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Hybrid cyst: a combined epidermoid and trichilemmal cyst.

Seven cases of hybrid cyst, a combined epidermoid and trichilemmal cyst, are reported. Hybrid cysts occurred in five men and two women, and involved the scalp, cheek, back, arm, elbow, and forearm. The clinical diagnosis was usually cyst or sebaceous cyst. Microscopically, the upper portion of the cyst showed epidermoid keratinization in continuity with the surface epidermis, and was indistinguishable from an epidermoid cyst. Showing sharp transition from it, the inferior portion of the lesion displayed trichilemmal keratinization and was indistinguishable from a trichilemmal cyst. Hybrid cyst is not merely a newly described pathologic curiosity; rather, it forms a meaningful link between the two most common types of follicular cysts and adds weight to the body of evidence that most epidermoid cysts are related to the follicular infundibulum, while trichilemmal cysts are related to the follicular isthmus.

Adult↗

Male breast disease: clinical, mammographic, and ultrasonographic features.

PURPOSE: To describe and quantitate the radiological (mammographic and ultrasonographic) characteristics of male breast disease and to report the clinical and pathological findings. MATERIALS AND METHODS: Two-hundred-thirty-six male patients with different male breast diseases, diagnosed at our institution between January 1990 and July 2001, were retrospectively evaluated. The history, physical examination, mammographic and ultrasonographic findings were analyzed. RESULTS: The spectrum of the disease in 236 male patients were gynecomastia (n=206), primary breast carcinoma (n=14), fat necrosis (n=5), lipoma (n=3), subareolar abscess (n=2), epidermal inclusion cyst (n=1), sebaceous cyst (n=1), hematoma (n=1), myeloma (n=1), and metastatic carcinoma (n=2). The distribution of patterns of gynecomastia were; 34% (n=71) nodular, 35% (n=73) dendritic and 31% (n=62) diffuse glandular. Gynecomastia was unilateral in 55% (n=113) and bilateral in 45% (n=93) of the patients. Male breast cancer presented as a mass without microcalcifications in 86% (n=12) and with microcalcifications in 7% (n=1) of patients. The mass was obscured by gynecomastia, partially in two, totally in one patient. The location of the mass was retroareolar in 46% (n=6) and eccentric to the nipple in 54% (n=7) of patients. On ultrasonography (US), the contours were well-circumscribed in 20% (n=3) and irregular in 80% (n=12) of the masses. CONCLUSION: Male breast has a wide spectrum of diseases, some of which have characteristic radiological appearances that can be correlated with their pathologic diagnosis. In the evaluation of the male breast, mammography and US are essential and should be performed along with physical examination.

Adolescent↗

Gardner's syndrome - a case report.

Gardner's syndrome is the association of multiple colonic polyps (familial adenomatous polyposis coli - FAP) with sebaceous cysts and jaw osteomas. The significance of this dominantly inherited condition to the dentist is that the colonic polyps usually undergo malignant change by the fourth decade and the extra-intestinal lesions may be apparent before those in the bowel. As such, early detection of multiple jaw osteomas and/or multiple sebaceous cysts (particularly on the scalp) may lead to appropriate further investigation and treatment which might be life saving. Diagnosis of this condition also has implications for other family members.

Adult↗

Carcinoma arising in sebaceous and epidermoid cysts.

Malignant degeneration of sebaceous and other epidermoid cysts in uncommon, but it does occur in approximately 2.2% of cysts examined. It should be suspected in patients with atypical appearance or a history of cyst recurrence. All cysts should be examined histologically and the histological grade carefully noted. This paper reports a well-differentiated squamous cell carcinoma arising in an epidermoid cyst. Wide excision was performed, including superficial parotidectomy, because of histological evidence of extension beyond the cyst. Based on the literature, recurrence or metastasis of our patient's tumor appears unlikely.

Aged↗

Lymphoepithelial cyst of the pancreas with sebaceous differentiation.

Lymphoepithelial cysts of the pancreas are rare cystic lesions that histologically resemble branchial cleft cysts. In this article, we report a case of lymphoepithelial cyst with sebaceous differentiation. Lymphoepithelial cysts may present clinically or may be incidental findings, and they should be considered in the differential diagnosis of cystic lesions of the pancreas. The histogenesis of lymphoepithelial cyst is briefly discussed.

Cell Differentiation↗

Anterior fontanelle scalp cysts in infancy.

Seven infant patients with anterior fontanelle scalp cysts who were managed at the Paediatric Surgical Department of Muhimbili Medical Centre, Dar-es-Salaam between January 1986 and December, 1992 were studied. They were all Africans. There were 2 boys and 5 girls. Their ages ranged from 4 months to 24 months. The onset was at birth in 6 infants while in one case it was at 3 months of age. Their mental as well as motor development was normal. They were all easily and completely excised and in none was there intracranial communication. The histology was that of dermoid cyst in 6 patients and sebaceous cyst in one. There were no preoperative or postoperative complications noted.

Age Factors↗

Eruptive vellus hair cysts. A follicular cyst of the sebaceous duct (sometimes)

The eruptive vellus hair cyst is an uncommon, yet distinct, clinical and pathological entity that may be acquired in a sporadic or hereditary form. This descriptive term gives no indication of the type of epithelium lining this cyst. A case report of eruptive vellus hair cyst is reported herein in which the epithelial lining differentiated toward the sebaceous duct. We propose that eruptive vellus hair cysts should be more accurately diagnosed by characterizing the type of epithelial lining.

