Subcutaneous dermoid cysts on the eyebrow and neck

We report a case of dermoid cysts on the right lateral eyebrow and anterior neck. Multiple concurrent dermoid cysts, as in the present case, are very rare. The differential diagnosis of dermoid cyst includes epidermoid (epidermal inclusion) cyst, trichilemmal cyst, pilomatrixoma, lymphatic malformation, and lipoma. In particular, thyroglossal duct cyst and midline anterior neck inclusion cyst are part of the differential diagnosis when the lesion is in the anterior neck.     

A Rare Presentation of a Dermoid Cyst with Draining Sinus in a Child: Case Report and Literature Review

Orbitofacial dermoid cysts in children are treated using surgical excision. Dermoid cysts of the frontotemporal region usually present as superficial, slow‐growing masses without deep extension. We report a rare case wherein a frontotemporal dermoid in a 21‐month‐old girl presented with a draining sinus tract to the skin and extended intracranially through the sphenoid bone. It was removed surgically and a dermoid cyst was removed from the frontotemporal region, extending superficially from the skin sinus tract through the sphenoid bone and attaching to the dura of the anterior temporal lobe. In addition to our case presentation, a literature review was performed to identify the few reported similar cases in the published literature, the combination of which suggests that frontotemporal dermoid cysts with associated draining sinus tracts may require preoperative imaging with computed tomography or magnetic resonance imaging before surgical intervention because of the high likelihood of intracranial extension.     

Paucisymptomatic Dermoid Cyst with Fatal Outcome

Dermoid cysts of the central nervous system can cause devastating complications because of the mass effect of meningitis due to sinus tract. We report the case of a 5‐month‐old girl who presented with a crusted lesion of the occipital region of the scalp. Clinical examination noted skin abnormalities suggestive of occult dysraphism. Magnetic resonance imaging (MRI) was recommended, however, 40 days after this evaluation, and before the MRI could be performed, the girl presented with neurologic complications. Unfortunately, the diagnosis of dermoid cyst was made after the onset of severe complications that led to her death. The findings in this case emphasize the importance of more prompt MRI evaluation, particularly in cases where cranial or spinal dysraphism is suspected to have any connection to the skin as a pit or tract. Should we perform an urgent MRI for any cutaneous sign of dysraphism to avoid a dramatic evolution?     

Congenital, ill-defined, yellowish plaque: the nasal dermoid

Congenital midline nasal masses are rare anomalies, of which dermoid cysts are the most common type. Nasal dermoids have been classically described in the literature as pale, flesh-colored, pearly, or erythematous nodules or masses. The presentation of a nasal dermoid as an ill-defined, yellowish plaques has not been emphasized previously. We describe three infants who presented with congenital, ill-defined, yellowish plaques of the midline nasal dorsum. We attribute the yellowish color to the relative prominence of sebaceous glands within the cyst, given the nasal location. Recognition of this unusual presentation of a nasal dermoid is important in order that appropriate imaging and intervention be undertaken.     

Orbital dermoid cysts showing conjunctival epithelium.

The orbital area is one of the most common sites for dermoid cysts. Most often these cysts are lined by keratinizing squamous epithelium; however, dermoid cysts may rarely be lined with conjunctival epithelium. We describe such a cyst and the features that distinguish it from other dermoid cysts.     

Cutaneous Bronchogenic Cyst: Delineation of a Poorly Recognized Lesion

Abstract: Bronchogenic cyst is a benign congenital developmental abnormality of the embryonic foregut. The most common extrapulmonary location of these lesions is the mediastinum. Over 50 cases of cutaneous bronchogenic cyst were reported in the English literature. Nevertheless, it is poorly recognized by clinicians and is sometimes confused with branchial cyst. In almost all cases the diagnosis is established by histopathologic examination. We report an unusual clinical presentation of bronchogenic cyst in a 4-year-old girl and review the literature. This lesion is four times more common in males than in females. The most common location is the suprasternal notch, followed by the presternal area, neck, and scapula. The characteristic histologic findings are a ciliated pseudostratified epithelial lining with the presence of smooth muscle cells, goblet cells and, less frequently, cartilage. Our review of the clinical and histologic features of all reported cases further delineates this entity and may facilitate its clinical diagnosis. Bronchogenic cyst should be included in the differential diagnosis of congenital cystic and nodular skin lesions on the upper chest, upper back, and neck.     

