Iatrogenic Cervical Epidermoid Cyst Following Tracheostomy

Epidermoid cysts are generally benign lesions surrounded by squamous epithelium with cystic contents. The lining of the cysts produce keratin, which resemble a cheese-like material. They typically occur in the skin and mucous membranes and are congenital in origin; iatrogenic epidermoid cysts are rare. Epidermoid cysts are usually painless and asymptomatic, and their diagnosis is based on histological examination. This paper aims to present the case report of a 23-year-old patient with an iatrogenic epidermoid cyst that occurred following tracheostomy. The importance of preoperative radiological imaging in the diagnosis of epidermoid cysts is also highlighted.

The largest epidermal cyst with vitiligo lesions following female genital mutilation: a case report and literature review

Epidermoid vulvar cystic lesions are proliferations of epidermal cells that can occur as a complication of female genital mutilation (FGM), which is still a common practice in many cultures, especially in Africa. A 36-year-old Sudanese woman presented with an enlarged clitoral mass that had first appeared 2 years earlier. Her medical history showed that she had undergone FGM when she was 3 years old. A perineal examination revealed a mobile, nontender, rounded cystic swelling with vitiligo lesions. After the cyst was excised, it revealed a 13 ×11 × 11 cm unilocular round mass. An epidermoid cyst was reported following microscopy. Follow-up 6 months later revealed a good result with no recurrence. To date, this is the largest epidermoid cyst following FGM and the first one with vitiligo lesions reported in the literature.

Surgical management of a huge post-circumcision epidermoid cyst of the vulva presenting unusually in a postmenopausal woman: a case report

BACKGROUND

Epidermoid cysts of the external genitalia are one of the late complications of female genital mutilation. These cysts are usually small and painless. The presentation of a giant vulvar cyst in a postmenopausal woman has not been reported; the surgical management of a large cyst is often challenging.

CASE PRESENTATION

A 60-year-old, para VI, Ethiopian woman presented with an 18 cm by 12 cm sized, fluctuant, multi-lobulated, mobile, non-tender vulvar mass involving the mons pubis. She had undergone genital cutting and sewing during her childhood. Informed consent was obtained for surgery and the vulvar cyst was excised successfully without any significant bleeding or injury to the adjacent structures. Her postoperative course was smooth and histopathology confirmed epidermoid cyst of the vulva.

CONCLUSIONS

Huge epidermoid vulvar cysts following genital mutilation are rare and presentation in a postmenopausal woman has not been reported. Practitioners in areas where female genital mutilation is prevalent should be aware of the peculiar anatomic and technical aspects of the surgical removal of these giant vulvar cysts for successful therapeutic and cosmetic outcomes.

Management of epidermal cysts arising from scar tissues: A retrospective clinical study

Few reports have described epidermal cysts (ECs) arising from scar tissues, and the standard course of treatment has not been established. We aimed to report the findings of a Korean patient series with ECs arising from scar tissues, to describe patient management in the context of previous publications, and to present a simple algorithm for managing ECs arising from scar tissues.We managed 6 patients with ECs arising from scar tissues, and retrospectively reviewed their demographic and clinical data.The scars were located on the anterior chest wall (n = 3), shoulder (n = 1), forehead (n = 1), and ear lobule (n = 1). Two patients with anterior chest wall scars, 1 with a shoulder scar, and 1 with an ear lobule scar had keloid scars, whereas the other patients had hypertrophic scars. The scar sizes ranged from 2 × 1 cm to 9 × 7 cm. The EC sizes ranged from 0.2 × 0.2 cm to 2 × 1.5 cm. Three patients underwent total scar revisions with complete EC excisions, 2 underwent partial scar tissue excisions with complete EC excisions, and 1 had laser therapy for the scar and EC. No complications occurred, and all patients' final outcomes were satisfactory during the mean follow-up period of 14.8 months.We successfully managed the patients with ECs arising from scar tissues. We recommend that surgeons and patients first decide whether the ECs and scar tissue should be completely removed. Moreover, consideration should be given to the options chosen for the management of ECs. Finally, postoperative scar care is necessary to prevent hypertrophic and keloid scar recurrences.

