Presacral epidermoid cyst. A case report

INTRODUCTION: Most of the primitive cystic neoplasms arising in the retrorectal presacral space are congenital. Presacral epidermoid cysts are classified as a type of developmental cysts, resulting from an error during the embryogenesis. They have a slowly-progressive growth that only lately can cause clinically remarkable symptoms. Most patients are middle-aged women. They are often asymptomatic. The discovery is almost always casual. It happens during controls like US, CT MRI, gynecological visit. The surgical treatment must be effected for a correct diagnosis of nature of the lesion and to remove the mass. In fact, infective complications may occur and the increasing volume of the cyst can give clinical symptoms. Posterior approach is indicated for low or mid presacral space tumors; it is the most commonly followed route. The abdominal approach may be adequate for large developmental cysts. CASE REPORT: A case of an incidentally found large presacral epidermoid cyst in a young woman, which was excised through an abdominal approach is reported.     

Giant Epidermoid Cyst on the Forefoot

BACKGROUND: Epidermoid cysts are the most common cysts of the skin, usually appearing in the hairy regions. However, epidermoid cysts on the non-hair-bearing areas, such as the palms and the soles, are rare and seldom reach a size of more than 5 cm in diameter. OBJECTIVE: To present a patient with an epidermoid cyst of unusual location and size. METHODS: A 23-year-old woman with a painless tumorlike mass on her right forefoot was examined and the mass was excised. RESULTS: The 6.5 cm x 5.5 cm x 5.5 cm mass was totally excised. Histologic diagnosis was reported as an epidermoid cyst. CONCLUSION: An original case regarding an unusual location and size of an epidermoid cyst is presented.     

A large epidermoid cyst of breast mimicking carcinoma: A case report and review of literature

INTRODUCTIONTriple assessment of a suspicious breast lesion may not always provide a definite diagnosis. We report a case of epidermoid cyst of breast, which caused diagnostic dilemma in spite of a thorough triple assessment and entailed mastectomy.PRESENTATION OF CASEA 69-year-old woman presented with a large painful retroareolar left breast mass. Clinical examination, ultrasound and mammography were highly suspicious of malignancy. However, core biopsy suggested a benign lesion. Due to size of the lesion and diagnostic uncertainty, various options were discussed with the patient. She opted for a simple mastectomy. The histology confirmed a large epidermoid cyst.DISCUSSIONIt is rare for an epidermoid cyst to present as such an advanced lesion, mimicking carcinoma. Excision of such a large retroareolar ‘benign’ lesion, however, may sometime entail mastectomy. This is the first reported case of an epidermoid cyst of breast necessitating mastectomy.CONCLUSIONDiagnostic dilemma while dealing with a suspected breast cancer is not rare. Involvement of multidisciplinary team as well as patient is important in the decision-making. The report illustrates a rare presentation of a deep seated large epidermoid cyst of breast, which mimicked carcinoma, caused diagnostic confusion and entailed mastectomy. We strongly advocate the option of breast reconstruction in such cases.     

Epidermoid cyst of the spleen,a case report

IntroductionSplenic tumors are rare and are either primary or secondary, benign or malignant. Most have none to minimal symptomatology and are found incidentally. Splenic cysts can be infectious, congenital, or traumatic. Epidermoid cysts and parasitic cysts are examples of primary cysts and usually have a classic presentation on imaging. Despite advanced imaging modalities and patient's clinical presentation, it can be difficult to diagnose an epidermoid cyst without histological examination. The purpose of this paper is to discuss typical findings of primary splenic cysts on imaging, but how they may differ in appearance.Presentation of case51 year old female who presented with vague abdominal discomfort and was found to have a large splenic mass with cystic components on imaging which did not demonstrate a typical primary splenic cyst appearance. Patient underwent an uneventful hand-assisted laparoscopic total splenectomy and had an uneventful recovery with histopathology revealing an epidermoid splenic cyst.ConclusionPrimary splenic cysts are difficult to diagnose and differentiate with imaging alone. They have a variable presentation and can present like as a cystic mass. It is important to include them in the differential diagnosis of splenic masses since histopathology is the final determinant of the diagnosis.     

