Quiste epidermoide en conducto auditivo externo: reporte de caso / Epidermoid cysts of the external auditory canal: case report

Resumen El quiste epidérmico es una lesión benigna y común de la piel. Se desarrolla por un bloqueo de la unidad pilosebácea, con la consecuente proliferación de células epiteliales y secuestro de queratina. El 7% se desarrollan en cabeza y cuello, sin embargo, son infrecuentes en canal auditivo externo. Su patrón de crecimiento es lento y progresivo durante años, siendo asintomáticos. Al aumentar de tamaño causan sintomatología variable, acorde a su localización; en el canal auditivo tienen un comportamiento obstructivo que genera síntomas como otalgia e hipoacusia. Se presenta caso de una paciente de 69 años, con acúfeno e hipoacusia progresiva derecha. Durante la otoscopia se observó una neoformación obstructiva del 100% de la luz del conducto. Se realizaron estudios de imagen que reportaron tumoración de características quísticas de conducto auditivo derecho, bien circunscrita, sin erosión ósea. Para el diagnóstico definitivo, se realizó resección quirúrgica y biopsia reportando quiste epidérmico. Durante el seguimiento posoperatorio sin hallazgos de recidiva.

Abstract The epidermal cyst is a common and benign lesion of the skin. It develops due to a blockage of the pilosebaceous unit, with the consequent proliferation of epithelial cells and keratin sequestration. Seven percent develop in the head and neck; however, they are infrequent in the external auditory canal. Its growth pattern is slow and progressive over the years, being asymptomatic. As they increase in size, they cause variable symptoms, according to their location. In the ear canal they have an obstructive behavior that generates symptoms such as earache and hearing loss. A case of a 69-year-old female with tinnitus and progressive right hearing loss is presented. At otoscopy, a 100% obstructive neoformation of the canal lumen was observed. Imaging studies showed a well circumscribed, cystic tumor of the right ear canal, without bone erosion. For the definitive diagnosis, a resection and biopsy were performed, reporting an epidermal cyst. During follow up there was no recurrence of tumor.

Esteatocistoma solitario de cuero cabelludo / Solitary steatocystoma of the scalp

El esteatocistoma es un hamartoma quístico de la porción media de las unidades folículo sebáceas que afecta principalmente el ducto sebáceo. Comúnmente se encuentra de manera múltiple y se transmite en forma autosómica dominante; en algunos casos se presenta en un contexto no familiar y en otros puede ser solitario. La primera descripción del esteatocistoma múltiple (EM) muy probablemente corresponde a Jamieson en 1873. La forma solitaria de esteatocistoma fue descrito por primera vez en 1982 por Brownstein y existen pocos casos descritos en la literatura Presentamos un caso clínico de paciente varón joven con tumoración solitaria en cuero cabelludo que fue extirpado cuyo resultado histopatológico fue de esteatocistoma solitario.

Steatocystoma is a cystic hamartoma of the middle portion of the sebaceous follicular units that mainly affects the sebaceous duct. It commonly presents in multiple forms and is transmitted in an autosomal dominant manner; in some cases, it occurs in a non-familial context and in others it may be solitary. The first description of steatocystoma multiplex (MS) is most likely by Jamieson in 1873. The solitary form of steatocystoma was first described in 1982 by Brownstein and there are few cases described in the literature. We present a clinical case of a young male patient with a solitary tumor on the scalp that was excised and whose histopathological result was solitary steatocystoma.

Quiste epidérmico gigante de región perianal: reporte de un caso / Giant epidermal cyst of the perianal region: a case report

Introducción: Quiste epidermoide de inclusión es una lesión dérmica benigna frecuente, predominante en hombres de 30-40 años, originada por secuestro de restos epidérmicos, oclusión pilosebácea o implantación traumática de elementos epiteliales en la dermis.Caso clínico: Paciente femenino de 75 años de edad la cual presenta tumoración perineal de 4 años de evolución, con aumento progresivo en el último año ocasionando disconfort. Resonancia magnética nuclear, muestra lesión quística. Escisión quirúrgica incluyendo capsula en su totalidad. Anatomía patológica, quiste de inclusión epidérmica. Control a los 6 meses sin evidencia de recidiva.Conclusión: El quiste epidérmico gigante de inclusión perineal es raro, por lo cual hay que descartar otras patologías similares. El tratamiento quirúrgico debe evitar la escisión fraccionada e incluir la capsula en forma completa, de lo contrario la recidiva es una constante.