Eruptive Milia Within a Tattoo: A Case Report and Review of the Literature

<p>Of the many tattoo reactions the most common are allergic, granulomatous, lichenoid, photosensitive, pseudolymphomatous, and infectious. Eruptive milia are a rare complication with only three prior reports in the English literature. A 19-year-old African American female presented with tiny, white papules confined within the margins of a tattoo. She denied trauma or associated symptoms at the site. Biopsy demonstrated deposits of black granular material within the dermis and a small infundibular cyst; a diagnosis of eruptive milia within tattoo was made. The milia responded to treatment with urea 40% cream and tretinoin 0.1% cream. Given its rarity, it is important to recognize the presentation of this disorder as other tattoo reactions require more aggressive management. While further research is necessary to determine the exact pathogenesis of this condition, the authors propose a mechanism along with a review of the literature to discuss management.</p> <p><em>J Drugs Dermatol. 2017;16(6):621-624.</em></p>.

Myofascial Closure of Intradural Inclusion Cysts following in utero Myelomeningocele Repair

Myelomeningocele is one of the most common congenital malformations. A randomized controlled trial, known as the Management of Myelomeningocele Study (MOMS), demonstrated that closure during the fetal period can be performed relatively safely and be of significant benefit to patients. However, postnatally, patients can develop resultant symptoms from a tethered cord and inclusion cysts; this often requires surgical treatment. Repeat surgery in this population can be challenging due to the age of the patients, the extent of surgical exposure needed and the need for resection of dermal and epidermal tissues in the midline. We describe our approach for closure of these complex defects using lateral fasciocutaneous flaps with relaxing incisions made in the posterior axillary line, in order to minimize tension and maximize soft tissue coverage of the midline.

Female genital mutilation/cutting: an update

Female genital mutilation/cutting (FGM/C) is a cultural practice involving several types of external female genitalia cutting. FGM/C is known to occur in all parts of the world but is most prevalent in 28 countries in Africa and the Middle East and among immigrant communities in Europe, Australia, New Zealand, Canada, and the United States. Studies of FGM/C suffer from many methodological problems including inadequate analysis and an unclear reporting of results. The evidence to link FGM/C to infertility is weak. The management of epidermal clitoral inclusion cysts includes expensive investigations like comprehensive endocrinology tests and MRI resulting in unnecessary anxiety due to delay in surgical treatment. Similarly, unnecessary cesarean sections or rupture of the infibulation scar continue to occur because of the inadequate use of intrapartum defibulation. A significant amount of efforts is required to improve and correct the inadequate care of FGM/C women and girls.

Cryotherapy-induced milia en plaque: case report and literature review

BACKGROUND

Cryotherapy-induced milia is a rarely described cutaneous reaction that may occur in patients who have received cryotherapy with liquid nitrogen. Cryotherapy-induced milia is characterized by 1-2 millimeter white dermal cysts that develop at the healed cryotherapy site. Milia en plaque, an erythematous plaque containing numerous milia, has not previously been described following treatment of a skin lesion with liquid nitrogen cryotherapy.

PURPOSE

We describe a man who developed cryotherapy-induced milia en plaque after receiving cryotherapy to his dorsal hand for the treatment of an actinic keratosis. We also summarize the potential complications of cryotherapy, the differential diagnosis of milia en plaque, and therapeutic interventions for this lesion.

MATERIALS AND METHODS

The features of a man with cryotherapy-induced milia en plaque are presented. Using PubMed, the following terms were searched and relevant citations assessed: cryosurgery, cryotherapy, hypothermia, milia, milia en plaque, and Wolf's isotopic response. In addition, the literature on cryotherapy-induced milia and cryotherapy-induced milia en plaque is reviewed.

RESULTS

Our patient developed cryotherapy-induced milia en plaque shortly after his cryotherapy site had healed. Some of the asymptomatic cystic dermal lesions had spontaneously resolved when a lesional biopsy was performed to confirm the diagnosis. The diagnosis, natural course, and potential treatments were discussed with the patient. Subsequent management was to observe the area; at follow-up examination, the remainder of the milia had also spontaneously resolved.

CONCLUSION

Cryotherapy-induced milia is a benign condition characterized by the development of small white dermal cystic lesions that develop at a healed liquid nitrogen cryotherapy site. The lesions may appear individually or as milia en plaque. While the mechanism of pathogenesis is unknown, we postulate that the condition is an example of Wolf's isotopic response, in which a new, unrelated skin disease develops at the site of a previously healed dermatosis - in this circumstance, following cryotherapy which created an immune compromised zone. The diagnosis of milia en plaque can usually be established by clinical presentation; if necessary, a biopsy can be performed to provide pathologic confirmation of the suspected diagnosis. Treatment options include manual extraction, topical retinoids, or observation. Similar to our patient, the milia may resolve spontaneously.

