Giant epidermal cyst with intramuscular extension: a rare occurrence

Low, Soo Fin; Sridharan, R.; Ngiu, Chai Soon

doi:10.1136/bcr-2013-202534

Cited by 12 publications

(14 citation statements)

References 7 publications

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“…MRIs showed the epidermal cysts as well-demarcated and oval-shaped lesions in all cases. The signal intensity of the cystic wall shows low signal intensity on T1-and T2-weighted images [8], which is consistent with what was observed among all our cases. The signal intensity for the content of the cyst was intermediate to slightly increased on T1-weighted images and of high intensity on T2 -weighted images [5,12].…”

Section: Discussionsupporting

confidence: 92%

Characteristic MRI Findings of Epidermal Cysts Categorized by Size

Sakamoto¹,

Okamoto²,

Matsuda³

2018

TOORTHJ

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Background: Epidermal cysts are lined with stratified squamous epithelium and filled with keratinous material.Magnetic resonance imaging (MRI) findings can be used for the diagnosis of epidermal cysts, but characteristic MRI findings related to cyst size in particular go unreported. Objective: To analyse characteristic MRI findings of epidermal cysts categorized by size. Materials and Methods: Unruptured epidermal cyst cases were analyzed according to 3 cyst size categories: large (≥4 cm), medium (≥2 to <4 cm), and small (<2 cm). MRI assessments focused on the keratinized material using low signal intensity on T2-weighted images because of intracystic diffuse foci (a sign of intracyst debris) and serpentine structures at the periphery (a sign of a peripheral lining) of cysts. Results: Thirty-three patients (26 males and 7 females; average age, 52.2 years; 33 cases) were grouped by cyst size: large (13 cases), medium (12 cases), and small (8 cases). MRIs revealed cyst walls via low signal intensity on T1- and T2-weighted images. On T1-weighted images, the signal intensity of cysts relative to that of muscle was hypointense (1 case, 3%), isointense (4 cases,12%), and slightly hyperintense (28 cases, 85%). On T2-weighted images, cysts were hyperintense in muscle relative to adipose tissue (20/33 cases, 61%) and isointense relative to adipose tissue (7/33, 21%) or hyperintense relative to adipose tissue (6/33, 18%). Overall, signal patterns were similar among groups. Signs of inner debris were observed in all large (13, 100%) and medium (2/12, 17%) cysts, but not in small cysts (0/8). Large, medium, and small cysts had signs of peripheral linings (12/13, 92%; 9/12, 75%; and 4/8, 50%, respectively). Conclusion: Slightly hyperintense signals on T1-weighted images were characteristic, even in small epidermal cysts. Signs of intracyst debris and a peripheral lining reflect the pathology and were considered useful for diagnosis. Larger cysts were more frequently positive for keratinous debris.

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Section: Discussionsupporting

confidence: 92%

Characteristic MRI Findings of Epidermal Cysts Categorized by Size

Sakamoto¹,

Okamoto²,

Matsuda³

2018

TOORTHJ

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“…However, it may also occur in the hairless skin (as in soles and palms) as a result of blunt, penetrating injury implanting epidermal fragments into the dermis [6]. Cases in which epidermal cysts have a size greater than 5 cm are referred to as giant epidermal cysts [7]. Depending on the location, epidermoid cysts should be distinguished from a lipoma, dermoid cyst, pilar cyst, furuncle, pilonidal cyst, calcinosis cutis, steatocystoma and cutaneous findings of Gardner syndrome [4].…”

Section: Discussionmentioning

confidence: 99%

“…It is important to note that there is also the so-called epidermoid cyst mimicry, describing seven cases of cyst mimickers: hidradenoma, cutaneous B-cell lymphoma, epithelioid sarcoma, Merkel cell carcinoma, metastatic adenocarcinoma of the lung, granular cell tumour, and cutaneous meningioma [8]. It is also possible that epidermal cysts grew to enormous sizes and misinterpreted as a soft tissue sarcoma [7]. However, in epidermoid cysts, there is a small but possible risk of switching to malignancy, and most often this is a development in the direction of squamous cell carcinoma (70% of the time) followed by basal cell carcinoma [2], [4].…”

Section: Discussionmentioning

confidence: 99%

Multiple Epidermal Cysts of the Scalp: Dermatosurgical Approach with Favourable Outcome!

