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[Classification of follicular cysts: epidermal cysts including Günther sebocystomatosis, steatocystoma multiplex and trichilemmal cysts].

The clinical and histopathological nomenclature of various follicle-derived cysts is confusing. A uniform terminology, based on histopathological criteria is proposed. Cysts may develop from vellus follicles, sebaceous follicles, and terminal hair follicles. The various sections from each follicle may give rise to various types of cysts: 1. the infundibulum to epidermal cysts (e.g. epidermal cysts, comedones, milia, and scrotal cysts); 2. the sebaceous ducts and sebaceous acini to steatocystoma multiplex; 3. the infraglandular portion of the infrainfundibulum to trichilemmal cysts (atheromas). A clinical variant of epidermal cysts, the scrotal cysts, at times incorrectly called sebocystomatosis Günther, is described in 10 patients. For all types of cysts clinical and histopathological guidelines are offered.

Cysts↗

Leukocyte chemotactic properties of soluble horny contents in epidermal cysts.

Epidermal cysts are one of the most common tumors of the skin. Although asymptomatic ordinarily, they may sometimes become severely inflamed with massive invasion of polymorphonuclear leukocytes (PMN). We studied in vitro PMN chemotactic properties of the aqueous extract prepared from the horny material of epidermal cysts obtained from three patients. A crude aqueous extract of the horny content of the cysts showed PMN chemotactic activity, which, however, was less than that of a horny layer extract prepared from normal skin. Characterization of PMN chemotactic activity using a Sephadex G-75 column showed a peak in the low molecular weight fractions eluting between the vitamin B12 and phenol red markers, which corresponds with the peak of absorbance at 280 nm. The chemotactic substances withstood boiling and trypsin or protease digestion. Although the chemotactic activity was partially ether-extractable, the presence of leukotriene B4 was not demonstrated by radioimmunoassay. In addition to their own chemotactic activity, the horny extracts of epidermal cysts showed cytotaxigenic properties in the presence of fresh serum.

Adult↗

[Palmoplantar epidermal cyst].

Epidermal cysts of the palms and sole of feet are rare. They originate from traumatic implantation of the epidermis into the dermis or subcutis. Three cases (one on the palm and two on the sole of the feet) are reported.

Aged↗

[Pigmented cysts. Pigmented epidermal cysts and pigmented trichilemmal cyst].

The clinical and histopathological picture of the pigmented epidermal cyst and the pigmented trichilemmcyst is illustrated by three case-reports. The pigment is melanin, which is located in the epithelium of the cyst-wall, the corneocytes of the lumen and in macrophages in the dermis. The clinical appearance of melanin pigmented cysts is blue due to the Tyndall-phenomenon.

Adult↗

Intrarenal epidermal cyst.

An epidermal cyst is a very unusual cause of a renal mass, with only three cases reported in English literature. The authors report a case of this in a 51-year-old man with left flank pain and hematuria. A 5 x 4 cm-sized cystic mass, having an irregular margin with stippled calcification, was identified in the lower pole of the left kidney. A retroperitoneal laparoscopic simple nephrectomy was performed under the assumption that it was a renal tumor. Histologically, the tumor was identical in appearance to an epidermal cyst within the skin. Aberrant ectodermal implantation during embryogenesis has been postulated as a histogenesis of intrarenal epidermal cyst. However, the present case had a history of renal stone, which was treated with extracorporeal shock wave lithotripsy. Therefore, the authors suspected the pathogenetic mechanism of this lesion was a metaplasia of traumatic origin. The diagnosis of an epidermal cyst was not made preoperatively in the present case, or in the cases described in the literature. This diagnosis should be included in the differentiation of calcified intrarenal masses.

Cysts↗

[Surgical treatment of diffuse scrotal epidermal cysts: case report].

Epidermal cysts are common, benign skin tumors that are found mainly on the face, neck, and trunk. This case was a 53-year-old male bus driver who had suffered from multiple papules on his scrotum for 7 years. This affliction had caused intractable itching and responded poorly to medical treatment. The patient received an excision of these papules (total 32) 3 years ago. According to the pathological reports, these papules were epidermal cysts; unfortunately, these papules recurred within 3 months after the operation and then resulted in itching more severe than before. The patient was again admitted to the hospital ward and received an operation in Oct. 1990. The diseased tissue (14cm x 8cm) was then excised and the defective scrotal skin was covered with a meshed, split-thickness skin graft. The cosmetic result was enhanced by the rugate appearance of the healed meshed graft. The patient was satisfied with both the functional and cosmetic results. The itching sensation on the scrotum improved and there was no recurrence of epidermal cysts within the graft area during the 9 month follow-up period. With this simple and safe operation, the result gave a satisfying improvement in both symptoms and appearance; so this case is offered for reference.

Epidermal Cyst↗

Squamous cell carcinoma arising in a giant epidermal cyst: a case report.

Epidermal cysts are commonly encountered in surgical practice. Malignant degeneration of epidermal sebaceous cyst is uncommon. The authors report the case of a 38-year Filipino woman presenting with a voluminous sebaceous cyst of the left buttock. Ultrasonography and computer tomography were made preoperatively without any hint of eventual malignant degeneration. Marginal excision was performed with direct closure of the skin. The histological examination revealed epidermal sebaceous cyst with squamous cell carcinoma in situ, which is a quite rare, but well known complication occurring in sebaceous cysts.

Adult↗

Squamous cell carcinoma arising in a cutaneous epidermal cyst--a case report.