Giant earlobe epidermoid cyst

Epidermoid cysts represent the most common cutaneous cysts. They are usually small and benign; however, sometimes they can grow to giant epidermoid cists, and occasionally malignancies develop. Giant epidermoid cysts at the earlobe have never been described but in other locations. We describe a case of a giant epidermoid cyst at the earlobe, a location where such a large cyst has never been reported before. The mass was completely resected and the wound of the pedunculated base was sutured with four stitches of nylon 5/0. Histopathology confirmed the presumptive diagnosis of an epidermoid cyst. Six months after the resection, the patient did not have any relapse of the epidermoid cyst. The earlobe is a potential location for giant epidermoid cysts. Although the clinical diagnosis could be enough, due to the possibility of malignancy and to ensure appropriate diagnosis, we consider that all cysts should be sent to the anatomic pathology laboratory for histological evaluation.     

Retroperitoneal bronchogenic cyst: a case report and review of the literature

This unusual clinical case adds itself to the limited list of existing reports of retroperitoneal bronchogenic cysts in the international literature. It emphasizes the difficulties encountered in making a preoperative diagnosis, since these lesions can be described as both solid and cystic masses. A 69-year-old man underwent surgery to remove an expanding mass diagnosed as originating in the adrenal gland and discovered during clinical investigation for other indications. The lesion was excised only after adrenalectomy whereupon its cystic nature was revealed. Retroperitoneal bronchogenic cysts, though rare, should be considered in the differential diagnosis of retroperitoneal expanding lesions, especially in the presence of cystic tumours of the left adrenal region. This is the first case of a retroperitoneal bronchogenic cyst reported in an adult in Italy.     

Quiste epidermoide testicular

IntroductionTesticular tumors are usually managed by radical orchiectomy because of the high incidence of malignant lesions.Epidermoid cyst of the testis is a rare benign tumor, and its differential diagnosis from malignant testicular tumors is difficult.Materials and methodsThe clinical records of seven patients who attended our hospital with testicular epidermoid cysts were reviewed.Preoperative evaluation consisted of testicular ultrasonography in 6 patients, and magnetic resonance imaging in 4 patients. A peroperative biopsy was performed in four patients.ResultsUltrasonographic appearance was specific for diagnosis of epidermoid cyst in 80% of patients. Pathological diagnosis was made in all biopsies taken during surgery.Conservative management was (tumorectomy or partial orquidectomy) performed in 6 patients (85%).ConclusionsPreoperative imaging findings, gross characteristics of the lesion, and peroperative biopsy results provide adequate information to attempt testis-sparing surgery instead of radical orchiectomy.     

Laparoscopic splenectomy for a large multilocular splenic cyst with elevated CA19-9: Report of a case

INTRODUCTIONBecause splenic cysts are rare, a definitive treatment regime for these cysts remains unclear. We report a case of a large multilocular splenic cyst with elevated carbohydrate antigen 19-9 (CA19-9) levels, which was successfully treated with laparoscopic splenectomy.PRESENTATION OF CASEA 22-year-old female was admitted to our hospital with severe left upper abdominal pain. Serum CA19-9 level was mildly elevated (65 U/ml). Computed tomography revealed a 25-cm long spleen with multilocular cystic lesions, for which an emergency laparoscopic splenectomy was performed. Histological findings revealed that the lesion was a benign true cyst, and immunostaining analyses showed that the epithelium was CA19-9-positive.DISCUSSIONAlthough some spleen-preserving approaches have been reportedly used, splenic cyst recurrence usually occurs in true cyst cases, wherein the cyst is incompletely removed. Most reported cases of splenic cysts producing CA19-9 are true cysts.CONCLUSIONThe treatment approach should be decided on the basis of the type, shape, location, and even CA19-9 levels of the splenic cyst.     

