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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.
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.
We present three unusual cases of molluscum contagiosum occurring in epidermal cysts. All of them are asymptomatic, elevated, oval nodules diagnosed clinically as epidermal inclusion cyst or prurigo nodularis. Histology showed true epidermal cysts containing molluscum bodies throughout the cyst wall and some type of laminated material within the cyst itself. The lesion, in all three cases developed in the pubic area of young adult men.
HPV-associated epidermal cysts of the sole (HAECS) of the foot have been reported recently in Japan in which there is positive staining for papillomavirus antibody in the nuclei of the epithelial cells in the cyst wall and vacuoles in the stratified horny material inside the cysts. A causative association with a newly recognized HPV, HPV 60, has been recorded. The authors report two new cases. The possible mechanism of cyst formation in HPV 60-infected epithelium is discussed.
In a 40-year old man undergoing, under local anaesthesia, excision of an epidermal cyst located in the frontal region, at the border of the scalp, the operator had difficulties in removing the deep part of the cyst and perceived an underlying bone depression. The depression was caused by a 2 x 1.3 cm wide lacuna in the calvarium, which was subsequently treated by neurosurgeons. Histology showed only fragments of a simple epidermal cyst wall and no evidence of dermoid cyst. The causes of osteolysis associated with congenital or acquired skin lesions are reviewed. In this case, the old age and volume of the cyst may explain the osteolysis by mechanical compression. This case is exceptional since we were unable to find other examples in the literature, apart from dermoid and trichilemmal cysts.
In the light of one case of epidermal cyst of the maxilla, the authors emphasize the operative difficulties and the need, in the presence of a severe abnormality of the pedicles of the upper wisdom teeth, to perform a careful tomographic examination of the head.
Cysts of the penis are rare and references to them in standard textbooks are sketchy. A case report of a congenital epidermal cyst of the median raphe of the penis is presented; therapy involved excision of the mass. Review of the literature is given.
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Cystic lesions of the eyelids are not uncommon and are variable in nature. A case report of a 42-year-old male patient is detailed. A bilateral cystic lesion was clearly visible at both medial canthuses. Surgical resection was performed under local anesthesia, followed by histopathological study of the specimens. This revealed that these lesions were hidrocystomas, of probable eccrine origin. As many different cystic lesions may be encountered on the eyelids (dermoid cysts, epidermic cysts, cystic basal cell carcinomas...), routine histopathological study of surgically removed cystic specimens is mandatory to obtain an accurate diagnosis.
One of the most frequent causes of epidermal inclusion cysts is trauma involving the epidermis with subsequent implantation of epidermal cells into the dermis or subcutis. Minimal incision surgery is capable of achieving this because it is performed by using small incisions and rapidly rotating power instruments. The technique requires that the surgeon master a high degree of dexterity and knowledge of the anatomy without the aid of direct visualization. Van Enoo and Cane suggest the use of fresh, sharp skin blades to protect against invagination of skin edges which could lead to epidermal inclusion cysts. They also state that an improper position or an incision that is too small will cause tension, which can lead to heat buildup with subsequent sloughing and dehiscence. It may also drive some epidermal cells underneath the dermis and foster an epidermal cyst. Other surgeons using small incisions suggest thorough and copious irrigation to flush away debris and to avoid potential foreign body reactions. The periosteum should be reflected away from the point where the drill bit exits the bone to prevent bone chips from being forced subperiosteally and potentially causing a foreign body reaction. By virtue of the technique, minimal incision surgery lends itself to a greater risk of causing epidermal inclusion cysts. Surgeons who use these techniques must be aware of this potential complication.
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In the present study, the expressions of p53 and N-myc gene were analyzed immunohistochemically in rat ovarian tumors induced by 7,12 dimethylbenz (a) anthracene (DMBA). 1) p53 could be seen in the nucleolei of tumor cells. The positive rates were: adenomas 17%, adenocarcinomas 37%, sarcomas 0%, mixed müllerian tumor 0% and epidermal cysts 100%. Neither the serial-allografted tumor nor DMBA-OC-1 was positive. 2) N-myc could be seen in the cytoplasm and perinuclear cytoplasm of tumor cells. The positive rates were: adenomas 33%, adenocarcinomas 77%, sarcomas 100%, mixed müllerian tumors 100% and epidermal cysts 100%. Both the serial-allografted tumor and DMBA-OC-1 were positive. 3) The positive rates in both p53 and p21 were: adenocarcinoma 20% and epidermal cysts 100%. The positive rates in both N-myc and p21 at the were: adenoma 17%, adenocarcinoma 50%, sarcoma 33%. Both the serial-allografted tumor and DMBA-OC-1 were positive. Only two cases were positive for p53, N-myc and p21. p53 was detected in most of the adenomas. 4) The positive rate for both N-myc and p21 was higher than that for both p53 and p21. This was similar to other reports. The results suggested that p53 plays a role in precancerous tumor as a recessive oncogene. It was supposed that tumors with N-myc gene expression were had malignant growth characteristics.
A series of experiments were carried out on 55 guinea pigs in four groups to study the conditions fostering bone resorbin epidermal cysts. The first group had free grafts of canal wall skin applied to the cochlea with and without talc application. The second group had canal skin flaps applied to the cochlea with and without subsequent talc application. The third group had talc applied either to the tympanic membrane or on the cochlea. The fourth group had a canal skin flap inserted into a mucosal pocket in the bulla. The animals were killed three to four months after surgery and the temporal bones were prepared for histology. Epidermal cysts were found at the cochlea in 8 of 55 animals. Cochlear fistulas were found in 6 of 55 animals. The fistulas were associated with epidermal cysts in three cases, otitis media in two cases, and talc granuloma in one case. These experiments show that migrating skin attached to a source of epithelium is capable of inducing bone resorption. Chronic foreign body granulomas and chronic sepsis are also capable of resorbing bone. These three conditions all produce a layer of undifferentiated connective tissue containing chronic inflammatory cells lying against the resorbing bone.