Peri-clitoral Epidermal Inclusion Cyst as Initial Presentation of Lichen Sclerosus in a Pediatric Patient

BACKGROUND

Lichen sclerosus (LS) is a chronic inflammatory disorder, presenting with pruritis and hypopigmentation of the vulvar and anogenital skin. LS presenting as a peri-clitoral mass has not been previously described.

CASE

A 5-year-old patient with vulvar pruritis and ultrasound showing a homogenous mass was referred for suspected clitoromegaly with normal labs. Examination demonstrated a prepubertal patient with a mobile, soft, peri-clitoral mass and surrounding hypopigmentation consistent with LS. The cyst was excised surgically; pathology revealed an epidermal inclusion cyst. Postoperatively, she began using topical steroids for LS with symptom resolution.

CONCLUSION

Thorough workup of clitoromegaly negative for hormonal causes requires further investigation to determine an alternative etiology of the mass. We suspect that inflammatory changes of LS and pruritus resulted in the peri-clitoral inclusion cyst.

Infected giant right seminal vesicle epidermoid cyst in young male patient with ipsilateral solitary kidney: Case report

This case report presents a young male patient with a 3-month history of a rapidly growing lower abdominal mass associated with lower urinary tract symptoms and recurrent urinary tract infection. Pelvic magnetic resonance imaging showed a large congenital cyst in the right seminal vesicle having a mass effect on the urinary bladder, rectum, and left ureter. Histopathologic findings from exploratory laparotomy showed an epidermal inclusion cyst with secondary inflammation and suppuration. This report adds to the literature by describing this unique location of an epidermoid cyst within the seminal vesicle.

Epidermal inclusion cyst of the axilla with calcifications

Epidermal inclusion cyst (EIC) is a benign mass that may occur in any area of abundant hair. It presents as a slowly growing firm nodule that is mostly asymptomatic. It may be confused with malignancy, making a definitive preoperative diagnosis difficult. Herein, we present a case of a 41-year-old patient with an EIC of the axilla containing calcifications on the mammogram.

Surgical management of large, connected perineal and pelvic epidermal inclusion cysts mimicking a dumbbell-shaped lesion in an adult male

INTRODUCTION AND IMPORTANCE

Epidermal inclusion cysts are a common benign finding, and they are predominantly asymptomatic. They can rarely form in the pelvis or abdomen, however, and may cause symptoms secondary to mass effect. This case highlights management of an anterectal epidermal inclusion cyst connected to the perineal cyst, mimicking a dumbbell-shaped lesion, found in a male.

CASE PRESENTATION

This is a unique case of a 21-year-old Caucasian male with a palpable perineal mass, lower extremity hypoesthesia, and constipation who was found to have a complex-shaped cyst on computed tomography and magnetic resonance imaging. This was ultimately managed with a two-stage perineal and transabdominal resection.

CLINICAL DISCUSSION

This case highlights that perineal epidermal inclusion cysts may have pelvic extension, especially in patients with additional new-onset neurologic, gastrointestinal, or urologic symptoms. These symptoms should completely resolve after resection. Additionally, resection is recommended to prevent complications including malignant degeneration and fistulization.

CONCLUSION

This is the first reported case of an anterectal, epidermal inclusion cyst connected to a perineal cyst found in a male. Perineal and pelvic cysts may be synchronous and may be connected through the pudendal canal. These masses can be safely removed via a combined perineal and transabdominal resection. The connecting portion of lesions that have both pelvic and perineal components should be meticulously identified and dissected because even a thin, patent segment - if left unresected - may result in lesion recurrence.

Mucoepidermoid carcinoma - A common neoplasm at an unusual site, mimicking a benign cyst on cytology: Diagnostic pitfall!

Mucoepidermoid carcinoma (MEC) is known to be a relatively common neoplasm of the major and minor salivary glands that can secondarily involve skin. The clinical manifestations, diagnostic cytology and histopathology of MEC presenting as a clinically benign periauricular cystic nodule have been analyzed. The challenge of accurate diagnosis can be illustrated by the fact that initially, on cytology, this tumor was misdiagnosed as a benign epidermal inclusion cyst due to the presence of mucin-filled cells which were misinterpreted as cyst macrophages. This case report emphasizes the need to include parotid tumors in the differential diagnosis of all periauricular cyst-like expansions. We also briefly discuss the reasons for false-positive cytology in this case. Delay in accurate diagnosis may result in larger surgical procedures, such as radical neck dissection, that may otherwise be avoided.

