Carcinoma arising in epidermoid cyst: a case series and aetiological investigation of human papillomavirus

Epidermoid cyst of the midline neck in an 8-year-old girl: A case report

Epidermoid cysts (ECs) are usually small, benign, keratin-filled cysts, can be congenital or acquired and encountered anywhere in the body. EC and dermoid cyst constitute approximately 7% of all cysts in the head and neck region and tend to occur in areas of embryonic fusion. Neck masses are commonly present in children, and there is often a diagnostic dilemma clinically with common differential diagnoses of this region such as thyroglossal cyst, pre-tracheal lymph nodes, thyroid mass, EC and dermoid cyst. EC is mostly present in middle-aged males, and here, we are going to present an EC of the midline neck in an 8-year-old girl, which is not common.

Perirectal epidermoid cyst in a patient with sacrococcygeal scoliosis and anal sinus: A case report

BACKGROUND

Perirectal epidermoid cysts are rare masses arising from the ectodermal germ cell layer of the hindgut and are predominantly found in middle-aged women. It is often difficult to make an accurate diagnosis of these cysts and it is equally challenging to distinguish it from other developmental cysts.

CASE SUMMARY

We report the case of an 18-year-old female patient with a perirectal mass who presented to the hospital with constipation. The patient experienced sacrococcygeal falls and burns on the left buttocks during growth. Three-dimensional computed tomography scans indicated abnormal sacral vertebrae with the sacral canal partially enlarged and opened. Pelvic magnetic resonance imaging showed a 55 mm × 40 mm × 35 mm unilocular cystic mass in the perirectal space and a solitary sinus in the left ischiorectal fossa. The cyst was completely resected posteriorly using the sacrococcygeal approach. The pathology was verified to be an epidermoid cyst. The patient remained recurrence-free after 6 mo of follow-up.

CONCLUSION

Successful treatment of perirectal epidermoid cysts depends on comprehensive evaluation. This is significant for the surgical approach and prognosis.

Retrorectal tumors: Case report and review of literature

BACKGROUND

Retrorectal tumors are rare diseases and they can be challenging to diagnose and to manage. Usually they have a slow growth and they are asymptomatic. When present, symptoms depends on the dimensions of the tumor and their position. Inside the retrorectal space may develope a wide variety of benign and malignant masses.

CASE REPORT

A 70-years-old, obese, female patient was admitted to our hospital referring pelvic and lower-back pain for six months. The retrorectal mass was incidentally detected on imaging, and treated with a modified Kraske procedure.
Pathological examination revealed a rare retrorectal epidermoid cyst. We also reviewed the informations present in the scientific literature about the incidence, diagnosis and treatment options of retrorectal tumors.

CONCLUSIONS

Even though the rarity and heterogeneity of these tumors, we agree with literature that their surgical management is mandatory in order to achieve a definitive diagnosis and to avoid complications including malignant transformation. The surgical approach should be tailored for each patient and according to tumor's features.

Rare squamous cell carcinoma arising from a presacral epidermoid cyst: A case report

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Presacral epidermoid cysts are extremely rare and require further study.

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Thorough preoperative imaging evaluation is important for complete resection.

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Multidisciplinary treatments may be effective.

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Presacral epidermoid cysts may be malignant.

Introduction

Presacral epidermoid cysts are uncommon, usually benign cysts caused by developmental abnormalities in the fetal period. We present a rare case of squamous cell carcinoma arising from a presacral epidermoid cyst.

Presentation of case

A 59-year-old woman complained of tenesmus and discomfort in the buttocks. Computed tomography revealed a 50-mm well-defined cystic mass in the presacrum and a 70-mm solid mass extending from the cyst into the rectum, vagina, and left sciatic spine. On T1-weighted magnetic resonance images, the cyst was unilocular and the mass was marginated with low intensity. On T2-weighted images, the mass had high intensity. A malignant presacral developmental cyst was diagnosed, without obvious metastasis. Using abdominal and parasacral approaches, Hartmann’s operation was performed with multiorgan resection, including the sacrum, coccyx, left sciatic spine, internal obturator muscle, rectum, and uterine appendage. Histopathology of the excised specimen revealed a squamous cell carcinoma originating from the presacral epidermoid cyst.

Discussion

Reports of malignant transformation of epidermoid cysts in the presacral space, as in the present case, are extremely rare. Because of their unusual location and slow growth, epidermoid cysts tend to remain asymptomatic. Because the patient had a malignant tumor with suspected invasion of adjacent organs, combination surgery was selected.

Conclusion

Although further research is required, presacral epidermoid cysts are extremely rare and may be malignant. Thorough preoperative image evaluation is crucial for complete resection.

Squamous Cell Carcinoma following Epidermoid Cyst in the Buttock

In the field of plastic surgery, subcutaneous masses in the buttocks are frequently observed. However, squamous cell carcinoma (SCC) after epidermoid cyst, which appears in the presacral space, is extremely rare. This report described a case of a 71-year-old woman, who previously received a skin incision by a doctor for treating a cystic lesion in the buttock; she was diagnosed with SCC by preoperative biopsy at the authors' department. In addition, computed tomography suspected that the tumor originated in the presacral space. Under general anesthesia, an extended resection of the malignant tumor with gastrointestinal surgery was performed. After resection, the defect of buttocks region was reconstructed with a V-Y advancement gluteus maximus myocutaneous flap. After pathological examination the tumor was diagnosed as SCC after epidermoid cyst; peplomycin sulfate at 50 mg/d was administered intramuscularly for 2 weeks as chemotherapy. No wound complications were observed after surgery, and no recurrence was noted for 5 years. For managing tumor in the gluteal region, a possibility of malignancy must be considered, and thorough radiographic studies must be pursued before surgery.