Introduction: The epidermoid inclusion cyst is a frequent benign dermal lesion, predominantly in men aged 30-40, caused by sequestration of epidermal remains, pilosebaceous occlusion or traumatic implantation of epithelial elements in the dermis.Case report: A 75-year-old female patient who has 4 years of evolution perineal tumor with a progressive increase in size in the last year causing discomfort. MRI shows a cyst lesion. Surgical excision including capsule. Pathological anatomy, epidermoid inclusion cyst. Following at 6 months without evidence of recurrence.Conclusion: The giant epidermoid cyst of perineum is rare, therefore we must rule out other similar pathologies. Surgical treatment should avoid fractional excision and include the capsule completely, otherwise recurrence is a constant.

Proliferating trichilemmal cyst with clinical, radiological, macroscopic, and microscopic correlation

Abstract: Proliferating trichilemmal cyst is an uncommon neoplasm arising from the follicular isthmus, whose histopathological hallmark is the presence of trichilemmal keratinization. We describe a case of proliferating trichilemmal cyst in a 57-year-old woman with a broad clinical, radiological, macroscopic and microscopic correlation.

Quistes epidermoides de cabeza y cuello / Epidermoid cysts of the head and neck

Los quistes epidermoides localizados en cabeza y cuello son poco comunes y pueden ser difíciles de diagnosticar. Se describen los casos de cuatro pacientes con quistes epidermoides de cabeza y cuello, dos con localización en la región sublingual y extensión suprahioidea, otro localizado en la pared orofaríngea posterolateral y otro en la región submaxilar y submentoniana. Fueron tratados con éxito mediante abordajes transorales y transcervical, respectivamente. Se realizó una revisión de la bibliografía y se describieron las características anatómicas, clínicas e histológicas y el tratamiento de estas infrecuentes lesiones. (AU)

Epidermoid cysts of the head and neck are rare and can be difficult to diagnose. Two cases of patients with epidermoid cysts of the floor of the mouth with suprahyoid extension, other located at posterolateral oropharynx wall andother located at the submandibular and submental space with extention to midline are described. They were successfully treated by a transoral and transcervical approach respectively. A review of the literature was performed, and the anatomical, clinical and histological aspects and treatment of these uncommon tumors were reported. (AU)

Steatocystoma multiplex suppurativa: case report of a rare condition

Abstract Steatocystoma multiplex is a rare genetic disorder characterized by the presence of hamartomatous malformations at the junction of the pilosebaceous duct. It consists of encapsulated cystic lesions in the dermis, with adjacent sebaceous gland. When associated with inflammation, resembling hidradenitis, it is called steatocystoma multiplex suppurativa, a condition rarely reported. This is the first case of steatocystoma multiplex suppurativa reported in the Brazilian literature. Female patient, 23 years old, with papular and nodular cystic lesions that started in the armpits and groin, later spreading to the trunk, lower limbs, anticubital fossa, face and scalp. The presence of papular-nodular lesions associated with disseminated hidradenitis-like lesions in flexural areas and the histopathological diagnosis of steatocystoma defined the diagnosis of steatocystoma multiplex suppurativa.

Quiste epidermoide testicular: diagnóstico ecográfico preoperatorio y correlación radiopatológica / Testicular epidermoid cyst. preoperative ultrasound diagnosis and radiopathological correlation

The low incidence of testicular epidermoid cyst (1-2 percent of all testicular tumors), makes ultrasound findings the key to making, or at least suggesting, a precise preoperative diagnosis, thus making a conservative treatment possible. We present two cases with ultrasound diagnosis of epidermoid cyst, confirmed later after surgery. We review the literature, emphasizing the evaluation of the ultrasound images and their correlation with the anatomopathological findings.