Microsurgery for intradural epidermoid cyst at cauda equina level in a 9-year-old child: A case report

Introduction and importanceEpidermoid cysts are rare benign tumors. Here, we present a case of spontaneous intradural epidermoid cyst at cauda equina level in a 9-year-old patient, which we believed the first case to be reported in Vietnam.Case presentationA 9-year-old boy presented with 4 months of spontaneous left lower extremity muscle weakness and paresthesia. The MRI images suggested the diagnosis of intradural epidermoid cyst at cauda equina level. The patient underwent L5–S1 laminectomy and durotomy for tumor resection. The histology confirmed the diagnosis of epidermoid cyst. Post-operative images demonstrated total cyst removal.Clinical discussionThe epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed.ConclusionDiagnosis of spinal epidermoid cyst is often delayed for its obscure presentation. Microsurgical dissection along with intra-operative mobile C-Arms enable total tumor resection while preserving spinal stability and neurological function. Follow-up with post-operative magnetic resonance imaging and tumor marker are helpful.     

Intradiploic arachnoid cyst identified by diffusion-weighted magnetic resonance imaging--case report

A 72-year-old woman presented with an intradiploic arachnoid cyst in the occipital intradiploic space which was found incidentally by magnetic resonance (MR) imaging. Computed tomography revealed a widened diploic space and thinning of the inner and outer tables of the occipital bone. The cyst appeared as isointense to the cerebrospinal fluid on both T1- and T2-weighted images. The differential diagnosis of intradiploic epidermoid cyst could be excluded because the lesion was low intensity on diffusion-weighted MR images. Arachnoid cyst is a benign lesion, so exploratory surgery should be avoided unless the cyst is symptomatic. Diffusion-weighted MR imaging is an effective modality to distinguish diploic epidermoid cysts from arachnoid cysts.     

Multiple epidermoid cysts located in the pineal and extracranial regions treated by neuroendoscopy

A 22-year-old woman presented with a rare case of multiple epidermoid cysts located in the pineal and extracranial regions. Magnetic resonance (MR) imaging showed a lesion in the pineal region as hypointense on the T(1)-weighted image and hyperintense on the T(2)-weighted image, without enhancement. Neuroendoscopic treatment was performed under a diagnosis of pineal cyst. However, the cyst wall was too thick to perforate, although third ventriculostomy was performed. Diffusion-weighted MR imaging demonstrated the lesions in the pineal and extracranial regions as marked hyperintensity. The diagnosis was epidermoid cyst. Subsequently, neuroendoscopic treatment of the pineal epidermoid cyst was performed. Careful preoperative diagnosis of epidermoid cysts based on diffusion-weighted MR imaging is required.     

Spinal extradural arachnoid cyst

Background contextSpinal extradural arachnoid cysts are uncommon expanding lesions. Idiopathic arachnoid cysts are not associated with trauma or other inflammatory insults. If they enlarge, they usually present with progressive signs and symptoms of neural compression.PurposeTotal removal of the cyst and repair of the dural defect is the primary treatment for large thoracolumbar spinal extradural arachnoid cysts causing neurogenic claudication. Laminoplasty may prevent spinal deformities in long segmental involvement.Study designA clinical case was performed.Patient sampleWe report a case of 25-year-old man with 1-year history of progressive back pain radiating to both legs. His diagnosis was dorsal intraspinal extradural cystic lesion longing from the level of T11 to L2 on magnetic resonance imaging.Outcome MeasuresThe patient's pain levels were noted as he reported. Physiologic outcome was assessed on pre- and postoperative motor and sensory examination.MethodsThe patient underwent a T11–L2 laminotomy and radical cyst wall resection was performed. A small communication with the subarachnoid space was seen at the level of T12. It was sealed with tissue fibrinogen after repair with primary suture. Titanium miniplates were used for laminoplasty.ResultsFollow-up magnetic resonance imaging demonstrated cyst resolution, and neurologic examination revealed no sensory and motor deficit.ConclusionExtradural arachnoid cysts are primarily treated with total removal of the cyst wall and closure of the dural defect. Surgical treatment is curative for this rare lesion.     

