A Retrospective Chart Review of Inflamed Epidermal Inclusion Cysts.

BACKGROUND: Epidermal inclusion cysts (EIC) are one of the most common forms of cysts found on and/or underneath the skin. Inflamed EICs typically show signs and symptoms such as pain and erythema, mimicking cutaneous abscess. However, prior studies have demonstrated at least 20% of lesions are culture negative. OBJECTIVE: To determine the rate of culture positivity in mild inflamed epidermal inclusion cysts, in particular to identify whether empiric antibiotics are warranted. METHODS: In a retrospective chart review 76 cases of inflamed EIC that were mild (lacking systemic symptoms) were analyzed who presented to the department of dermatology at Mount Sinai between 2016–2019. RESULTS: Of cultures taken from inflamed cysts, 47% resulted in no bacterial growth or growth of normal flora, 38.4% resulted in growth of aerobic bacteria with methicillin-resistant Staphylococcus aureus (8%), Staphylococcus lugdunensis (5%), and methicillin-sensitive Staphylococcus aureus (13%) predominating, and 9.3% resulting in growth of anaerobic bacteria with Finegoldia magna, Peptostreptococcus, and Cutibacterium acnes presenting. Review of prescribed treatment regimens often involved antibiotic medication, despite a high prevalence of negative culture. CONCLUSIONS: Almost half of cases of mild inflamed EIC (lacking systemic symptoms) cultured will not grow pathogenic bacteria, therefore incision and drainage with culture and appropriate therapy is a viable therapeutic option in uncomplicated inflamed EIC lesions. In this way, over prescription of antibiotics can be minimized. J Drugs Dermatol. 2021;20(2):199-202. doi:10.36849/JDD.5014.

Intraosseous epidermoid cysts of adjacent digits in a dog.

BACKGROUND: Intraosseous epidermoid cyst (IEC) is a rare, non-neoplastic, pathology in animals and humans that most commonly affects the distal phalanx. In dogs, it is important to differentiate this lesion from malignant digital tumours causing bone lysis. In previous reports, IEC has been described to affect only a single digit at the time of diagnosis which is usually based on histopathology. This is the first case report to describe immunohistochemically confirmed IECs affecting simultaneously multiple digits. CASE PRESENTATION: A 4-and-a-half-year-old female spayed Great Dane was presented with a 2-month history of progressive swelling of the distal phalanx (PIII) of digits IV and V of the right pelvic limb. Eleven weeks prior to presentation, the dog had a low-grade cutaneous mast cell tumour completely excised from the craniolateral base of its left pinna. A history of trauma to 1 of the nails of the same pes 4 years prior to referral was also reported. Examination of the right pelvic limb identified firm non-painful swelling of PIII of digits IV and V, with concurrent deformation of the nails. Radiographs of the right pes obtained by the primary veterinarian identified an expansile lesion of PIII of digits IV and V. Computed tomography identified large expansile lesions of PIII of digits IV and V, with associated cortical thinning and soft tissue swelling. Neoplasia was considered the most likely radiographic diagnosis. Histopathology of Jamshidi bone biopsies was consistent with intraosseous epidermoid cyst, which was confirmed with immunohistochemistry. Amputation of PIII of digits IV and V at the level of mid-PII was performed as definitive treatment. No recurrence of the lesion occurred during the 10-month follow-up period. CONCLUSIONS: Intraosseous epidermoid cysts should be included in the differential diagnosis for expansile lesions affecting the canine digit. It is important to differentiate them from other digital lesions, with bone involvement, such as malignant digital tumours, which often require more extensive surgery for definitive treatment. The case herein highlights that this lesion can affect simultaneously multiple digits. Definitive diagnosis can be achieved by identification of keratin-producing epithelial cells on histopathology and confirmed by pancytokeratin labelling.

Spontaneous Regression of Radiologically Diagnosed Epidermoid Cyst Originating from the Cerebellopontine Angle.