La escasa incidencia del quiste epidermoide de testículo (1-2 por ciento de todos los tumores testiculares), hace de los hallazgos ecográficos la clave para realizar o al menos sugerir un diagnóstico prequirúrgico preciso, haciendo por tanto posible un tratamiento conservador. Presentamos dos casos con diagnóstico ecográfico de quiste epidermoide, confirmado posteriormente tras cirugía. Realizamos una revisión de la bibliografía, enfatizando en la valoración de las imágenes ecográficas y su correlación con los hallazgos anatomopatológicos.

Tumourlike Lesions of Skin - A Clinicopathological Analysis of 175 Cases.

As the skin is the largest and complex organ, a wide variety of tumourlike lesions are encountered in the clinical practice. The ability to properly diagnose & treat these common lesions & to distinguish them from malignant tumours is the vital skills for all clinicians. Objective: To analyse retrospectively tumourlike lesions of skin with respect to age, sex, clinical features and histopathological features in a tertiary referral centre in Maharashtra, India. Methods : The present study consisted of analysis of tumourlike lesions of skin received in the histopathology section of department of pathology over a period of 5 years that is from August 2005 to July 2010 .The material comprised of biopsies and excision specimens. The clinical and histopathological details were noted. The findings were compared with those reported by other authors. Results : One hundred and seventy five (175) cases of tumourlike lesions of skin were seen .These lesions presented as skin swellings or tumours. Maximum cases (34.8%) of tumourlike lesions occurred in fourth & fifth decades with male preponderance (1.35:1). The maximum number of cases was encountered in the head & neck region (63.4%). Their size ranged from 0.4 to 9 cms. Epidermal cyst was the commonest tumourlike lesion (59.4%) followed by dermoid cyst (13.1%).Other lesions were trichilemmal cyst, fibroepithelial polyp, keloid, hypertrophic scar and epidermal nevus. Conclusion : Tumourlike lesions are clinically diagnosed by their presentation. However, the histopathological examination confirms the clinical diagnosis. The pathologic evaluation of all tumourlike lesions is mandatory to avoid patient’s and family’s anxiety.

Multicentric calcified trichilemmal cysts with alopecia universalis affecting siblings.

Trichilemmal cyst, also known as "pilar cyst," is a benign cyst containing keratin and its breakdown products with a wall resembling external root sheath of hair. It occurs mostly in females as a solitary firm nodule over scalp. Occurrence of multiple trichilemmal cysts in areas other than scalp is extremely rare. We are reporting a case of a 40-years-old female who presented with multiple calcified trichilemmal cysts in multicentric distribution associated with alopecia universalis. Similar complaints were present in elder sister of the patient, indicating a genetic background. Multicentric distribution of trichilemmal cysts, calcification, familial occurrence, and association with alopecia universalis seen in our case are all rare and intriguing features.

Proliferating trichilemmal tumor of the nose / Tumor triquilemal proliferante do nariz

Proliferating trichilemmal tumor is a rare tumor originating in the external root sheath, that is usually found in the scalp of middle-aged or elderly females. Its histologic appearance may not correlate with its clinical behavior. In addition, there are no guidelines available for the treatment of these tumors, making its management a challenge for physicians. We report the case of a 53 year-old woman with a proliferating trichilemmal tumor on her nose, which is a very uncommon location for these lesions.

Tumor triquilemal proliferante é um tumor raro com origem na baínha radicular externa, que é encontrado geralmente no couro cabeludo de mulheres de meia idade ou idosas. A sua aparência histológica pode não se correlacionar com o seu comportamento clínico. Além disso, não há diretrizes disponíveis para o tratamento destes tumores, tornando a sua gestão um desafio para os médicos. Relatamos o caso de uma mulher de 53 anos com com um tumor triquilémico proliferante no nariz, que é uma localização muito incomum para essas lesões.

Congenital inclusion dermoid cyst of the posterior fontanel: a case report

Background: Dermoid cysts are rare and benign tumors originating from failure of the normal embryologic development. Congenital inclusion dermoid cysts are usually located over the anterior fontanel. Surgical treatment is curative and provides good aesthetic results. The authors present a rare case of congenital inclusion dermoid cyst over the posterior fontanel and discuss the location, differential diagnosis, treatment and prognosis of this unusual pathological entity. Case description: A two-year old boy presented with a lesion on the posterior aspect of the head which had dated since birth. Imaging studies revealed an extracranial lesion over the posterior fontanel without intracranial extension. Surgical removal was performed and the histopathological examination confirmed the diagnosis of a dermoid cyst. The patient was discharged free of any medical complications. Conclusion: Although congenital inclusion dermoid cysts are more common over the anterior fontanel, they can occur over the posterior fontanel as well. Surgical treatment is curative in both locations with favorable aesthetic results.

