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The nomenclature and pathogenesis of cutaneous cysts is discussed along the lines of their pathological properties. On the basis of histological and experimental evidence it is concluded that most cysts represent benign neoplasms derived from pluripotential cells.
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Sinus pilonidalis or the sacrococcigea cyst, normally is considered a "small surgical pathology" and actually it is controversial disease regarding its pathogenesis and treatment. Today the congenital hypothesis of this pathology is not considered. The etiopathogenesis exclude vestigia embryonic origin and consider it an inflammatory disease. Traumatism of the sacral region, hirsutism, hormonal secretion stimulating, and furrow sacral furrow cutaneous, explain the prevalence of this pathology in the male sex and in the puberale age. It usually appears after the pubertà and extension one various frequency of presentation in males sex (1.3%) regarding females (0.11%). The symptomatology can be rare or introduce itself in violent and intense way with on abscess of the region, or with only or multiple fistulas orifices from which exit materialclarly purulent. Normally cystic cavity is one, situated in the subcutaneous tissue with annexed inflammatory phenomena. This cavity to times communicates with the skyn fistulating. The treatment of election is surgical and must weighted and be regulated in relation to the entity of the lesion and its inflammatory picture. Sometimes the medical therapy with anti-inflammatory and antibiotic is not control the symptomatology and it need the surgical treatment.
Only 15 cases of pilonidal sinus of the umbilicus have so far been reported. A 16th case is described; it supports the theory of acquired origin of the disease. The case fulfilled the criterion for pilonidal sinus--the 36-year-old man had a hair in the infected umbilical cyst. The cyst and umbilicus were excised. The umbilicus was not reconstructed because of the danger of recurrence. It is recommended that a careful search be carried out for hair in all patients with an infected umbilicus.
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OBJECTIVE: Umbilical discharge is a symptom of varied pathology. Treatment policies of this clinical problem vary among different institutions. Our experience in the management of 44 patients with umbilical discharge is presented. METHODS: This is a retrospective study of the 44 patients treated at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia over a period of 19 years from 1982 to 2001. RESULTS: With the exception of one patient, all patients were treated in the outpatient clinic. General anesthesia was not employed but instead local anesthesia was used in some cases. One patient required admission for surgical excision, diagnosed to have an ulcerating dermoid cyst. Most patients had hair tuft in the infected umbilicus (pilonidal sinus of umbilicus), 2 patients had concrete like material inside the infected umbilicus. CONCLUSION: We propose a conservative approach to treat this problem and preserve surgical excision only for selected cases.
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Pilonidal disease is a common acquired condition believed to arise from penetration of short hairs into the subcutaneous tissue that induces a cyst or sinus formation. Malignant degeneration is rare and is typically seen only after decades of antecedent disease presence. Condylomata acuminatum in association with pilonidal disease have been described in two prior case reports, however, the coexistence of condyloma with pilonidal disease complicated by malignant degeneration has not been previously reported. Condylomata have known potential for malignant degeneration and are correlated with human papilloma virus infection, with certain serotypes of higher oncogenic potential. Coinfection with human immunodeficiency virus and human papilloma virus is associated with higher rates of anal neoplasia. We report two cases of human immunodeficiency virus-infected patients with the constellation of pilonidal disease, condylomata acuminatum, and subsequent malignant degeneration into squamous-cell carcinoma. In contrast to other case reports in the literature, these two patients had considerably shorter antecedent periods of pilonidal disease before malignant degeneration was detected. Both cases also had intractable courses. We conclude that the existence of condylomata acuminatum and pilonidal disease in an immunocompromised patient may represent a more ominous condition than solitary pilonidal disease. Therefore, careful inspection of the pilonidal area in human immunodeficiency virus-infected patients presenting with condylomata is important and earlier intervention should be considered. Moreover, further evaluation of the prevalence of squamous-cell carcinoma arising from pilonidal disease complicated by condylomata, particularly in the immunosuppressed, is warranted.
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A method of programmed revision has been developed and used in 20 patients after excision of the pilonidal sinus.
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