A giant epidermoid cyst demonstrated by magnetic resonance imaging

Rare Huge Tubular Papillary Adenoma on the Buttock Demonstrated by Magnetic Resonance Imaging (MRI)

Patient: Male, 35

Final Diagnosis: Tubular papillary adenoma of the buttock

Symptoms: Firm • redness • pain • swelling of the fixed perianal mass

Medication: —

Clinical Procedure: Excision biopsy

Specialty: Surgery

Perforator flaps after excision of large epidermal cysts in the buttocks

BACKGROUND

Epidermal cysts are commonly occurring masses usually less than 5 cm in diameter, but in predisposed patients, epidermal cysts can grow relatively large due to chronic infection.

METHODS

From June 2002 to July 2010, 17 patients received 19 regional perforator-based island flaps to cover defects due to the excision of large epidermal cysts (diameter >5 cm) in the buttocks. Eight patients had diabetes, and seven had rheumatoid arthritis. The pedicles were not fully isolated to prevent spasms or twisting.

RESULTS

All the flaps survived completely, except for one case with partial necrosis of the flap, which necessitated another perforator-based island flap for coverage. There were two cases of wound dehiscence, which were re-closed after meticulous debridement. There were no recurrences of the masses during follow-up periods of 8.1 months (range, 6-12 months).

CONCLUSIONS

In patients with large epidermal cysts and underlying medical disorders, regional perforator-based island flaps can be the solution to coverage of the defects after excision.

Two cases of giant epidermal cyst occurring in the neck

Epidermal cysts are the most common cysts of the skin. Aconventional epidermal cyst rarely reaches a size of more than 5 cm in diameter. We report on two cases of giant epidermal cyst occurring in the neck. One patient had a cyst measuring 12×9×9 cm and the other patient had a non-pulsatile, dome-shaped lesion in the neck, which measured 6×5×3 cm. The lesions were totally excised. Histopathologically, both were confirmed as giant epidermal cysts.

Fluid-fluid level in a giant epidermal cyst of the buttock

We describe a case of a giant epidermal cyst of the buttock that demonstrated a fluid-fluid level on imaging. There have been no previously reported cases of epidermal cysts containing a fluid-fluid level, so our case was considered to be very exceptional. A 39-year-old man had had a slowly enlarging giant subcutaneous mass in the left buttock for more than 10 years. It was elastic-soft, well-circumscribed and smooth-surfaced. Ultrasonography showed a well-circumscribed hypoechoic mass with a fluid-fluid level in the subcutis of the left buttock. Magnetic resonance imaging (MRI) showed a well-circumscribed cystic mass measuring 8 cm x 5.5 cm x 5.5 cm in the same place that the ultrasonography indicated. It was hypointense on the T1-weighted image, hyperintense on the T2-weighted image, and contained a fluid-fluid level on both the T1- and T2-weighted images. It bordered on the anus, but neither adhered nor formed a fistula with it. A surgical excision was performed. The mass was diagnosed histopathologically as an epidermal cyst. The occurrence of fluid-fluid levels in epidermal cysts should be kept in mind in the differential diagnosis of subcutaneous soft tissue tumors.

Atlas of breast magnetic resonance imaging

Magnetic resonance imaging (MRI) of the breast has become important not only for assessing the extent of breast cancer for breast-conserving surgery but also for the evaluation and diagnosis of other benign and malignant pathologies. We radiologists therefore need to know the appropriate indications for performing breast MRI and understand the MRI features of breast disease. We herein review and discuss the application of current pulse sequences and the imaging strategies for MRI of breast pathologies. We will illustrate the MRI features of various breast pathologies including malignant tumors such as invasive and noninvasive ductal carcinoma, special types of invasive carcinoma (mucinous, apocrine, lobular carcinoma, spindle cell carcinoma, and so on), inflammatory carcinoma, semimalignant tumor (phyllodes tumor), benign tumors (fibroadenoma, intraductal and intracystic papilloma), inflammatory conditions, and postsurgical changes. We will also demonstrate three-dimensional fusion images of MR ductography and breast MRI of patients with nipple discharge.

Giant Multilocular Epidermoid Cyst on the Left Buttock

BACKGROUND

Epidermoid cysts are the most common cysts of the skin. They are generally small and slow-growing and rarely reach more than 5 cm in diameter.

OBJECTIVE

We present a patient with a giant multilocular epidermoid cyst.

METHODS

A 75-year-old man presented with a giant, soft, painless, tumorlike mass on the left buttock that had gradually enlarged over a 12-year period. Excision of the mass from the surrounding tissue was extremely easy because of a well-defined capsule.

RESULTS

The 28 x 14 x 12 cm mass was totally excised. A histopathologic examination revealed that it was an epidermoid cyst.

CONCLUSION

This rare case of giant epidermoid cyst was treated successfully by local excision followed by primary closure. Dissection of the mass from the surrounding tissue was extremely easy because of a well-defined capsule.