Giant epidermal cyst of the tarsal plate.

A 35-year-old male patient presented with a right upper eyelid mass with mechanical ptosis. The patient gave no history of trauma or surgery. On examination, there was a huge cystic mass fixed to the tarsal plate. Excisional biopsy with tarsectomy was done. Histopathology sections demonstrated a keratin-filled cyst arising from the tarsus. A thorough Pubmed search did not reveal an epidermal cyst of the tarsal plate of this size which was successfully managed. The incision was made in such a way that postoperative ptosis would be avoided. Excess skin was removed during the surgery.

Endoscope-Assisted Microsurgical Removal of an Epidermoid Tumor within the Cavernous Sinus

Epidermoid tumor of the cavernous sinus is rare. The aim of this case report is to discuss the role of neuroendoscopes in the removal of such lesions. A 21-year-old man presented with 6-year history of progressive headache, diplopia, and visual disturbance. Work-up revealed an epidermoid tumor located in the right cavernous sinus. An extradural transcavernous approach was utilized via a traditional frontotemporal craniotomy with endoscopic assistance. The postoperative course was uneventful with immediate improvement of the patient's headache. Postoperative magnetic resonance imaging demonstrated complete removal of the tumor. There were no signs of recurrence during a 2-year follow-up period. The endoscope is a useful tool for removing epidermoid tumors from the cavernous sinus and enhances visualization of areas that would otherwise be difficult to visualize with microscopes alone. Endoscopes also help minimize the retraction of neurovascular structures.

Vellus hair cysts presenting as an atypical acneiform eruption / Cisto de pelo velos apresentando-se como erupção acneiforme atípica

A 32-year-old male patient presented for 8 months an asymptomatic therapy-resistant acneiform eruption on his back and buttocks. Skin examination showed several inflammatory papules, which evolved to hyperpigmentation. At the same distribution non inflammatory papules, which resembled rice grains, were also observed. Light microscopy showed small keratin-filled cysts, with an epithelial multilayered wall, without granular layer. Keratin and some vellus hairs were identified inside the cyst, confirming the diagnosis of vellus hair cysts. Diagnosis of vellus hair cysts should be suspected in cases of multiple papules or therapy-resistant cases of acneiform eruptions.

Um paciente de 32 anos apresentou há 8 meses uma erupção acneiforme resistente à terapêutica, localizada no dorso e nádegas. Ao exame apresentava inúmeras pápulas inflamatórias, que evoluiam para hiperpigmentação. Na mesma distribuição havia lesões não inflamatórias, lembrando grão de arroz. A microscopia óptica demonstrou cisto dérmico cuja parede era de epitélio estratificado, sem camada granular, preenchido de queratina e com pelos no interior, confirmando o diagnóstico de cisto de pelo veloso. Essa entidade deve ser suspeitada em casos de múltiplas pápulas ou erupções acneiformes resistentes à terapia.

Tumor triquilemal proliferante: relato de caso / Proliferating trichilemmal tumor: case report

Tumor triquilemal proliferante é uma neoplasia incomum que surge do istmo folicular, cuja característica histológica é a presença de ceratinização triquilemal. Apresenta-se usualmente como nódulo solitário no couro cabeludo de mulheres idosas. Descreve-se um caso de tumor triquilemal proliferante que se apresenta como lesão tumoral nodular na região glútea de uma jovem de 16 anos de idade.

Proliferating trichilemmal tumor (PTT) is an uncommon neoplasm arising from the follicular isthmus. Its histological characteristic is the presence of trichilemmal keratinization. PTT usually presents as a solitary nodule on the scalp of elderly women. We describe a case of a PTT on the gluteal region (buttocks) of a 16-year-old female, presenting as a solitary nodule.