and should be considered on differential diagnoses for dermatologic findings in Lowe syndrome patients.
... This entity is frequently confused with other cutaneous tumors such as lipoma, cystic basal cell carcinoma, trichilemmal cyst and other variants of cutaneous cysts especially the 'Dermoid cyst' because of its diagnostic similarities but "Epidermoid cyst" and "Dermoid cyst" are two different entities. Both cysts contain abundant keratin produced by keratinizing squamous epithelium yet the histopathological difference between these two entities is that dermoid cysts have skin appendages on their lining while epidermal cysts do not have these appendages (14). A single lesion of an epidermoid cyst is seen to be more protruding than the dermoid cysts. ...
Epidermoid cysts are common benign intradermal or subcutaneous tumors. Their prevalence is 7% in head and neck patient and 1.6% within the oral cavity. We present the case of a 30 year old male with a solitary epidermoid cyst on the right supra-orbital region which was asymptomatic but aesthetics being his primary concern. Clinical examination was performed and decided upon initial investigation with FNAC followed by surgical enucleation of the lesion. Histopathological findings of the excised lesion revealed that it was an epidermoid cyst. From the surgical point of view, they have a very good prognosis and plus it is a nonaggressive lesion. Even Though this is the classical site for occurrence of epidermoid cysts the removal of these cysts is of great concern as it can cause social stigma, aesthetic and functional impairment.
... It is also possible that with the increase of operation steps and the increase of operation time, the probability of infection is increased, and postoperative infection is more likely to occur, thereby inducing secondary epidermoid cysts of the penis. The diagnosis of secondary epidermoid cyst of the penis is easily confused with lipomas, fatty cysts, dermoid cysts, boils, and carbuncles 26 . A diagnosis must be made before treatment in order to decide on a treatment plan. ...
Secondary epidermoid cyst of the penis is a very rare epidermoid cyst that occurs in the penis. The purpose of this study was to investigate the relationship between the occurrence of secondary epidermoid cyst of penis and circumcision-related factors, and to provide possible reasonable and effective suggestions for circumcision. The data of all patients who visited the clinic for epidermoid cysts of the penis from September 2000 to September 2021 in Xiangya Hospital were collected. A retrospective study was carried out on whether the patients had been circumcised and the surgical method, anesthesia method, cyst location, surgical age, postoperative wound infection, whether they were phimosis patients, and the level of the surgeon. Among the 24 patients followed up, 95.8% had a history of circumcision, and only 4.2% had no history of circumcision, and the more traumatic surgical methods developed secondary epidermoid cyst of the penis after surgery the higher the probability. Injecting anesthesia at the base of the penis increases the chances of developing a secondary epidermoid cyst of the penis. Postoperative secondary epidermoid cyst of the penis were mainly located in the anterior segment and posterior segment, and the anterior segment had a higher proportion, followed by the posterior segment. Secondary epidermoid cyst of the penis occur mainly in adults. Postoperative wound infection accelerates the appearance of secondary epidermoid cyst of the penis. Patients with phimosis have an increased probability of developing secondary epidermoid cysts of the penis after surgery. The incidence of secondary epidermoid cysts and postoperative infection after manual circumcision by the attending physician was higher than that of the chief physician. Circumcision, injection of anesthesia at the base of the penis, ligation of the penis, and postoperative wound infection may be the etiologies and triggers of secondary epidermoid cysts of the penis. Adults and phimosis patients may be high-risk groups. Lower-level surgeons may increase the odds of postoperative secondary epidermoid cysts of the penis, and it is recommended that surgery be performed by a clinically-experienced, higher-level surgeon. The indications for circumcision should be strictly evaluated and the operation should be performed as soon as possible, and the less invasive surgical method and anesthesia method should be selected. Reduce irrelevant operations during surgery and avoid wound infection after surgery.
... Malignancy transformation is so rare, but there is a possibility of it. (Wollina et al. 2018). ...
Highlight:
• Sebaceous cyst or epidermoid cyst is a benign capsulated tumour on the scalp region, face, neck, and trunk that subepidermal nodule filled with keratin.
• Proliferating Pilar Tumours (PPT) are rare tumours was found in hair follicle.
• Sebaceous cyst diagnose on facial hairline tumour turned out to be a rare Proliferating Pilar Tumour (PPT).
Abstract:
Sebaceous cyst, also known as an epidermoid cyst, is a subepidermal nodule filled with keratin and it is a benign capsulated tumor. It is often located on the scalp region, face, neck, and trunk; but can be found elsewhere such as the scrotum, genitalia, fingers, and buccal mucosa. Proliferating Pilar Tumors (PPT) are rare tumors. It is derived from the external root sheath of the hair follicle. These tumors are like irregular subcutaneous nodules and often appear on the scalp. This case report was about a 59 years old woman who came to the hospital following excision of a frontal lump elsewhere, with a sebaceous cyst as the initial diagnosis. From the histopathologic examination, grossly there was a whitish and greyish lump with a soft outer surface. Microscopically, there were malignancy signs with areas with keratinization. The tumor formed a solid pattern of enlarged cells with moderate to marked nuclear pleomorphism with vesicular nuclei, prominent nucleoli, and abundant pale eosinophilic to clear cytoplasm. There was also much free keratinous debris noted and numerous foci of calcification identified within the tumor. Mitotic figures with abnormal forms were frequently seen. The final diagnosis after the histopathological examination was Proliferating Pilar Tumour with focal malignancies. In conclusion, facial hairline tumor differentially diagnosed as a sebaceous cyst turned out to be a rare Proliferating Pilar Tumor (PPT). Following histopathological confirmation, the patient was referred for further management by a specialist team.