Is Routine Pathologic Evaluation of Sebaceous Cysts Necessary?: A 15-Year Retrospective Review of a Single Institution

A question arose in our practice of whether all cysts considered sebaceous should be sent for pathologic evaluation. To address this controversial topic, we performed a retrospective study of our single institution's histopathology database. A natural language search of the CoPath database across the institution was undertaken using the diagnosis of sebaceous cyst, epidermal cyst, epidermoid cyst, epithelial cyst, infundibular cyst, pilar cyst, trichilemmal cyst, and steatocystoma. A surgical pathologic review of all specimens with one of these preexcision diagnoses was included in the 15-year retrospective study of 1998 to 2013. All slides were confirmed to have undergone histopathologic review, and the preexcision diagnoses were compared with the postexcision diagnoses. Chart review was undertaken in instances of a diagnosis of malignancy. A total of 13,746 samples were identified. Forty-eight specimens had histopathologic diagnosis of malignancy, for an incidence of 0.3% and with the most common malignancy being squamous cell carcinoma. Chart review showed that for all cases, the surgeons reported uncertainty with regard to the diagnosis because of history or physical characteristics, or both. In addition, a comprehensive literature review showed results consistent with our data and illustrated 19 cases during the past 10 years in which most of the findings were squamous cell carcinoma. We propose the recommendation that routine pathologic evaluation of sebaceous cysts is necessary only when clinical suspicion exists.

Routine histological examination of epidermoid cysts; to send or not to send?

Backround

The diagnosis of epidermoid cyst is seldom in doubt, and associated malignancy extremely rare, yet it is commonplace for the lesion to be sent to the pathology laboratory for analysis. The aim of this study was to evaluate our current practice with regards to diagnostic accuracy among clinicians, and assess risk of not routinely sending suspected epidermoid cysts for histological examination. Potential cost savings were also estimated and calculated.

Methods

Retrospective analysis of clinical and pathology data on all suspected epidermoid cysts excised from a Scottish district general hospital over a 5-year period between January 2011 and October 2015.

Results

Five hundred and thirty-six suspected epidermoid cysts were excised during the study period. Three hundred and ninety-six were sent for histological examination which confirmed a diagnosis of epidermoid cyst in 303 (76.5%) cases. There was good agreement between preoperative suspicion and final histological diagnosis: 80.8% (257/318) among referring clinicians, 81.9% (289/353) among reviewing surgeons, and 88.4% (243/275) where there was preoperative agreement between both. There were no malignant lesions. An average of 80 clinically apparent epidermoid cysts were excised and sent for histology each year at a cost of £4800 per annum.

Conclusion

There was close agreement between clinical and final histological diagnosis of epidermoid cyst. Where a characteristic, odorous, toothpaste-like material is present on transection intra-operatively, the diagnosis is confirmed and the lesion can be discarded. We argue that significant cost savings can be achieved by adopting this approach.

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Epidermoid cysts are common but malignant transformation extremely rare.

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Good association between a clinical diagnosis and a final pathology diagnosis of epidermoid cyst.

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Intra-operative transection of resected specimen may improve confidence in diagnosis.

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Where classical features are present clinically and on excision, the specimens do not require histological examination.

Basal-Cell Carcinoma Occurring in Cutaneous Infundibular Cysts: Report of 2 Cases and Review of the Literature

Cysts lined by stratified squamous epithelium indistinguishable from the epidermis, referred to as epidermoid cysts, epidermal inclusion cysts, and infundibular cysts, are the most common type of cyst occurring in the skin. They are invariably benign, and malignant neoplasms arising within the wall of such cysts are distinctly uncommon. Even basal-cell carcinoma, which is the most common cutaneous malignant neoplasm of the skin, has rarely been reported to occur in association with epidermoid cysts. The authors report their experience studying 2 patients with basal-cell carcinoma arising in association with an epidermoid cyst. These cases highlight the need to examine, histopathologically, tissue from this common and usually benign lesion. The authors also review the medical literature.

An unusual case of a recurrent seborrheic/epidermal inclusion cyst of the maxillofacial region

A Seborrheic or epidermal inclusion cyst is basically an epidermoid cyst resulting from the traumatic implantation of epidermal elements into the dermis with their subsequent cystic transformation. A case of an epidermal inclusion cyst of the chin region is described in a 72 year old male, whose features were rather unusual, in that it presented as a fixed, indurated, inflamed, and extremely painful swelling associated with two draining extraoral sinuses, mimicking a submental space infection. The cyst was particularly persistent and recurred within a month of its excision and had to be re-excised along with the overlying epithelium.

An unusual encounter of an epidermoid cyst

Epidermoid cysts are extremely common and can occur in any hair-containing area. We present the case of a 20-year-old man with an epidermoid cyst in the perianal region. Epidermal cysts have been described in this area previously after haemorrhoidectomy, but cysts of the size seen in this case are rare in the absence of previous anal trauma. The diagnosis was confirmed by excision biopsy.

Dermal atypical lipomatous tumor/well-differentiated liposarcoma obfuscated by epidermal inclusion cyst: a wolf in sheep's clothing?

Epidermal inclusion cysts are an exceedingly common entity seldom seen in association with a malignant tumor. Herein, we report a unique case of an epithelial inclusion cyst seen in association with an atypical lipomatous tumor/well-differentiated liposarcoma. The epidermal inclusion cyst was delimited to the dermis and circumferentially enveloped by an atypical adipocyte tumor containing myxoid foci and comprised of lipoblasts. This case underscores the importance of scrutinizing the entirety of cysts and other ostensibly trivial dermal entities to avoid the pitfall of misdiagnosing a potentially serious tumor.