Squamous cell carcinoma arising in an epidermal inclusion cyst

An epidermal inclusion cyst is a widespread benign intradermal lesion and may occur anywhere in the body. Normally, it appears as a non-tender, soft mass of variable size. Dissection usually reveals grayish-white or whitish gelatinous materials and a smooth inner surface. The overlying skin almost always shows unremarkable changes. On occasion, the cyst may rupture and induce an inflammatory reaction. It rarely turns malignant or displays a firmer mass. This study reports on a rare case of squamous cell carcinoma arising from the lining cells of an epidermal inclusion cyst, which was located in the left axillary region of a 68-year-old male patient. Clinically, it is difficult to differentiate between a benign and malignant cystic lesion. Histological examination normally yields the diagnosis. Once a diagnosis is confirmed, the tumor should be widely excised with a free margin. The outcome is always excellent. We therefore emphasize that all resected skin cystic specimens should undergo further microscopic examination to avoid any unnecessary misdiagnosis.     

Hepatic hydatid cyst presenting as cutaneous abscess

Hydatidosis is a parasitic zoonotic echinococcal infection that affects both humans and other mammals. These diseases are common worldwide but particularly common in sheep and cattle farming regions. Anaphylaxis mediated by IgE is a serious complication of surgery or trauma which necessitates more aware of its clinical features, diagnosis and management. It is important to make a preoperative diagnosis based on the typical image findings, so that particular precaution can be taken not to rupture the lesion. A woman presented with a right upper quadrant cutaneous abscess. USG reveals multiple cystic lesions in the liver arranged in cartwheel appearance, CT disclosed a cystic lesions having daughter cysts, marginal calcifications, marginal enhancement and contiguous abdominal wall abscess, which led to a diagnosis of complicated hepatic hydatid cysts with abdominal wall abscess formation. FNAC showed scolices surrounded by chronic inflammatory cells. Abdominal wall abscess may be a presentation of hydatid liver disease.     

Massive hepatic cyst presenting as right-sided heart failure

A 70-year-old woman presented with clinical features of right heart failure. Cardiopulmonary investigations included an echocardiogram, which showed a hepatic cyst compromising venous return and affecting right atrial filling and a CT abdomen showed a 15.5?×?11.5?cm-cystic mass involving the right hepatic lobe and compressing the right atrium. Percutaneous drainage of the cyst was performed. This led to complete resolution of symptoms but these recurred as the fluid re-accumulated. Subsequent definitive treatment with excision of the cyst was undertaken with symptomatic cure. This case is the first report of a hepatic cyst presenting as right heart due to compression of the right atrium.     

Thoracic duct cyst presenting as a left supraclavicular mass

Thoracic duct cysts may occur either in the mediastinum or in the neck. The majority of such lesions occurring in the neck consist of chylous fistulae and are secondary to surgery on the neck. Fewer than five cases have been reported in the literature of primary thoracic duct cysts occurring in the neck (1).     

Haemorrhage into a urachal cyst presenting as an 'acute abdomen'

A previously well 3 year old Asian girl presented as an emergency with the acute onset of generalized abdominal pain. On examination her abdomen was distended with generalized tenderness and guarding most marked centrally. Under anaesthesia a central abdominal mass arising from the pelvis was palpated which on proceeding to laparotomy was found to be a blood-filled urachal cyst. This was excised and her recovery was uneventful. Subsequent investigations have revealed no associated renal tract abnormalities.     

Solitary cyst of the liver presenting as an abdominal emergency

A case of torsion of a solitary non-parasitic cyst of the liver presenting as an acute abdominal emergency is described. Reference is made to the pathogenesis of such cysts, which occur infrequently and only rarely present with complications. A review of previous reports of complications in such cysts is presented.     

