Cutaneous ciliated cyst

[Main Types of Cysts in Dermatopathology: Part 2]

This is the second article in a two-part series published in this journal, in which we examine the histopathological characteristics, as well as the differential diagnosis, of the main entities that present as cystic and pseudocystic structures in cutaneous biopsy. In this second article, we address ciliated cutaneous cysts, branchial cysts, Bartholin's cysts, omphalomesenteric cysts, thymic cysts, thyroglossal duct cysts, synovial cysts, and median raphe cysts, as well as mucocele, ganglion, and auricular and digital myxoid pseudocysts.

Cutaneous ciliated cyst of the scalp: a case report of a cutaneous ciliated eccrine cyst and a brief review of the literature

Cutaneous ciliated cysts (CCC) are rare benign cysts known to occur in the lower extremities of females of reproductive age. Currently, there are 2 theories that attempt to explain the histogenesis of this rare entity. The theory of Mullerian heterotopia provides a plausible histogenetic explanation for the vast majority of CCC. A proposed alternative theory is the ciliated metaplasia of eccrine glands. We believe that previously reported cases of CCC include 2 distinct entities. We report, herein, the first case reported in the literature of a cutaneous ciliated eccrine cyst occurring on the scalp.

PAX-8 expression in cutaneous ciliated cysts: evidence for Müllerian origin

Cutaneous ciliated cysts (CCC) are exquisitely rare, benign cystic lesions demonstrating simple, ciliated epithelial linings reminiscent of fallopian tube epithelium. Most commonly, CCC show a predilection for the lower extremities of young reproductive age women and demonstrate immunohistochemical positivity for estrogen and progesterone receptors, supporting the theory that they are derived from ectopic Müllerian rests. PAX-8 is a paired box gene, important in the development of Müllerian and thyroid organs and has utility in the identification of tumors of Müllerian, renal, and thyroid origin. Prompted by the precedent studies on PAX-8 immunohistochemical expression in tumors of Müllerian origin, this article aimed to explore the utility of this antibody in defining the histogenesis of 2 bona fide cases of CCC, both occurring in young reproductive age women. Herein, 2 prototypic index cases of CCC with strong nuclear positivity for estrogen and progesterone receptors are shown to also have positive nuclear staining for PAX-8, further supporting their likely Müllerian origin. These data support the designation of these lesions as cutaneous Müllerian cysts, distinct from potential ciliated cysts of eccrine origin.

Cutaneous ciliated cyst of the inguinal area in a man

Cutaneous ciliated cysts are rare, predominantly occurring on the lower extremities of young women. Most of them have been regarded as müllerian remnants. Cases in men are rarely reported. We report a case of a cutaneous ciliated cyst involving the inguinal area of a 56-year-old man and briefly review the published work.

Cutaneous ciliated cyst of the abdominal wall: a case report with a review of the literature and discussion of pathogenesis

A cutaneous ciliated cyst is a rare lesion typically found on the lower extremity of young girls shortly after puberty. Here, we report a case involving a previously unreported site (i.e., abdominal wall) in a 14-year-old girl. We also describe immunohistochemical and ultrastructural findings, review and analyze the world literature, and offer insights as to the pathogenesis of this lesion.

Cutaneous ciliated cyst with interspersed apocrine features presenting as a pilonidal cyst in a child

We present a case of a cutaneous ciliated cyst that presented in a 13-year-old female. The lesion was felt to be a pilonidal cyst, based on its location and clinical appearance. This case is unusual because it is the youngest reported example of this very rare lesion. In addition, the admixture of apocrine and ciliated cells is extremely unusual. The histogenesis of cutaneous ciliated cysts is considered.

Cutaneous ciliated cyst: a case report with immunohistochemical evidence for dynein in ciliated cells

Cutaneous ciliated cysts (CCCs) are rare benign lesions predominantly occurring in the lower limbs of young women. We observed such a lesion in the perineal region of a 12-year-old girl. The histogenetic interpretation of CCCs is controversial. The similarity of the epithelial lining of the cyst to the salpingeal epithelium supports the hypothesis of a Müllerian heterotopia. Strong dynein positivity observed immunohistochemically in the apical portion of CCC lining cells suggests the integrity of the ciliary apparatus. There was a marked similarity between a CCC and normal salpingeal epithelium in the mode of staining for dynein, whereas the dynein reactivity of bronchial epithelial cells showed larger cytoplasmic aggregates of positive material in proximity to the nucleus. No immunohistochemical staining for estrogen or progesterone receptors was identified in our observation, although this finding could have supported the Müllerian histogenetic hypothesis. To the best of our knowledge, this is the first time that antidynein immunohistochemistry has been applied to paraffin-embedded samples from human surgical pathology.

Cutaneous ciliated cyst of the right lower leg

A 23-year-old Japanese woman with a cutaneous ciliated cyst on her right lower leg is reported. A subcutaneous cyst, measuring 2.5 cm in diameter with papillary projections into the lumen, was lined with ciliated cuboidal to columnar epithelia with partial stratification, histologically. These lining cells did not produce mucin. Immunohistochemically, the ciliated lining cells of the cyst were diffusely positive to epithelial membrane antigen and cytokeratin. In addition, positive immunoreaction with anti-desmin monoclonal antibody was observed in the body of the cilia. Less than 10% of the epithelial cells revealed positive immunoreaction to S-100 protein and estrogen receptor.

Cytologically interesting cases of primary skin tumors and tumor-like conditions identified by fine-needle aspiration biopsy

The aims of this study are to depict the special but constant cytomorphologic features which allow a distinction among grossly similar skin tumors and to show that cytological assessment of many uncommon skin lesions is possible. The fine-needle aspiration findings of 181 cytologically interesting cases of primary skin tumors selected from 2,301 primary skin lesions examined in our department from 1990-1995 are described. Seventy-five cases were cytologically reported as benign and 89 as malignant. In 17 cases the aspirated material was considered inconclusive, although some possible diagnoses could be supported. A subsequent histological examination followed the cytologic assessment in all cases. Fine-needle aspiration cytology identified uncommon cutaneous cystic lesions (bronchogenic, dermoid, myxoid), benign and malignant tumors of epidermal appendages such as chondroid syringomas, cylindromas, pilomatrixomas, sebacecous carcinoma, and primary adenoid cystic carcinoma, as well as tumors of the dermis and subcutaneous fat. Primary cutaneous lymphomas were also diagnosed and classified morphologically and immunocytochemically. In our diagnoses of uncommon skin tumors new cytologic criteria were created and utilized and are described in this report in detail.