Intradermal Dermoid Cyst Associated with Occult Spinal Dysraphism

A 2-year-old boy with congenital lumbosacral skin lesions is described. He presented with associated occult spina bifida and a sagittal cleft of the vertebral body deep in the skin lesions. The skin lesions presented as a combination of a lipoma, telangiectasia, mild hypertrichosis, and a dermoid cyst. Magnetic resonance imaging (MRI) revealed that the lipoma extended to the spina bifida region, but that it did not connect to the dura. MRI also demonstrated no other spinal lesions requiring surgical treatment. The intradermal location of the dermoid cyst observed in our patient was unusual. We discuss the location of dermoid cysts in the lumbosacral region associated with spinal dysraphism.     

Bronchogenic Cyst Presenting as a Nodular Lesion

We report a subcutaneous bronchogenic cyst in a 7-year-old girl with unusual presentation as a nodular lesion. The cyst was excised and no connection with deeper structures was found. Histologic examination showed the typical features of a bronchogenic cyst. The characteristic clinical and histologic features of bronchogenic cysts are reviewed. The problems of differential diagnosis are also discussed.     

Eruptive vellus hair cysts.

Umbilicated and nonumbilicated papules were present on the presternal area of a patient with eruptive vellus hair cysts. Histopathological examination of umbilicated papules showed penetration of vellus hairs through cyst walls, surrounding granulomatous foreign body reaction, and communication to the surface of the skin with released vellus hairs present in the pore. This suggests that resolution of some of the cysts in this disorder may occur by transepithelial elimination.     

Hybrid cyst: A combined epidermoid and trichilemmal cyst

Seven cases of hybrid cyst, a combined epidermoid and trichilemmal cyst, are reported. Hybrid cysts occurred in five men and two women, and involved the scalp, cheek, back, arm, elbow, and forearm. The clinical diagnosis was usually cyst or sebaceous cyst. Microscopically, the upper portion of the cyst showed epidermoid keratinization in continuity with the surface epidermis, and was indistinguishable from an epidermoid cyst. Showing sharp transition from it, the inferior portion of the lesion displayed trichilemmal keratinization and was indistinguishable from a trichilemmal cyst. Hybrid cyst is not merely a newly described pathologic curiosity; rather, it forms a meaningful link between the two most common types of follicular cysts and adds weight to the body of evidence that most epidermoid cysts are related to the follicular infundibulum, while trichilemmal cysts are related to the follicular isthmus.     

Intratarsal keratinous cysts of the meibomian gland (a sebaceous duct cyst): report of 2 cases

Intratarsal keratinous cyst of the meibomian gland is a recently described entity that recurs if not completely excised. Herein, we report 2 cases and discuss their diagnosis and management: (1) A 57-year-old man with a recurrent mass of the upper eyelid treated with incision and drainage as a chalazion for more than 5 years and (2) An 85-year-old man presented with a slow growing nodule of the upper eyelid. Exploration via the eyelid crease approach revealed cysts fixed to the tarsus that were completely excised with a portion of the anterior tarsus. Histologically, these cysts exhibited a keratinizing squamous epithelium without a granular layer (trichilemmal keratinization), were lined by an eosinophilic undulating cuticle, contain string-like keratin debris, and had a fibrous wall without sebaceous lobules. All epithelial components strongly expressed high-molecular weight keratins, whereas the lining, cuticle, and keratin contents strongly expressed carcinoembryonic antigen. No recurrence has occurred 7 and 12 months postoperatively. The location and clinicopathologic findings of intratarsal keratinous cysts distinguish it from sebaceous tumors, steatocystoma simplex, epidermoid cyst, and dermoid cyst. However, like steatocystomas, intratarsal keratinous cysts exhibit a sebaceous duct phenotype. The anterior lid crease approach with partial tarsectomy seems to be an effective treatment.     