Parathyroid carcinoma presenting as a giant mediastinal retrotracheal functioning cyst

Parathyroid carcinoma is a rare malignancy of the parathyroid glands, and is the cause of primary hyperparathyroidism in fewer than one percent of cases. Symptoms are mainly due to local compression or hypercalcaemia secondary to markedly elevated parathyroid hormone levels. A minority of patients remain asymptomatic. Mediastinal parathyroid cysts are infrequent and may or may not be functioning. We present an 84-year-old woman with a giant functioning cystic parathyroid carcinoma located in the middle mediastinum. We performed a thorough MEDLINE and LILACS database search on published cases of parathyroid carcinoma and functioning parathyroid cysts, and found no case report with identical features to the one presented here.     

Childhood cervical enterogenous cyst presenting with hemiparesis

The clinical features of a cervical enterogenous cyst in a one-year-old boy mimicked those of an intracranial mass. Following removal of the cyst the neurological signs rapidly disappeared. The literature is reviewed from histological and clinical aspects and a classification of these cysts is proposed.     

Epidermal inclusion cyst in the foot of a Vietnam Veteran

Epidermal inclusion cysts are soft-tissue lesions that result from traumatic implantation of epidermal cells into the dermis. A case report is presented involving a large recurrent plantar inclusion cyst secondary to trauma sustained in the Vietnam War. The patient reported that the initiating trauma was the result of stepping on a punji stake in Vietnam. Punji stakes, sharpened spikes typically made of bamboo and dipped in poison or excrement, were used by the Vietnamese soldiers to wound enemy soldiers. Careful excision of the lesion is imperative to prevent recurrence.     

Intact bronchogenic cyst presenting as a lung mass provoking a pleural effusion: a rare presentation

This case report describes a 49 year old woman with an intra-parenchymal bronchogenic cyst masked on chest x-ray examination by a pleural effusion. The cyst was intact. It is likely that the cyst provoked the pleural effusion by repetitive mechanical irritation of the pleura. At surgery, the cyst was removed and the pleural effusion drained without recurrence. The cyst was unilocular and measured 8.5 x 7.0 x 0.8 cm with a smooth and glistening lining. It was filled with approximately 300 ml of clear fluid. Microscopic examination confirmed the bronchogenic cyst. This is the first case of an intact intra-parenchymal bronchogenic cyst associated with a pleural effusion that was not due to rupture of the cyst, infection or malignancy.     

Squamous cell carcinoma arising from an epidermal cyst.

There are few case reports in the English literature concerning malignant transformation of an epidermal cyst into squamous cell carcinoma. We report a case of squamous cell carcinoma arising from a 40-year epidermal cyst in the proximal left thigh of a 74-year-old man. The epidermal cyst had increased in size in the previous 3 years. The patient presented with a discharge from the lesion. Ultrasonography and magnetic resonance imaging of the lesion suggested malignancy. An intra-operative frozen section of an incisional biopsy of the lesion found it to be an epidermal cyst with suspected malignant change, so a marginal excision of the lesion was performed. Squamous cell carcinoma arising from the epidermal cyst was confirmed histologically. A wide excision was done in order to obtain an adequate resection margin. A computed tomographic scan of the thorax and abdomen found no evidence of metastases. No evidence of recurrence was noted in the latest follow-up, 2 years postoperatively.     

Epidermal inclusion cyst of the breast: a rare benign entity

Epidermal inclusion cyst (EIC) arising from the breast is an uncommon benign condition. We report two cases of enlarging EIC of the breast in two women in their forties. The diagnosis of this condition may not be straightforward with imaging alone if an EIC presents as an enlarging lump in the breast and mimics a benign breast lesion, most commonly a fibroadenoma or malignant lesion with benign imaging features. Excision is usually recommended for a definite histopathological diagnosis and for the prevention of potential risks of malignant transformation. Asymptomatic stable lesions do not require treatment; biopsy is unnecessary, and follow-up imaging suffices if typical sonographic and clinical findings are found.     

Myelodysplasia presenting as erythroderma

Erythroderma has not previously been reported to be a feature of myelodysplasia. We report two cases of myelodysplasia presenting with erythroderma, one of which was associated with skin infiltration by blast cells.