BACKGROUND: Generally, asymptomatic epidermoid cysts (ECs) or ECs with minor symptoms controlled by medication are not treated further. Although epidermoid carcinomas are only sporadically reported, the possibility of malignant transformation of ECs is of concern. CASE DESCRIPTION: A 77-year-old man under observation for a left cerebellopontine angle tumor presented with no symptoms, including headache, dizziness, or other cranial nerve abnormalities typical of cerebellopontine angle tumors. The tumor manifested as an extra-axial mass in the left cerebellopontine angle and measured 24 × 16 mm (length × width) on magnetic resonance imaging (MRI). As he was asymptomatic, his primary physician did not pursue invasive treatment but ordered follow-up MRI every 2 years. The tumor decreased in size 2 years after the initial MRI, and no tumor fragmentation was observed on the patient's spinal MRI. Ultimately, the tumor shrank to 19 × 11 mm over 22 years. CONCLUSIONS: The reduction of an EC is extremely rare. We report a case of spontaneous regression of an EC and consider similar previous cases.

The clinical features and treatment options of intratesticular epidermoid cysts. / Las características clínicas y opciones de tratamiento de los quistes epidermoides intratesticulares.

OBJECTIVES: In this study, we aimed to define the clinico-radiological data and treatment options for intratesticular epidermoid cysts (IEC). MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients that under went surgery for testicular mass between 1995 and 2017. Data of the patients whose histopathological evaluation revealed IEC were recorded.  RESULTS: A total of 20 patients with IEC were identified.While three of 20 patients were excluded due to incomplete data, the remaining 17 patients with pathologically proven IEC were reviewed and analyzed in the study. The mean patient age was 22.2 years (range, 17-29 years). All patients were presented with painless testicular swelling and/or mass. Serum tumor markers of all patients were within the ranges. Four patients treated with radical orchiectomy (23.5%), while 13 patients under went partial orchiectomy (76.5%). The mean size ofthe IEC was 17.7x15.1 mm (range, 26x10 mm). IEC swere mostly located in the middle pole of the testes (10of 17 patients, 58.8%). CONCLUSIONS: This study is designed in retrospective nature, but the patient population is one the largest reported in the literature. According to our study, we can easily state that partial orchiectomy can be performed safely after FSA in patients that have IECs.

OBJETIVOS: En este estudio, nuestro objetivofue definir los datos clínico-radiológicos y las opciones de tratamiento de los quistes epidermoides intratesticulares (CEI). MATERIALES Y MÉTODOS: Revisamos retrospectivamente los registros médicos de los pacientes que se sometieron a cirugía para la masa testicular entre 1995 y 2017. Entre ellos se registraron los datos de los pacientes cuya evaluación histopatológica reveló IEC. RESULTADOS: Se identificaron un total de 20 pacientes con IEC. Mientras que tres de los 20 pacientes fueron excluidos debido a los datos incompletos, los 17pacientes restantes con IEC patológicamente probada se revisaron y analizaron en el estudio. La edad media de los pacientes fue de 22,2 años (rango, 17-29años). A todos los pacientes se les presentó hinchazón y/o masa testicular indolora. Los marcadores tumorales séricos de todos los pacientes estaban dentro de los rangos. Cuatro pacientes tratados con orquiectomía radical (23,5%), mientras que 13 pacientes se sometieron a orquiectomía parcial (76,5%). El tamaño medio de la IEC fue de 17,7x15,1 mm (rango, 26x10 mm). Los IEC se encontraban principalmente en el polo medio de los testículos (10 de 17 pacientes, 58,8%). CONCLUSIONES: Este estudio está diseñado de forma retrospectiva, pero la población de pacientes es una de las más numerosas que se han publicado en la literatura. Según nuestro estudio, podemos afirmar fácilmente que la orquiectomía parcial se puede realizar de manera segura después de la FSA en pacientes que tienen CEI.