Epidermal cyst and osteolysis of the cranial vault]

In a 40-year old man undergoing, under local anaesthesia, excision of an epidermal cyst located in the frontal region, at the border of the scalp, the operator had difficulties in removing the deep part of the cyst and perceived an underlying bone depression. The depression was caused by a 2 x 1.3 cm wide lacuna in the calvarium, which was subsequently treated by neurosurgeons. Histology showed only fragments of a simple epidermal cyst wall and no evidence of dermoid cyst. The causes of osteolysis associated with congenital or acquired skin lesions are reviewed. In this case, the old age and volume of the cyst may explain the osteolysis by mechanical compression. This case is exceptional since we were unable to find other examples in the literature, apart from dermoid and trichilemmal cysts.     

CONGENITAL INCLUSION DERMOID CYSTS OF THE SCALP

The natural history of congenital inclusion dermoid cysts of the scalp is unknown. We report three cases of this condition, which has been followed from birth for up to ten years. Dermoids are congenital subcutaneous cysts, which gradually flatten and scar over a number of years. The lesions are covered with skin showing focal alopecia but they may be surrounded by a collar of hypertropic hair. Later in life flattened cysts may be mistaken for aplasia cutis, but the history of a cyst at birth allows the clinician to distinguish these two conditions. As these cysts have a potential for intracranial extension, this is an important clinical entity.     

Extension of a malignant tailgut cyst to a subcutaneous space in the buttock

Tailgut cysts are rare benign cystic lesions of the retrorectal space. The recommended treatment is complete resection because these cysts have occasionally shown malignant transformation. However, a high index of clinical suspicion is required to reach a diagnosis. We report a 68-year-old man complaining of a subcutaneous mass in his right buttock. Magnetic resonance imaging (MRI) showed a large cystic mass extending 25.7?cm from the pelvis to the buttock. Radiological features indicated a benign cystic tumor, but the level of serum carcinoembryonic antigen (CEA) (87.5?ng/mL) was increased. An incisional biopsy did not define the true histological nature of the lesion and was not useful for surgical planning. Although MRI could not detect malignant changes, the elevated serum CEA indicated malignant degeneration. The patient required a Miles operation for?complete resection. Surgical pathology revealed focal areas of high-grade adenomatous and adenocarcinomatous changes in the cyst wall. After surgery, the serum CEA level decreased to below the normal range. The case presented here shows that early malignant degeneration of TGC is difficult to detect by MRI. Thus, a tailgut cyst should be completely removed, even if radiological examination cannot detect malignant features. Measurement of serum CEA may be helpful when the tumor expresses this antigen.     

Subcutaneous Midline Nasal Mass in an Infant due to an Intramuscular Lipoma

Intramuscular lipomas are rare, benign, mesenchymal tumors occurring deep in the fascia, typically involving large muscle groups in adults. We report a case of an intramuscular lipoma occurring as a subcutaneous midline nasal mass in a 3‐month‐old infant. The differential diagnosis of a midline mass on the glabella of an infant is important and should include developmental anomalies such as nasal glioma, nasal dermoid cyst, and encephalocele, so neuroimaging is an essential first step in evaluating these lesions to exclude intracranial extension.     

Surgical treatment for a giant epidermoid cyst on the buttock

An epidermoid cyst is a common keratin‐filled epithelial‐lined cyst in clinic, which generally present as a slowly and progressively growing lesion. Surgical treatment is usually performed for epidermoid cysts. In this article, we describe a giant epidermoid cyst on the buttock, which has been growing for 20 years with no rupture.     

Folliculo-sebaceous cystic hamartoma.