Clitoral Epidermal Inclusion Cyst Leading to Anorgasmia: A Case Report and Literature Review

BACKGROUND

Clitoral epidermal inclusions cysts are most frequently seen following trauma, especially female genital mutilation. Spontaneous clitoral epidermal inclusion cysts are rare with an unclear etiology and their impact on later sexual function has not been described.

CASE

A 15-year-old spontaneously developed a clitoral mass that progressively enlarged over seven years, ultimately leading to secondary anorgasmia. Surgical removal resulted in restoration of normal anatomy and complete return of clitoral function. Final pathology revealed the mass to be an epidermal inclusion cyst.

SUMMARY AND CONCLUSION

Clitoral epidermal inclusion cysts typically present in childhood or early adolescence and can lead to sexual dysfunction if left untreated. Physicians must consider the potential sequelae of these cysts when counseling and managing these patients.

Subsynovial epidermal inclusion cyst of the knee

We report a case of a subsynovial epidermal inclusion cyst in a 47-year-old woman with a painful spontaneous swelling of the right knee and a 2-year history of puncture and arthroscopy. Epidermal inclusion cysts are one of the most common benign subcutaneous tumours. Very rarely, they are located in an articulation and can cause an inflammatory reaction when rupture occurs. Simple surgical excision is the preferred therapy. The main goal of this case report is to include the possibility of an intra-articular epidermal inclusion cyst into the differential when imaging shows an intra-articular structure, and more so if there is a history of trauma, intra-articular puncture or arthroscopy.

Epidermoid Cyst in Male Patient Mimicking a Suspicious Breast Mass and Consequences of Biopsy

Male patients presenting to the mammography department for workup of breast disease is an overall rare event compared to females. Gynecomastia is statistically the most common breast condition afflicting male patients, with ductal carcinoma an uncommon secondary diagnostic consideration. Secondary benign breast conditions or mimickers of breast disease in men are even rarer than primary carcinoma and can pose a significant challenge in breast imaging workups. We present a challenging workup of a superficial epidermoid cyst (EC) in a male patient with significant subcutaneous growth and indeterminate imaging characteristics, mimicking a breast neoplasm. Furthermore, we present undesirable consequences of performing a biopsy of an EC including rupture and abscess formation.

Case report of squamous cell cancer arising in perineal epidermal inclusion cyst, presenting as rapidly enlarging and cavitating lesion

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Perineal inclusion cysts may harbor clinically occult malignant degeneration.

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Histological analysis of large inclusion cysts required to rule out occult malignancy.

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Perineal cysts with malignant degeneration are diagnostic, reconstructive challenge.

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Risk of malignancy in perineal inclusion cysts helps treatment decisions.

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Large perineal cyst requires multidisciplinary surgical team for excision and closure.

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Colostomy as adjunct of perineal reconstruction after excision of inclusion cyst.

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Perineal inclusion cysts may present as atypical, cavitating lesions.

Introduction

Cutaneous squamous cell cancer (cSCC) is a common condition, with straight forward and well-known heuristics regarding diagnosis, treatment, and surveillance. cSCC arising in an epidermal inclusion cyst is rare, but not unheard of. In contrast, the authors’ are unaware of any prior reports of cSCC arising in an epidermal inclusion cyst within an atypical cavernous and cavitating lesion in the perineum.

Presentation of case

A 48-year-old male presented with a cavitating and rapidly growing cutaneous perineal lesion. Preliminary diagnostic procedures (biopsy) showed benign pathology and imaging showed no involvement of perineal organs such as prostate or rectum. Discordance between initial diagnostics and clinical features prompted multi-specialty consultation, including dermatological pathology. Repeat biopsy yielded in situ, possibly invasive squamous cell cancer, arising in the background of an epidermal inclusion cyst. Wide excision with advancement flap reconstruction was employed, with temporary diverting colostomy to avoid perineal sepsis.

Discussion

Location and appearance of this lesion provided a diagnostic and treatment challenge requiring multi-specialty involvement for diagnosis and successful treatment. Specialists from urology, general surgery, dermatology, general and dermatological pathology, plastic and reconstructive surgery, colorectal surgery and medical and radiation oncology were involved in diagnosis, treatment plan and execution. None of the specialists involved had seen this singular presentation before, and this created an ownership and management challenge.