Kystes épidermoïdes de la grande citerne et du quatrième ventricule : à propos de quatre cas

IntroductionEpidermoid cyst is a congenital and benign tumor, developed from ectodermal inclusion. These cysts occur very rarely in the cisterna magna and the fourth ventricle.ObjectiveTo report four cases of epidermoid cyst of the cisterna magna and the fourth ventricle in the light of the data of literature.Patients and methodsWe report a retrospective study of four cases of epidermoid cysts of the cisterna magna and the fourth ventricle. The data was collected from January 2000 to December 2006 from to series of 18 cases of epidermoid cysts of posterior cranial fossa (14 cases were localised at the cerebellopontine angle). All the patients had a physical examination and a complete neuroradiological imagery. The treatment was surgical. The follow-up was at least 9 months.ResultsThere were two men and two women. The mean age was 47.75 years. All patients presented with cerebellar syndrome. Three patients had intracranial hypertension. Neuroradiological explorations showed a cystic lesion developed in the cisterna magna in two cases, in the fourth ventricle in one case and in the two locations in one case. Two patients had hydrocephalus. All patients had surgery with a posterior approach and one patient had first ventriculoperitoneal shunt. The diagnosis was confirmed by histological examination. Postoperatory outcome was favourable in all cases. One patient developed bilateral chronic subdural hematoma, which was surgically removed. A long time follow-up was good in all cases.ConclusionEpidermoid cysts are characterized by a long evolution. The diagnosis is relatively characteristic in the imagery. The prognosis was favourable with a complete surgical resection.     

Early recurrence of an intracranial epidermoid cyst due to low-grade infection: case report.

Intracranial epidermoid cysts are slow-growing lesions, which may recur after incomplete resection, but do so over many years. The authors present the case of an epidermoid that repeatedly recurred over a short period, which was discovered to be secondary to a low-grade bacterial infection. A 30-year-old woman presented with signs and symptoms related to brainstem and cranial nerve compromise from a large cerebellopontine angle epidermoid cyst. She underwent a subtotal excision of a macroscopically and histologically typical epidermoid. The lesion recurred within 1 year of surgery, but with atypical radiological appearances. No systemic or local evidence of infection was found during a second resection. A further large recurrence with the same atypical features occurred after another 6 months, necessitating a third surgical resection. On this occasion, the atypical cyst contents grew coagulase-negative Staphylococcus after prolonged culture in an enrichment medium. Following a course of appropriate antibiotics, the residual cyst contents completely resolved. This case highlights an unusual complication of an epidermoid cyst. Early recurrence of an epidermoid, even in the absence of overt evidence of infection, should produce a high index of suspicion that there may be a low-grade infective cause. Surgical excision coupled with antibiotics resulted in a symptomatic and radiological recovery.     

Percutaneous resection of anteriorly located midline prostatic cyst: A case report and description of technique

IntroductionMidline prostatic cysts are common and are usually discovered incidentally. However, anterior midline prostatic cysts are considered rare.Presentation of CaseWe report a 36-year-old man who presented with severe lower urinary tract symptoms. The patient was diagnosed with an anterior midline prostatic cyst bulging into the bladder. The location of the cyst did not allow for a safe transurethral resection. He was managed successfully through a percutaneous approach.ConclusionPercutaneous resection of an anteriorly located prostatic cyst is simple and safe. This procedure is advised if bladder neck injury is possible during transurethral resection to avoid retrograde ejaculation.     

Benigne zystische Raumforderungen des Hodens

Testicular cysts are increasingly diagnosed in the course of scrotal ultrasound examination. Among other things this is due to the general availability of modern high-resolution ultrasound devices. Benign and malignant diseases with testicular cyst formation need to be differentiated by differential diagnosis and by their aetiology. Benign diseases with cystic space-occupying lesions of the testicle are tubular ectasia of the rete testis, cystic dysplasia, epidermoid cysts, simple intraparenchymatous testicular cysts and cysts of the tunica albuginea. Testicular dermoid cyst was long misleadingly regarded as potentially malignant, but is now classified as benign. On diagnosis of a benign lesion of the testis an organ-conserving surgical therapy or an observational watch-and-wait strategy can be recommended in most cases.     