Gardner's syndrome, a rare combination in surgical practice

A 45-year-old man presented to the emergency ward with features of intestinal obstruction of 2 days duration. On admission, there was abdominal distension and multiple sessile polyps found on digital rectal examination. In addition, a soft tissue swelling near the elbow and a bony swelling over scalp were noted. Abdominal radiography revealed gaseous distension of the small and large bowel, and ultrasound revealed diffuse, gas-filled bowel with sluggish peristalsis. The obstruction failed to resolve with conservative measures and at emergency laparotomy an irregular hard recto-sigmoid junction mass was identified. A defunctioning transverse loop colostomy was undertaken and the abdomen closed. During recovery, a colonoscopy was performed and a malignant appearing lesion was identified 15 cm proximal to the anal verge. Further per-stomal colonoscopy revealed multiple sessile polyps from the ileo-caecal valve to the descending colon. The cutaneous and abdominal findings were consistent with a rare acute presentation of Gardner's syndrome.

Squamous cell carcinoma manifesting as cutaneous cystic lesions

Squamous cell carcinoma (SCC), a malignancy of epidermal keratinocytes, is the second most common cause of skin cancer in the United States. Our case represents an unusual variant of this common tumor. We report a clinical presentation of a case of SCC occurring as cutaneous cystic lesions on the face of an 87-year-old white woman with a medical history of multiple SCCs.

Milia: a unique reaction to tattoos

Tattoo-related dermatoses are varied and uncommon. Although rare, reactions to tattoos have been reported with a multitude of tattoo pigments and most commonly present with an eczematous reaction pattern. Milia are small keratinous cysts that may arise as primary lesions or secondary to some other trauma to the skin. We report the case of a 28-year-old man who presented with a papular eruption of 3 months' duration confined to the area of recently placed tattoos; the eruption was diagnosed as milia.

[Observation of dirofilariosis in the practical work of the otorhinolaryngologist]

A case of dirofilariosis is reported. The disease is believed to be caused by the contact with the cat that the patient brought in from Uzbekistan. The authors emphasize the importance of analysis of the medical history of the patients presenting with the pathology being considered, their medical examination, and correct interpretation of X-ray images of the paranasal sinuses taking into account the possibility of distribution of rare helminth species beyond their usual ranges.

Clitoral epidermoid cyst secondary to blunt trauma in a 9-year-old child

Epidermoid cysts are slowly growing tumors arising from invagination of the epidermis into the dermis traumatically or spontaneously. This implantation in the clitoris is most commonly induced by female genital mutilation. The reported cases with spontaneous onset of this clitoral lesion are scarce. Trauma other than female circumcision predisposing to the onset of the cyst has not been mentioned before. A nine-year-old girl was presented for swelling in the pubic region with the onset following an accidental trauma; the diagnosis was determined to be epidermoid cyst of the clitoris after a brief preoperative evaluation and an accurate surgical management.

Penile epidermal inclusion cyst

We report a case of epidermal inclusion cyst of penis in a five-year-old boy, who had presented to the outpatient department of our hospital. Epidermal inclusion cysts are benign lesions that can develop in any part of the body. However, the finding of an epidermal inclusion cyst in the penis is rare. The child was operated and discharged uneventfully. The objective of reporting this case is to highlight the rare possibility of an inclusion cyst arising from penis as a late complication of circumcision.

Milia after allergic contact dermatitis from poison ivy: two cases

Milia have rarely been reported as a complication of severe allergic contact dermatitis. To our knowledge, milia have not previously been associated with poison ivy dermatitis. We present two cases of milia after allergic contact dermatitis to poison ivy.