Conclusion

The cavitating, atypical appearance of lesion complicated diagnosis. Location required pre-treatment coordination and deliberation between dermatology, urology, general surgery, and plastic surgery. Malignant degeneration of inclusion cysts, although rare, has to be kept in mind, especially when presenting with rapid growth, and persistence in ruling out malignant diagnosis is fundamental.

Idiopathic scrotal calcinosis - A case report

INTRODUCTION

Idiopathic scrotal calcinosis is a rare benign condition which presents with asymptomatic multiple nodules on the scrotal skin.

PRESENTATION OF CASE

Our patient, a 64-year-old Indian male with Fitzpatrick skin type 4, presented with multiple nodules, which were completely surgically excised with no complications. Histological examination reveals extensive intradermal deposition of calcium surrounded by histiocytes and without cystic structure.

DISCUSSION

Numerous theories about the pathogenesis have been proposed and the evidence presented suggests this is a continuum.

CONCLUSION

The nature of idiopathic scrotal calcinosis is still unknown and it is up to debate whether the term "idiopathic" is appropriate for the condition.

Epidermal Cysts: A Clinicopathological Analysis with Emphasis on Unusual Findings

BACKGROUND

Epidermoid cysts, one of the common benign intradermal or subcutaneous tumors commonly result from the trauma to the pilosebaceous unit in the hair bearing area. In areas without hair, these cysts are considered implantation and proliferation of squamous epithelium into the dermis due to injury.

AIMS

The aim is to evaluate the clinicopathological details with emphasis on unusual findings related to epidermoid cysts.

STUDY DESIGN

This is a retrospective cross-sectional study carried out over 2 years.

MATERIALS AND METHODS

A total of 103 cases of epidermoid cysts were included in the study. The clinical details such as age, gender, sites, and dimensions were noted. The histopathological findings were evaluated and correlated with the clinical findings.

RESULTS

The highest incidence was observed in the age group of 21-30 years (23.3%, 24/103) and the most common affected region was the head and neck region (32%, 33/103). The size of cysts ranged from 0.3 to 9 cm in diameter with a mean of 2.1 cm. The unusual sites observed in this study were four at the left sole, two at right sole, two at prepuce, and one each at the right finger, left palm, and oral cavity. Histopathological findings included rupture of epidermoid cysts with giant cell reaction, melanin pigmentation, and association with other pathologies such as keloid and lipoma.

CONCLUSION

Epidermoid cysts are common benign intradermal or subcutaneous tumors, but they can have unusual presentations and histopathological findings. Epidermoid cysts need early diagnosis and treatment as they can cause cosmetic and functional impairment.

Dermoid cysts of maxillofacial region

The dermoid cyst is an uncommon clinicopathological lesion of developmental origin. The term dermoid cyst is used to describe 3 cysts that are closely related histologically: dermoid cyst, epidermoid cyst, and teratoma. Epidermoid and dermoid cysts are benign nature, which may occur anywhere in the body, but most predominantly in the ovary and scrotal regions. Only about 7% are found in the head and neck. The occurrence of such cysts in the oral cavity is extremely rare, with approximately 1.6% located in this area. The floor of the mouth is one of the most commonly affected area, however, these cysts can also be found in the tongue, lips, buccal mucosa and jaw bones. There is always a difficulty of making a correct diagnosis of these lesions with clinical examinations and conventional radiography. To achieve a diagnosis and to develop correct surgical strategy specialized imaging examinations such as ultrasonography (US), computed tomography (CT), Magnetic Resonance Imaging (MRI) and histopathological examination should be carried out. Treatment comprises total surgical excision the approach remains dictated logically by the cyst's location. Ample understanding and vigilance about this slow growing painless mass is essential not only because of the symptoms it produces but also due to its malignant potential. When dermoid cysts occur on the floor of the mouth, they may enlarge to such an extent that they can interfere with deglutition and produce respiratory obstruction. Early diagnosis and treatment are essential for these cystic entities.

Epidermal inclusion cyst of the styloid process: a case report

We report an unusual case of epidermal inclusion cyst of the styloid process which presented to us with decreased hearing and tinnitus. The patient underwent complete excision via a combined postaural cervical approach. The unusual location of the tumor and the absence of a history of trauma or intervention in that area added confusion to the diagnosis, which was finally made on histopathology.