Concept: Pilonidal cyst
Periorbital dermoid cysts are benign tumors most often seen in young children. Intraorbital location, though rare, should not be overlooked. Good quality imaging plays a major role in the etiological diagnosis, providing a precise analysis of the location of the lesion, its components, and its effects on adjacent and nearby structures, as well as in planning the surgical approach. The authors report a case of a 46-year-old male with an intraorbital dermoid cyst presenting with progressive left proptosis. Appearance on imaging (CT and MRI) was consistent with intraorbital dermoid cyst. The tumor was extirpated. Histopathologic examination confirmed the diagnosis of dermoid cyst. We also present a review of the literature.
BACKGROUND: Pilonidal sinus is a common condition often managed with invasive surgery associated with a significant morbidity and often a prolonged recovery time. Fibrin glue has been used in our institution as an alternative to conventional surgery. The purpose of this study was to perform a service evaluation of patient satisfaction and recovery following fibrin glue treatment for pilonidal sinus. METHODS: All pilonidal glue procedures for a single surgeon were identified from theatre and consultant diary records from March 2007 to September 2011. A questionnaire was sent by post to all patients. Patient satisfaction, time to return to normal activities, the need for further procedures and whether they would recommend a glue procedure to a friend were evaluated. RESULTS: Ninety-three patients were identified, accounting for a total of 119 glue procedures and 57/93 responses were received (61 %). The median age of respondents was 26 (17-70) years. Seventy-nine per cent (n = 45) were satisfied, pleased or very pleased with the result of their procedure. Fifty-four per cent (n = 31) were back to normal activities within a week with a further 17 % (n = 10) back to normal activities within 2 weeks. Seventy-four per cent (n = 42) required no further treatment. Of the 15 patients requiring a further procedure, 3 went on to have a repeat glue treatment which resulted in complete healing. Eighty-two per cent (n = 47) would recommend a glue procedure to a friend. CONCLUSIONS: Fibrin gluing for pilonidal sinus should be considered as first-line treatment for most pilonidal sinuses. It has a high level of patient satisfaction and allows a rapid return to normal activities in this group of patients of working age.
PURPOSE: In previous studies, a lack of antibiotic prophylaxis, smoking and obesity were described as factors that contribute to the development of a surgical site infection (SSI) after pilonidal disease (PD) surgery. In this study, we evaluated whether the volume of the excised specimen (VS) was a risk factor for SSI. METHODS: The patients who underwent surgical treatment for PD from January 2010 through December 2011 were retrospectively evaluated in terms of SSI, time off work and healing time. The single and multiple explanatory variable(s) logistic regression analyses were performed. RESULTS: One-hundred and sixty patients were included in the study. SSI occurred in 19 (11.9 %) patients. In the multiple explanatory variable logistic regression analysis, VS was emerged as a risk factor for SSI (OR 18.78, 95 % CI 2.38-148.10; P < 0.005). The healing time and time off work were longer when a SSI occurred (P < 0.001). CONCLUSIONS: This study suggests that the rate of SSI after the surgical treatment of PD is higher in patients with a high VS. A SSI significantly prolongs the healing time. Surgeons can use this data for assessing the SSI risk. As a preventive measure, prolonged use of an empiric broad-spectrum antibiotic may be beneficial in patients with a high VS.
We describe an 11-month-old boy with an unusually large presternal mass present since birth. The large size, fluctuant properties, transillumination, compressibility, and imaging of this lesion were characteristic of a lymphatic malformation. Although four treatments with sclerotherapy markedly reduced its size, it was not until definitive treatment with surgical excision and the final pathology report that we arrived at the ultimate diagnosis of dermoid cyst. Dermoid cysts, although appearing along embryologic lines of closure, are rarely presternal. They are usually small, thick walled, and filled with sebaceous or keratinous fluid, which typically allows for clinical diagnosis, and show characteristic features on magnetic resonance imaging (MRI) and ultrasound. However, this case illustrates that dermoid cysts can appear in somewhat atypical locations, and imaging is not always diagnostic, so dermoid cyst should remain a part of the differential diagnosis for any lesion presenting midsternally, regardless of the size and imaging characteristics.
Dermoid cysts, encephaloceles, and dermal sinus tracts represent abnormalities that develop during the process of embryogenesis. The elucidation of the precise timing of formation for these malformations has remained elusive at the molecular level of study. Yet, clinical experience has demonstrated that these malformations do not all occur in the same patient, suggesting a shared pathway that goes awry at distinct points for different patients, resulting in 1 of the 3 malformations. Herein the authors describe a case in which all 3 malformations were present in a single patient. This is the first description in the English literature of a sincipital encephalocele occurring with a dermoid cyst and a dermal sinus tract.