[Case of enlargement of an intradiploic epidermoid cyst by a head contusion]

We report a case of enlargement of a intradiploic epidermoid cyst following head trauma in a 19-year-old man. The patient had a swelling on the right side of his forehead from the time of his birth. He sustained a bruise in this region when he was 15 years old, following which the swelling gradually enlarged. When the diameter of the mass increased to 5 cm, he visited our hospital. Computed tomography (CT) scan of the head showed a subcutaneous mass of low density extending from the diploe to the outer tables of the skull. Magnetic resonance imaging (MRI) showed a hyperintense mass in both T1- and T2-weighted images. During the operation, we found a tumor that was intradiploic and had a thin capsule. The effusion from the tumor resembled an old hematoma, and the tumor did not involve the paranasal sinuses. We concluded the operation by performing cranioplasty using artificial bone. Histological examination revealed that the thin capsule consisted of stratified squamous epithelium and ciliated epithelium. Needle-like cholesterol crystals and hemosiderosis were seen shown in the granulation-like tissue. On the basis of these findings, we diagnosed the mass to bean intradiploic epidermoid cyst and thought that it might have grown following head trauma associated with chronic hemorrhage. This paper reviews the differential diagnosis and pathologic findings of the intradiploic epidermoid cyst along with some previously published cases.

[Diagnostic image. A woman with a vulvar swelling]

A 25-year-old woman presented with a tumour above the labia minora, due to an epidermal cyst.

[Diagnostic image (389). A woman with a multicystic vulvar mass]

A 28-year-old woman presented with a multicystic vulvar mass due to epidermal inclusion cysts, probably caused by trauma to the left labium minus at her last parturition.

[Guided healing and skin graft for the treatment of skin wounds]

OBJECTIVE

The present study compared the treatment of skin wounds by means of conducted healing (an innovative method for treatment of secondary healing) and autogenous skin graft.

METHODS

Seventeen rabbits were submitted to removal of two skin segments, one on each side of the dorsum. The graft donor area was left as a wound for conducted healing (A) and was submitted only to debridement, local care and dressings. The skin removed from the above mentioned side was implanted as a graft (B) to cover the wound on the other side. Thus, each animal received the two types of treatment on its dorsum (A and B). Rabbits were divided into two groups according to size of the wounds: Group 1--A and B (4 cm2) and Group 2--A and B (25 cm2). Healing time was of 19 days for Group 1 and of 35 days for Group 2. The final macro- and microscopic aspects of healing were comparatively analyzed in the four subgroups. Presence of inflammatory cells, of epidermal cysts and of giant cells was assessed by histology. Data were statistically analyzed by the nonparametric Fisher, Kruskal-Wallis and Wilcoxon tests.

RESULTS

No macro- or microscopic difference was observed between conducted healing and skin graft, although conducted healing led to a more rapid wound healing.

CONCLUSION

Conducted healing seems to be a good therapeutic option for skin wounds in rabbits.

Epidermoid inclusion cysts After APTOS thread insertion: case report with clinicopathologic correlates

The APTOS threading procedure is a relatively new method in antifacial ptosis surgery. The reported cases present a small percentage of minor complications. A 57-year-old woman experienced scarring after APTOS threading. Scar biopsy showed an epidermoid inclusion cyst. Epidermoid inclusion cysts are a potential complication of APTOS threading. Proper surgical technique may reduce their likelihood.

Effect of dermal fibroblasts on long-term maintenance of regenerating xenotransplanted human esophageal epithelial cells in immunodeficient mice

OBJECTIVE

Artificial esophagus of various materials has been tried without satisfactory results. Effects of fibroblasts derived from human dermis on cultured human esophageal epithelial cells were investigated regarding their preservation over time.

METHODS

Human esophageal epithelial cells (EE) were subcutaneously injected either alone or with human esophageal fibroblasts (EF) or human dermal fibroblasts (DF) into the flank of the BALB/cA-nu, scid mice of 8 to 12 weeks of age. At 10 days, 3, 6 and 48 weeks after transplantation, randomly chosen mice were sacrificed and the rates of nodule formation at the injected sites were compared. Nodules were examined histologically by hematoxylin and eosin staining and immunohistochemically with anti- Ki-67 and anti-p63 antibodies.

RESULTS

The rate of subcutaneous epidermoid cyst formation at 10 days was 33% for EE, and 67% for EE with EF, and 100% for EE with DF transplantation. At 6 weeks after transplantation, subcutaneous cysts were not found for EE alone or EE with EF, but were detected in 100% of the mice transplanted EE with DF and still preserved at 12 months.

CONCLUSIONS

Long-term preservation of regenerated esophageal epithelium in vivo after transplantation of cultured esophageal epithelial cells is possible by co-transplantation of human dermal fibroblasts.