Adult↗

Recurrent epidermal cyst infection caused by Brucella melitensis in a diabetic patient.

A presternal swelling diagnosed clinically as a sebaceous cyst in a 60-year-old diabetic patient was surgically drained, and the aspirated purulant material yielded growth of Brucella melitensis. The swelling recurred four times and was drained on every occasion. The patient responded to surgical excision and antibrucella treatment. The histologic diagnosis was an epidermal cyst.

Brucellosis↗

Signal intensity characteristics of mediastinal cystic masses on T1-weighted MRI.

OBJECTIVE: We evaluated the intracystic MR signal intensity of mediastinal cystic masses to identify characteristic intensity patterns according to histologic type. MATERIALS AND METHODS: Magnetic resonance imaging was performed on 26 cystic mediastinal masses consisting of 8 thymic cysts, 5 bronchogenic cysts, 4 pericardial cysts, 5 cystic teratomas, and 4 cystic neurogenic tumors. Signal intensity ratios of each cyst to muscle were calculated on T1-weighted imaging. Surgical records were reviewed to document the presence of intracystic hemorrhage. Chemical analysis of intracystic fluid was performed in three cases. RESULTS: Bronchogenic cysts, cystic teratomas, and cystic neurogenic tumors had relatively high levels of signal intensities. Each pericardial cyst had a lower signal intensity than muscle. The signal intensities of thymic cysts were variable. Intracystic hemorrhage was present in 1 bronchogenic cyst, 2 cystic neurogenic tumors, 4 cystic teratomas, and 3 thymic cysts. No hemorrhage was found in any of the pericardial cysts. Sebaceous fluid was present in 1 cystic teratoma. CONCLUSION: The varying intensities of different cysts were considered to reflect the nature of the intracystic fluid. Since the nature of the fluid can reflect the histology to some extent, T1-weighted MRI will help to differentiate cystic mediastinal masses.

Bronchogenic Cyst↗

Pilo-sebaceous cystic ectopy of the uterine cervix.

The infrequent finding of pilo-sebaceous cysts in an uterine cervix is presented. The different histopathogenetic hypothesis and Literature reports are critically reviewed. The histogenesis can be referred to ectodermic embryonal germs which come in the ectopic site following an abnormal cephalic migration. Also stressed is the possibility that neoplasms of the pilo-sebaceous structures could arise in the ectopic site and, thereafter, due to their rarity, might be under-diagnosed at the histology.

Adult↗

Are they spherules of ovarian cystic teratoma or daughter cysts of echinococcosis?

Teratoma is a germ cell tumour which accounts for approximately 15-20 % of all ovarian cancers. The tumour is possibly derived from ectodermal differentiation of totipotent cells or mitotic germ cells. We present a case of a 37-year-old female patient with multiple spherical structures floating in a large pelvic-abdominal cystic mass seen on sonographic images. A giant echinococcal cyst gravid with its daughters was the presumed preoperative sonographic diagnosis. The patient underwent excision of the lesion, and the pathological diagnosis was teratoma. The striking feature of multiple spherical structures in the cyst was caused by multiple spherules of a mature ovarian cystic teratoma which were representing numerous mobile sebaceous cysts and desquamative keratin formations.

Adult↗

The value of sonography in the management of cystic neck lesions.

Eight cases of cystic neck lesion of differing causes in whom sonography was carried out as part of investigation are described. These are thyroid cyst with haemorrhage, thyroglossal cyst, branchial cyst, cystic hygroma, parotid abscess of the neck secondary to malignant external otitis, cystic degeneration of a recurrent malignancy in the neck, sebaceous cyst and a cold abscess. They showed that sonography is better than clinical judgement in obtaining a diagnosis. Therefore, we recommend that ultrasound should be performed in all neck lesions prior to needle aspiration or open excisional biopsy.

Abscess↗

Development of multiple tumors in a sebaceous nevus of Jadassohn.

We report the case of a 56-year-old male with a sebaceous nevus of the scalp, complicated by multiple tumor development. Histologic examination revealed a basal cell carcinoma, a syringocystadenoma papilliferum and a proliferating trichilemmal cyst. Sebaceous nevus has a well-documented neoplastic potential. Multiple tumors may occasionally arise, but the coexistence of 3 or more tumors is extremely rare. Close monitoring and early complete surgical excision of sebaceous nevi are warranted, in order to ensure a favorable prognosis.

Adenoma, Sweat Gland↗

Cystic and glial mixed hamartoma of the tongue.

Choristomas and mixed hamartomas of the oral cavity are uncommon lesions that show a variety of clinical presentations, histological appearances and growth patterns. We report a case of an unusual mixed hamartoma of the posterior tongue composed of dermoid cyst, sebaceous and glial elements. Magnetic resonance imaging indicated a predominantly cystic lesion limited to the pharyngeal and posterior part of the anterior tongue. A conservative approach was adopted and the lesion has shown minimal growth for 2 years following diagnosis.

Child, Preschool↗