Case 1 A 6‐month‐old boy presented to our clinic with a scalp lesion dating since birth ( Fig. 1 ). The lesion was in the form of an erythematous, dome‐shaped nodule, measuring around 1.5 cm in diameter and having a slightly irregular surface. The lesion was nonitchy, nontender, and showed limited mobility. Our clinical differential diagnosis included: meningocele, hemangioma, dermoid cyst, and apocrine nevus. A computed tomography (CT) scan was performed to exclude possible intracranial connection, and the lesion was surgically excised.

Figure 1 Open in figure viewer PowerPoint Case 1: erythematous nodule on the occipital area of a 6‐month‐old boy. The lesion was clinically suggestive of apocrine nevus, dermoid cyst, or meningocele     

Multiple cutaneous bronchogenic cysts located on the neck and the scalp. A case report

Bronchogenic cyst is a benign congenital developmental abnormality of the embryonic foregut. The skin is a rare site for bronchogenic cysts, and in this location it is often a solitary lesion. It is poorly recognized by clinicians and in almost all cases the diagnosis is established by histopathologic examination. This report documents a new case of multiple cutaneous bronchogenic cysts bilaterally located on the neck and on the scalp, which are unusual locations of this lesion.     

Isotretinoin for the treatment of squamous cell carcinoma arising on an epidermoid cyst

A 63‐year‐old man showed multiple concentric erythemato‐nodular lesions of approximately 1.5–3 cm in diameter, located in the parietal and temporal region. The skin biopsy allowed histological diagnosis of infundibular epidermal cyst associated with chronic granulomatous flogosis; in one of these, a well‐differentiated squamous cell carcinoma arising from the cyst wall was found. The patient received isotretinoin at the daily dosage of 0.5 mg/kg/day for 5 months. During 1‐year follow‐up, laboratory tests, computed tomography scans, and control histology were all in the normal range, with a good improvement of the lesions. Epidermal cysts and squamous cell carcinoma are both commonly encountered in practice. However, the association of epidermal inclusion cysts and squamous cell carcinoma in the skin is very rare. In some cases, including the present one, more potent chemopreventive strategies, such as the use of systemic retinoids, must be considered. Systemic retinoids are the most heavily researched chemopreventive agents and have shown promise for multiple types of cancer, including bladder and head and neck carcinomas. We would like to recommend the possibility to administer retinoids in a squamous cell carcinoma, achieving very satisfactory results; in our case, a complete remission of malignant lesion and an improvement of epidermal cysts were made, without the development of side effects associated with retinoids.     

Eruptive vellus hair cysts: an effective extraction technique for treatment and diagnosis

BACKGROUND: Eruptive vellus hair cysts are uncommon developmental anomalies of vellus hair follicles that are observed in young patients. Two patients were evaluated for asymptomatic flesh-coloured papules appearing on the chest, abdomen and axillae. Lesions of both patients were diagnosed histologically as eruptive vellus hair cyst, which is a disorder with no standard treatment option. OBJECTIVE: To introduce an alternative treatment and diagnostic technique for eruptive vellus hair cysts and to evaluate this technique's effectiveness histopathologically. MATERIALS AND METHODS: We treated the lesions by using cautery and a standard dissecting forceps under topical anaesthesia. After puncturing the overlying skin in the centre using the sharp-tipped cautery point, we grasped the base of the cyst using a standard dissecting forceps and we extracted the cysts out. In patient 1, extracted cysts were sent for histopathological examination; in patient 2, microscopic examination of the extracted material was performed in potassium hydroxide preparations. RESULTS: Over 150 cysts were extracted with this technique in two patients. The technique was simple, quick and tolerated well. No lesion recurrence was observed after 4 months. On histopathological examination, extracted cysts were observed to have cyst walls. In patient 2, the diagnosis was made within minutes by microscopic examination of the potassium hydroxide preparations of the extracted material. CONCLUSION: Our extraction technique is a simple and effective treatment option for these cysts. It can be regarded as curative since the cyst walls were also extracted. Microscopic examination of the potassium hydroxide preparation of the extracted cysts suggests that this technique can also be used as a simple diagnostic procedure.