Epidermal inclusion cyst of the umbilicus following abdominoplasty

The incidence of retained epidermal inclusion cyst at the site of the umbilicus following abdominoplasty has yet to be well documented. Compliant patients who are seen in scheduled follow-up, and who display signs of infection or wound issues at the site of the umbilicus, usually have these factors addressed before inclusion cysts manifest. Here, however, we present a patient who underwent abdominoplasty, lost her surgeon because of geographic relocation, presented to our office 1 year following surgery with a large retained umbilical epidermal inclusion cyst. This case gave us a unique opportunity to observe a well-developed retained umbilical epidermal inclusion cyst. Her evaluation and management are reviewed in an effort to familiarize the practicing plastic surgeon with a rare, but significant potential complication of abdominoplasty.

Mycotic cysts: report of 21 cases including eight pheomycotic cysts from Saudi Arabia

BACKGROUND

Mycotic cysts are subcutaneous cystic granulomas caused by either dematiaceous (pigmented) fungi (pheomycotic cysts) or eumycotic (nonpigmented fungi) present in soil, wood, and decaying plant material. These fungi gain access to the tissues via a wooden splinter or thorn. No deep tissue involvement or extension to bone is known to occur.

METHODS

We reviewed our surgical pathology files for the last 32 years. All cases with the diagnosis of cysts with fungi, thorns, or splinters and associated granulomatous and acute inflammation were reviewed. Gomori's silver and periodic acid-Schiff stains were performed in all cases.

RESULTS

Twenty-one cases of mycotic cyst were found, including eight pheomycotic cysts (one with a recurrent lesion seen 11 months after the initial excision of the cyst). Thirteen cysts had nonpigmented fungal hyphae. There were 14 males and seven females, with an age range of 5-76 years. The dorsum of the foot was the most frequently affected site (12 cases). Four cases involved the fingers, two involved the knee area, two involved the big toe, and one each involved the leg, ankle, and forearm. The cysts measured 0.6-4.5 cm in diameter. Histologically, there was granulomatous inflammation with a variable degree of neutrophilic infiltrate giving central abscess formation. Twelve cases showed a wooden splinter. All cases were positive for fungal organisms, mostly septate hyphae and spores that were highlighted by special stains. Fungal pigment, ranging from yellow-brown to light brown to black, was observed in eight cases. No extension to deep tissues was noted. The clinical impression varied widely including ganglion, sebaceous cyst, giant cell tumor of the tendon sheath, and lipoma. One patient was immunosuppressed following renal transplantation. All patients were treated by simple excision. No antifungal chemotherapy was needed or administered in any of the patients. One patient had a recurrence of his lesion within 1 year as a result of inadequate initial excision. A second re-excision was curative.

CONCLUSION

Mycotic cysts are uncommonly encountered lesions that can be easily missed, especially in cases with scant fungal elements, thus requiring special stains to detect the organisms. We reported 21 cases of mycotic cyst, including eight pheomycotic cysts, with emphasis on the histopathologic recognition of this unusual entity.

Iatrogenic epidermoid tumor: late complication of lumbar puncture

Intraspinal epidermoid tumors can be congenital and acquired. Acquired intraspinal epidermoid tumors are extremely rare. Epidermal elements are implanted into the arachnoid space by trauma, spinal anesthesia, surgery, bullet wounds, myelography, or lumbar puncture. Approximately 40% of acquired epidermoid tumors are considered a late complication of lumbar puncture. The authors report the case of an 8-year-old boy who presented with a 1-year history of back and hip pain and radiating pain to both thighs posterior. Lumbar puncture was performed in the neonatal intensive care unit to rule out meningitis in the patient's past medical history. The patient underwent total surgical excision of the epidermoid tumor. Pathologic examination revealed the diagnosis of epidermoid tumor.

KEYWORDS

intraspinal epidermoid tumor; lumbar puncture; children.

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.

Hyperdense intracranial epidermoid cysts: a study of 15 cases

BACKGROUND

Although intracranial epidermoid cysts generally appear as hypodense lesions on CT scans, occasionally, they may appear hyperdense, making diagnosis difficult. The aim was to study clinical features and possible pathogenesis of hyperdense intracranial epidermoid cysts (HIECs).

METHODS

Fifteen patients with HIECs were surgically treated in our department during a 21-year period (1985 up to 2005). We reviewed each patient's clinical records, radiological findings, operative reports, and pathological examinations, along with a review of the literature.