A cutaneous ciliated cyst is a rare entity found predominantly in the lower extremities and perineal region of young females. Although initially described by Hess in 1890, the present day term, “cutaneous ciliated cyst,” was proposed by Farmer in 1978 and includes a wide array of cyst types. Despite their typical female predominance and location, many have described cutaneous ciliated cysts in males and atypical locations. In addition, Mullerian cysts in the posterior mediastinum and the retroperitoneum have been reported. To date, only 40 cases have been reported in the literature of a Mullerian-type, cutaneous ciliated cyst. Here, we report a case of 13-year-old female with one in the gluteal cleft, initially presenting as a pilonidal cyst. We also discuss the differential diagnosis of pediatric sacrococcygeal lesions and pathogenesis of a Mullerian-type, cutaneous ciliated cyst.
Dermoid cysts are the most common teratomatous lesion; however, they infrequently arise in the head and neck region. Very rarely, dermoid cysts have been described in the thyrohyoid region, masquerading as a thyroid nodule. We describe the case of a 31-year-old woman with a lateral neck mass, associated with the thyroid gland inferiorly, which was excised and found to be a dermoid cyst. We then review the pathogenesis of dermoid cysts in this region, as well as review diagnosis and treatment of dermoid cysts of the head and neck.
Dermoid cysts are unusual neoplasms and can occur in every part of the human body. They represent only 6.9% of all dermoid cysts in the head and neck region; in the oral cavity, the incidence is low, approximately 1.6% of all dermoid cysts. Our aim is to present an unusual case of a large sublingual dermoid cyst with mandibular prognathism caused by cyst growth. We reported a case of a large sublingual dermoid cyst in an 8-year-old female patient. A bibliographic research from 1937 to 2013 is reviewed and we found only three cases of mandibular deformity, of which only one was a dermoid cyst of the floor of the mouth. Removal of dermoid cysts of the floor of the mouth should be completed as early as detected, especially in newborns and infants when osseous growth abnormalities could result if removal is delayed.
The existence of a benign form of postpubertal testicular teratoma, apart from the rare dermoid cyst, is not widely recognized. This study reports 25 apparently benign postpubertal testicular teratomas, including 10 cases of dermoid cyst and 15 of nondermoid teratomas, which occurred in 25 patients, 12 to 59 years of age (mean, 24 y). Postpubertal status was based on active spermatogenesis in the testis. On gross examination 15 of 16 tumors with available information had a variably prominent cystic component filled with keratinous or mucoid material. On microscopic examination, the 10 dermoid cysts were lined by keratinizing, stratified squamous epithelium with associated pilosebaceous units and sweat glands in an organoid arrangement. Squamous cysts also occurred in 10 of 15 nondermoid teratomas, which by definition lacked adnexal structures. Apart from 2 dermoid cysts additional elements occurred in all cases, most commonly ciliated or respiratory-type epithelium (64%) and smooth muscle (68%). Organoid arrangements were also present in 5 of the nondermoid teratomas. No case showed cytologic atypia nor did the parenchyma adjacent to the teratomas of either type show intratubular germ cell neoplasia, unclassified type, microlithiasis, scarred zones, or more than focal perilesional tubular atrophy/sclerosis. Spermatogenesis was intact in all cases. FISH study for chromosome 12p was performed in 18 cases, and none displayed an abnormal 12p chromosome. All 17 patients that had follow-up information were alive at postoperative intervals of 5 to 168 months, although physician-confirmed disease-free status was unfortunately not available in 6 of these. This study supports the recognition and separate classification of not only dermoid cysts but also a small subset of apparently benign testicular teratomas in postpubertal patients that share many features with dermoid cysts but lack cutaneous-type adnexal structures. Features important in the recognition of both forms of these specialized teratomas of the postpubertal testis include absence of all of the following: cytologic atypia, intratubular germ cell neoplasia, unclassified type, significant tubular atrophy/tubular sclerosis, scarred zones, impaired spermatogenesis, microlithiasis, and evidence of chromosome 12p amplification. Other features include frequent organoid morphology and prominent components of ciliated epithelium and smooth muscle. It is important to distinguish these teratomas from the usual ones seen in postpuberal patients because of the malignant potential of the latter.
In the literature, less than ten cases of holocord intramedullary abscess in children have been described. A 15-month-old girl presented with flaccid paraplegia and dermal sinus in the sacral region. MRI highlighted an infected lumbar dermoid cyst. The child underwent surgery to remove the cyst and purulent collection. Five days after surgery, she developed upper limbs paresis. An MRI showed a holocord abscess. A catheter was inserted through a cervical myelotomy into the abscess for drainage with a good postoperative recovery. A rapid management, even for extended or recurrent intramedullary abscess, can prevent potential severe neurological dysfunctions.