A large epidermoid cyst developing in the palm: A case report

INTRODUCTIONEpidermoid cysts, also called atheromas, are frequently observed. These cysts originate mostly in the pilosebaceous apparatus but rarely in areas without hair, such as the palm and sole. The mechanism of their development has been reported to be epidermal inclusion secondary to trauma or human papillomavirus (HPV)-60 infection. We report the patient who developed an epidermoid cyst in the palm without any known cause.PRESENTATION OF CASEA 93-year-old male noticed a mass in the left palm 3 years earlier, was diagnosed with an epidermoid cyst based on incisional biopsy, and underwent incision drainage several times during the 3-year period. However, since the cyst spontaneously ruptured and was infected, debridement and resection of the cyst were performed. The postoperative course was favorable, without signs of infection. The pathological diagnosis of the resected specimen was an epidermoid cyst.DISCUSSIONThis case was a rare epidermoid cyst originating in an area without hair, and there was neither a clear history of injury nor findings strongly suggesting HPV-60 infection. Causes other than repeated loading on the palm could not be considered for epidermal inclusion. To our knowledge, this case is the largest reported epidermoid cyst.CONCLUSIONEpidermoid cysts are frequently observed, but their development in areas without hair is rare, and its mechanism has not been clarified. The association between this cyst and trauma or HPV is clear. However, repeated loading on areas such as the palm that tend to undergo chronic loading can also be a cause, as in this patient.     

Splenic cysts and tumors: diagnosis and management

Cysts and tumors of the spleen are rare and are often discovered fortuitously. They are most often asymptomatic but may present with abdominal pain in the left upper quadrant. Splenic cysts are far more common than solid lesions; true cysts must be differentiated from pseudocysts of the pancreas and from cystic degeneration following splenic contusion or infarction. Cysts may be congenital (epidermoid cysts), infectious (abscess or hydatid cyst), or neoplastic (lymphangioma or angioma with tumor necrosis). Diagnosis can usually be established with the clinical context and imagery (ultrasound, CT, MRI). Surgery should be avoided for angiomas and pseudocysts. Spleen-conserving surgery is indicated for large symptomatic epidermoid cysts. Splenectomy is often required for hydatid cysts and tumors. Of the solid tumors, hemangiomas and lymphangiomas often have a characteristic fleshy appearance. For other solid tumors, whether benign or malignant, imaging may give some clues to the diagnosis, but diagnostic certitude often requires pathologic examination of the piece. Needle biopsy is contraindicated because of the risk of bleeding. Resection should be as limited as possible in order to avoid the risks of total splenectomy (overwhelming sepsis, thrombosis).     

高频超声诊断浅表组织表皮样囊肿120例

目的探讨高频超声诊断浅表组织表皮样囊肿的价值。方法对120例经病理证实的浅表组织表皮样囊肿的高频超声声像图进行回顾性分析。结果超声病变全部病变均发现为单房性,其中58例超声提示表皮样囊肿,43例误诊为实性包块,12例误诊为囊实性混合性肿块,7例无法判断囊实性。109例肿块边界清楚,49例内部呈低、中回声,分布均匀;59例内部为细密强回声夹杂小管道样低回声;12例回声不均匀,内可见到小片状无回声区。92例肿块探头加压可产生形变,但内部细密强回声缺乏流动感。所有肿块内部均未见血流信号。结论表皮样囊肿具有特征性声像图表现;超声在表皮样囊肿的诊断中可以发挥重要作用。     

Giant epidermoid cyst in the breast: A common benign lesion at a rare site—A case report

IntroductionEpidermoid cyst is a common clinical entity and it can occur anywhere in the body. But its occurrence and huge size in the breast is very rare and more liable to develop complications, including malignant transformation.Presentation of caseWe present here an unusual case of a giant epidermoid cyst in the breast, which is about 7 cm in greatest dimension. After proper preoperative diagnosis by clinical, imaging and histopathological findings, it was managed by total excision.DiscussionImaging and fine needle aspiration cytology is essential for accurate preoperative diagnosis. However, it is often very difficult to differentiate it from other benign and malignant conditions of breast. Infection and malignant transformation are its potential complications. Total excision along with its capsule is the treatment of an epidermoid cyst.ConclusionEpidermoid cyst is an important differential diagnosis while managing benign breast disease.