FINDINGS

The incidence of HIECs in our series was approximately 3.02%, with female predominance. The average age was 32 years and the average duration of complaints was nine months. The most common location was the parasellar area (6 cases), followed by cerebellum (4 cases), clival region (3 cases), cerebello-pontine angle (1 case) and lateral ventricle (1 case). Gross-total excision of the tumor was achieved in ten patients (66.7%). Four (26.7%) patients underwent subtotal resection; and one (6.6%) patient underwent partial resection. Aseptic meningitis that occurred postoperatively in two cases was controlled by lumbar drainage.

CONCLUSIONS

Recurrent leakage of the irritating cyst contents and subsequent chemical inflammatory response may be responsible for the high-density on CT scans and the cystic nature. A correct histological diagnosis is important because, in contrast to typical ECs and other lesions, HIECs are more prone to spread intra-operatively and result in severe aseptic meningitis.

[Tumoral degeneration occurring over a non-healing meningocele. Report of two cases]

A giant meningocelic sac has not been usually described in adult patients, due to the fact that it shows a low incidence and few newborn have survived to date though the malformation is benign. We report two cases of patients born with the described malformation and who were not operated at that time, so they reached adulthood with bigger sacs. They needed surgery to remove the sacs, for a different reason. The older one had a fistulous abcess but the LCR did not come out, and it did not improved by the application of topic and antibiotic treatment. The other patient showed a progressive growth of the malformation during the last year, skin hardening and pain. The histological study of the dried sacs proved the existence of a carcinomatous degeneration. In the patients we have treated, it seems that a chronic irritation of the LCR and the appearance of multipotent cells in the meningocele may favour the malignancy of the tissues surrounding the sac. This possible malignancy, already described in the bibliography, suggests a prompt elective surgical treatment of the patients with these congenital lesions as soon as possible.

Intradiploic frontal epidermoid cyst in a patient with repeated head injuries: is there a causative relationship?

Epidermoid cysts are rare disontogenetic tumoral lesions in the cranial compartment (1% of all intracranial tumors) and are usually located in relation to the cranial sutures; the intradiploic location is the less frequent. We report a clinical case in which the post-traumatic etiology of a frontal intradiploic epidermoid is considered. The histological findings revealed the presence of an epidermoid tumor associated with a typical foreign body inflammatory reaction, after repeated head traumas at the site of the tumour. This is the first case in whom the association between this tumoral lesion and a tissue inflammatory reaction due to foreign bodies is demonstrated.

Histological evaluation of full thickness skin as an interpositional graft in the rabbit craniomandibular joint

PURPOSE

The purpose of this study is to determine the histological fate of the full thickness skin graft when placed into the temporomandibular joint using a rabbit model.

MATERIALS AND METHODS

Fourteen New Zealand white rabbits were used and divided into 3 groups. Two rabbits were used as controls (Group A) whereby a sham operation was undertaken with an incision made and immediately repaired without breaching the joint space of the left craniomandibular joint (CMJ). In 6 rabbits (Group B), the joint capsule of the left CMJ was surgically breached but the articular disc was preserved and the wound was repaired. The remaining 6 rabbits (Group C) also had the left CMJ surgically exposed with preservation of the articular disc and the interpositional placement of a full thickness skin graft that was taken from the skin of their necks. All grafts were placed above the articular disc and head of condyle in the superior joint space and firmly secured to the surrounding tissues with nonresorbable sutures. The rabbits were sacrificed at 1, 3, and 5 months after surgery and the left CMJs were histologically prepared and examined under light microscopy.

RESULTS

The condylar head in the regions where the disc was present appeared to closely resemble that of the control rabbits. However, where the disc was breached by inadvertent surgical trauma (Group B), the underlying condyle showed an irregular outline with increased fibrosis and a marked reduction in mature cartilage. In the subarticular bone there was increased osteoblast and osteoclast activity reflecting high bone activity indicative of a remodeling rather than a degenerative process. The interpositional skin grafts in all experimental animals (Group C) were found adjacent to the condyle on the lateral aspect rather than above the condylar head where it was originally sutured in place. Significant atrophy and reduction in the number and size of the skin appendages such as sweat glands and hair follicles was found within the grafted skin of all experimental animals (Group C) compared with normal skin. All the grafts showed evidence of epidermoid inclusion cysts.

CONCLUSIONS

The full thickness skin graft is not a suitable interpositional material for the TMJ because of the high risk of epidermoid cyst formation and the propensity for lateral displacement of the graft even when sutured into the appropriate intra-articular position.