INTRODUCTION: Cutaneous epidermal cysts are common lesions, but fortunately, malignant transformation of their epithelium is rare. There are only a few cases mentioned in recent literature, mostly occurring in epidermal cysts in the head and neck region. CLINICAL PICTURE: We present a case of malignant transformation in a long-standing buttock epidermal cyst, presenting a month after trauma to the cyst. TREATMENT: An excision biopsy and rotation flap was done. When the pathology was confirmed, a second resection was carried out and the defect covered with a free latissimus dorsi flap, a buttock rotation flap and a posterior thigh rotation flap. CONCLUSION: Although malignant transformation is rare, this case illustrates the importance of routine histology in excision of epidermal cysts.

Biopsy↗

Pigmented epidermal cysts.

There are few reports documenting the presence of melanin or melanocytes in epidermal cysts. One hundred and twenty five epidermal cysts from Indian patients were analyzed for the presence of melanin pigment and their sites were noted. A Masson's Fontana stain and immunohistochemistry for S-100 protein and HMB 45 was performed for localization of melanin and melanocytes within the epidermal cysts. Seventy-nine (63%) of the epidermal cysts showed presence of melanin pigment or melanocytes to a variable extent. Melanin was not present in epidermal cysts occurring along lines of fusion of skin folds during embryonogenesis (e.g., ventral midline, inner canthus, nose, upper lip and in the distal most parts like leg and foot and also scrotum). Ten of the 79 epidermal cysts showed extensive accumulation of melanin pigment and infiltration with melanophages in the cyst wall. Four of these patients gave history of trauma and the follow-up was uneventful in two of them. Pigmentation of epidermal cysts thus follows a definite anatomic pattern and is dependent on the natural skin color. Large amount of pigment accumulation within epidermal cysts occurs after cyst rupture and is not associated with hemochromatosis as was believed in the past.

Adolescent↗

Microbiology of infected epidermal cysts.

Specimens from 231 epidermal cyst abscesses were inoculated on media supportive for growth of aerobic and anaerobic bacteria. Of these, 192 yielded bacterial growth. Aerobic or facultative bacteria only were recovered in 84 specimens (44%), anaerobic bacteria only in 57 specimens (30%), and mixed aerobic and anaerobic bacteria in 51 specimens (26%). A total of 315 isolates (162 anaerobes and 153 aerobes) were recovered. An average of 0.8 aerobic or facultative isolates per infected cyst were recovered, and this number was unrelated to the cysts' anatomic sites. However, the number of anaerobic bacteria varied; they were isolated more frequently in perirectal (1.5 isolates per specimen), vulvovaginal (1.4), and head (1.1) infections, and less frequently in trunk (0.7) and extremities (0.4) infections. The predominant aerobic or facultative bacteria were Staphylococcus aureus (81 isolates), group A streptococcus (9 isolates), and Escherichia coli (7 isolates). The predominant anaerobic organisms were Peptostreptococcus species (85 isolates) and Bacteroides species (55 isolates, including 12 Bacteroides melaninogenicus and 9 Bacteroides fragilis groups). The study highlights the polymicrobial nature and predominance of anaerobes in cyst abscesses in the perirectal, vulvovaginal, and head areas.

Adolescent↗

Completely reversible, severe, acute neurological deterioration with an otherwise asymptomatic, huge intradiploic calvarial epidermal cyst.

A huge, intradiploic, right temporoparietal epidermal cyst was known to be present, unchanged in extent, for over 14 years in a 55-year-old man. Although extreme mass effect was demonstrated by computed tomography scans, results of the neurological examination were within normal limits. Treatment of nausea and vomiting after vestibular testing caused somnolence and an acute diencephalic-mesencephalic syndrome of tentorial herniation. However, only moderate amounts of analgesics and sedatives were given. These symptoms disappeared as the pharmacological sedative effect diminished. Thereafter the tumor was resected radically. Neuropathological examination confirmed an epidermal cyst. Results of the postoperative neurological examination were within normal limits.

Bone Diseases↗

Basal cell carcinoma showing connections with epidermal cysts.

Basal cell carcinomas arising from epidermal cysts are rare. A 76-year-old Japanese man had had a blackish nodule on his right knee for 15 years, under which he later noticed the development of a subcutaneous nodule. On histological examination masses of tumour cells showed the feature of adenoid and solid patterns of basal cell carcinoma that were connected to the wall of epidermal cysts in many places as well as with the overlying epidermis.

Aged↗

[Tumors developing in an epidermal cyst].

The paper presents clinical and morphological characteristics of neoplasms arising in epidermal cysts (73 observations). It is emphasized that the epithelium of epidermal cyst may be the source of growth of not only benign cystic epithelioma ("proliferating epidermal cyst" as designated by the foreign authors) but also of squamous cell carcinoma. Cystic epithelioma (54 observations) is a slowly growing tumor represented by outgrowths in the cyst lumen of differentiated squamous epithelium apt to form smaller cysts. A predominance in cystic epithelioma of the basal type cells and complexes of squamous epithelial cells with hyperchromic and slightly polymorphous nuclei (7 observations) is considered to be the initial sign of malignancy of the noninvasive cancer type. Cancer arising in epidermal cyst (11 observations) is characterized by rapid growth, invasion into derma and trend for relapses. Frequently it has the structure of keratinizing squamous cell carcinoma. A malignant tumor is described characterized by a combination of cystic epithelioma, squamous cell carcinoma of pseudosarcomatous structure in some areas and glandular formations whose origin is obscure.

Carcinoma, Squamous Cell↗