Cutaneous Ciliated Cyst on the Finger

Abstract

As previously recognized by various authors, "cutaneous ciliated cyst" is a confusing term. Typically, the term refers to rare cystic lesions, commonly found on the lower limbs of women in their reproductive years. To date, 40 cases diagnosed as "cutaneous ciliated cyst" have been reported in the literature. Histologically, the cysts are composed of a simple layer of ciliated columnar cells along with nonciliated columnar cells, cuboidal cells, and round "peg-like" cells, resembling fallopian tube epithelium. This histology has been described in cysts found in males and females and in locations other than the lower limbs. Controversy has thus arisen over the etiology of these lesions, with some believing that the cysts arise from heterotopic Mullerian rests and others advocating for ciliated metaplasia of eccrine glands. We herein describe the first case of cutaneous ciliated cyst of Mullerian origin occurring on the dorsal thumb of a 16-year-old female. A review of literature shows that 2 groups of cysts are covered under the umbrella term "cutaneous ciliated cysts." We thus propose the abandonment of the confusing term "cutaneous ciliated cyst" and the adoption of "cutaneous Mullerian cysts" for estrogen receptor/progesterone receptor-positive lesions resembling simple fallopian tube epithelium and "Cutaneous ciliated eccrine cyst" for estrogen receptor/progesterone receptor-negative lesions usually occurring in males, which are immunohistochemically compatible with an eccrine origin.

Subcutaneous ciliated Mullerian cyst

“…1 In theory, migration of Mullerian rests occurs early in embryogenesis, and cysts later enlarge in response to hormonal development after puberty. 4,5 Examination of ultrastructure also corroborates a Mullerian origin. 4,5 There have been confounding reports of similar histologic findings arising in men and women with a supposed eccrine origin and ciliated metaplasia, but proper sampling and immunohistochemistry should render an appropriate diagnosis.…”

“…4,5 Examination of ultrastructure also corroborates a Mullerian origin. 4,5 There have been confounding reports of similar histologic findings arising in men and women with a supposed eccrine origin and ciliated metaplasia, but proper sampling and immunohistochemistry should render an appropriate diagnosis. 4,5 Distinction should be made from cutaneous ciliated eccrine cyst.…”

“…4,5 There have been confounding reports of similar histologic findings arising in men and women with a supposed eccrine origin and ciliated metaplasia, but proper sampling and immunohistochemistry should render an appropriate diagnosis. 4,5 Distinction should be made from cutaneous ciliated eccrine cyst. 5 In summary, cutaneous ciliated cysts are a rare entity primarily in the lower limbs of reproductive females, and should be reviewed with immunohistochemical studies for proper diagnosis.…”

“…4,5 Distinction should be made from cutaneous ciliated eccrine cyst. 5 In summary, cutaneous ciliated cysts are a rare entity primarily in the lower limbs of reproductive females, and should be reviewed with immunohistochemical studies for proper diagnosis. …”

Mullerian-Type Ciliated Cyst of the Thigh with PAX-8 and WT1 Positivity: A Case Report and Review of the Literature

“…The majority of cysts being located in the lower limbs may be explained by the close proximity of the Mullerian ducts to the lower limbs during development. However, the presence of similar cysts at distant sites such as scalp and mediastinum may be explained by vascular or lymphatic dissemination [7]. …”