Tchernev

Temelkova²,

Yungareva

et al. 2019

Open Access Maced J Med Sci

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BACKGROUND: Epidermal cysts are subcutaneous tissue formations that are most commonly located in the area of scalp, trunk and face. In addition to single ones, the cysts may also be multiple, located near each other. Although they are considered to be a cystic ectasia of the hair infundibulum and mainly affect hairy parts, they can also be seen in the area of palms and feet as a result of trauma. Rare extracutaneous localisations are also described in the medical literature, affecting the oral cavity, intraosseous, cerebrum and sublingual epidermoid cyst. Although the majority of epidermal cysts are benign, a malignant transformation may also occur in the direction of development of squamous cell carcinoma, basal cell carcinoma or Merkel cell carcinoma. Clinically, they are presented as benign lesions, and only histological examination may reveal their malignant potential. Therefore, their surgical removal and subsequent histology are of paramount importance for the elucidation of their origin. CASE PRESENTATION: An 88-year old patient was hospitalized for surgical removal of two tumorous formations in the head area which have been available for many years. During the dermatological examination in the frontal and parietal area of the head, the presence of two oval pink cystic neoplasms, clinically suspected for epidermal cysts, was found. The lesion located in the frontal area was removed by elliptical excision. The resulting surgical defect was closed by undermining the wound edges and mobilisation of the released skin to the middle of the defect, as the latter being closed by single interrupted sutures. In the second surgical session, the lesion located in the parietal region of the head was also removed under local anaesthesia. A so-called island flap was performed in which the tumour formation was removed by oval excision followed by contouring a triangle in the distal direction and transposition of the undermined triangle to the oval surgical defect. The resulting defect was recovered by single interrupted sutures. CONCLUSION: First-line treatment of epidermal cysts is surgical excision, and it is important to remove the cyst wall to minimise the risk of relapses and recurrence. Other treatment options include laser therapy with CO2, erbium-YAG laser or intralesional drainage injection of triamcinolone acetonide.

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“…They may be treated with observation or surgical resection based on the patient’s symptoms. There is a 3% recurrence rate despite complete surgical excision of the cyst 5…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis is based on history, physical examination, imaging and histology 3 4. Epidermal cysts have been found in the gluteal region,4–6 the foot,2 7 8 the perineum9 and the forearm 8 10. However, an epidermal cyst of the arm exceeding 5 cm is extremely rare and has not been reported in the literature.…”

Section: Introductionmentioning

confidence: 99%

Giant epidermal cyst of the arm: a rare presentation

Patel¹,

Tsoi

Joseph

2018

BMJ Case Rep

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A giant epidermal cyst is a benign soft tissue mass commonly involving the trunk, hand and face. The authors report a rare presentation of a 69-year-old man who presented with a painful, slow-growing left arm mass for 30 years duration. Examination revealed a large, mobile, soft tissue mass of the lateral aspect of the left arm. MRI showed a large, cystic left arm soft tissue mass. The mass was excised and the diagnosis of a giant epidermal cyst was made based on imaging and histopathology after surgical resection. The mass measured 9.5 cm x 8 cm x 4 cm, which is the largest reported giant epidermal cyst of the upper extremity.

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Giant epidermal cyst with intramuscular extension: a rare occurrence

Cited by 12 publications

References 7 publications

Characteristic MRI Findings of Epidermal Cysts Categorized by Size

Characteristic MRI Findings of Epidermal Cysts Categorized by Size

Multiple Epidermal Cysts of the Scalp: Dermatosurgical Approach with Favourable Outcome!

Giant epidermal cyst of the arm: a rare presentation

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