A peri-anal extramammary Paget's disease associated with two well-differentiated invasive intramucosal sigmoid carcinomas, a very rare case: an immunohistochemical and clinical review of extramammary Paget's disease

A 59-year-old patient had been treated by the general surgery department at her local hospital for a recurrent sebaceous cyst on the back of her neck. Cervical MRI showed a cystic structure, posterior to fused vertebral bodies, connected to the skin by a sinus passing through the middle of a split cord malformation. The lesion was excised via an anterior approach. Histology confirmed a benign neurenteric cyst. This rare developmental anomaly, mimicking a common acquired surgical condition, highlights the need for caution in the diagnosis of midline pathology.

Wnt signaling induces epithelial differentiation during cutaneous wound healing

Background

Cutaneous wound repair in adult mammals does not regenerate the original epithelial architecture and results in altered skin function. We propose that lack of regeneration may be due to the absence of appropriate molecular signals to promote regeneration. In this study, we investigated the regulation of Wnt signaling during cutaneous wound healing and the consequence of activating either the beta-catenin-dependent or beta-catenin-independent Wnt signaling on epidermal architecture during wound repair.

Results

We determined that the expression of Wnt ligands that typically signal via the beta-catenin-independent pathway is up-regulated in the wound while the beta-catenin-dependent Wnt signaling is activated in the hair follicles adjacent to the wound edge. Ectopic activation of beta-catenin-dependent Wnt signaling with lithium chloride in the wound resulted in epithelial cysts and occasional rudimentary hair follicle structures within the epidermis. In contrast, forced expression of Wnt-5a in the deeper wound induced changes in the interfollicular epithelium mimicking regeneration, including formation of epithelia-lined cysts in the wound dermis, rudimentary hair follicles and sebaceous glands, without formation of tumors.

Conclusion

These findings suggest that adult interfollicular epithelium is capable of responding to Wnt morphogenic signals necessary for restoring epithelial tissue patterning in the skin during wound repair.

Iatrogenic intraspinal epidermoid tumor: case report

Iatrogenic spinal epidermoid tumors are extremely rare and may be caused by skin fragments which were implanted in the spine as a result of a trauma or lumbar puncture. Due to the time lag between the lumbar puncture and the development of a symptomatic tumor, this relationship is often overlooked and can cause a delay in the proper diagnosis. Here, we report a rare case of an intraspinal epidermoid tumor, which developed 7 years after a lumbar puncture in a 12-year-old boy, who presented with back pain and radiating pain to the posterior of both thighs. A total excision of the tumor via L3-L4 hemilaminectomy yielded a good functional recovery.

An epidermal cyst in the parotid gland following ear surgery: a case report

PROBLEM/OBJECTIVE

Iatrogenic epidermal cysts have been reported in various locations following otological surgical procedures. Especially after endaural incisions, surgeons may implant squamous epithelium into underlying tissue. An epidermal cyst of the parotid region may appear years after ipsilateral ear surgery.

METHODOLOGY

A cystic lesion in the superficial lobe of the parotid gland was identified by computed tomography and ultrasonography in a 30-year-old man with a history of myringoplasty and endaural surgery. A superficial parotidectomy was performed to remove the mass.

RESULTS

The mass was histopathologically diagnosed as an epidermal cyst.

CONCLUSION

If a cystic lesion is present in the parotid gland in a patient with a history of otologic surgery, it must be considered that the mass is of epidermal origin.

Hereditary familial polyposis and Gardner's syndrome: contribution of the odonto-stomatology examination in its diagnosis and a case description

Familial Adenomatous Polyposis (FAP) and its phenotype variant, Gardner's syndrome, constitute a rare autosomal dominant inherited disorder. They are characterised by the development, generally during the second and third decades of life, of multiple adenomatous polyps in the colon and rectum. These polyps have a high risk of subsequently becoming malignant, which normally occurs in the third and fourth decades of life. The phenotypical features of FAP can be very variable. As well as colorectal polyps, these individuals can present with extra-colonic symptoms, among which are particularly: gastro-duodenal polyps, dermoid and epidermoid cysts, desmoid tumours, congenital hypertrophy of the retinal pigment epithelium, disorders of the maxillary and skeletal bones and dental anomalies. In this paper the most important aspects of this syndrome are reviewed, showing an example based on a well documented clinical case. The importance of odonto-stomatological examinations should be pointed out, among others, as a means of reaching a presumptive diagnosis, whose confirmation is vital to the patient.