Las características clínicas y opciones de tratamiento de los quistes epidermoides intratesticulares / The clinical features and treatment options of intratesticular epidermoid cysts

OBJETIVOS: En este estudio, nuestro objetivofue definir los datos clínico-radiológicos y las opciones de tratamiento de los quistes epidermoides intratesticulares (CEI). MATERIALES Y MÉTODOS: Revisamos retrospectivamente los registros médicos de los pacientes que se sometieron a cirugía para la masa testicular entre 1995 y 2017. Entre ellos se registraron los datos de los pacientes cuya evaluación histopatológica reveló IEC. RESULTADOS: Se identificaron un total de 20 pacientes con IEC. Mientras que tres de los 20 pacientes fueron excluidos debido a los datos incompletos, los 17pacientes restantes con IEC patológicamente probada se revisaron y analizaron en el estudio. La edad media de los pacientes fue de 22,2 años (rango, 17-29años). A todos los pacientes se les presentó hinchazón y/o masa testicular indolora. Los marcadores tumorales séricos de todos los pacientes estaban dentro de los rangos. Cuatro pacientes tratados con orquiectomía radical (23,5%), mientras que 13 pacientes se sometieron a orquiectomía parcial (76,5%). El tamaño medio de la IEC fue de 17,7 x 15,1 mm (rango, 26 x 10 mm). Los IEC se encontraban principalmente en el polo medio de los testículos (10 de 17 pacientes, 58,8%). CONCLUSIONES: Este estudio está diseñado de forma retrospectiva, pero la población de pacientes es una de las más numerosas que se han publicado en la literatura. Según nuestro estudio, podemos afirmar fácilmente que la orquiectomía parcial se puede realizar de manera segura después de la FSA en pacientes que tienen CEI

OBJECTIVES: In this study, we aimed to define the clinico-radiological data and treatment options for intratesticular epidermoid cysts (IEC). MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients that under went surgery for testicular mass between 1995 and 2017. Data of the patients whose histopathological evaluation revealed IEC were recorded. RESULTS: A total of 20 patients with IEC were identified.While three of 20 patients were excluded due to incomplete data, the remaining 17 patients with pathologically proven IEC were reviewed and analyzed in the study. The mean patient age was 22.2 years (range, 17-29 years). All patients were presented with painless testicular swelling and/or mass. Serum tumor markers of all patients were within the ranges. Four patients treated with radical orchiectomy (23.5%), while 13 patients under went partial orchiectomy (76.5%). The mean size ofthe IEC was 17.7 x 15.1 mm (range, 26 x 10 mm). IEC swere mostly located in the middle pole of the testes (10of 17 patients, 58.8%). CONCLUSIONS: This study is designed in retrospective nature, but the patient population is one the largest reported in the literature. According to our study, we can easily state that partial orchiectomy can be performed safely after FSA in patients that have IECs

Tumors of the Ischiorectal Fossa: A Single-Institution Experience.

BACKGROUND: Ischiorectal fossa tumors are rare. OBJECTIVE: This study reviews a single institution's series of ischiorectal tumors with comparison against presacral tumors and assesses the utility of preoperative biopsy and angioembolization. DESIGN: This is a retrospective study. SETTINGS: This study was conducted at a quaternary referral center. PATIENTS: All patients with ischiorectal tumor treated between February 1995 and April 2017 were retrospectively reviewed. Tumors extending secondarily into the ischiorectal fossa and inflammatory pathologies were excluded. INTERVENTIONS: Preoperative biopsy, neoadjuvant therapy, angioembolization, and surgical excision of these tumors were reviewed. MAIN OUTCOME MEASURES: Demographic, perioperative, pathological, and oncologic outcomes were evaluated. RESULTS: Twenty-four patients (15 female; median age 54) were identified. Two-thirds were symptomatic. Forty-six percent had a palpable mass. All patients had CT and/or MRI. Fifty percent had a preoperative biopsy, of which 83% were diagnostic, and management was altered in 50%. All patients underwent surgical excision. Fifty-five percent had local excision, 38% had radical pelvic excision, and 8% had total mesorectal excision. Two patients had preoperative angioembolization. Both had successful R0 local excision. Morbidity occurred in 25%, with 1 major complication. There was no 30-day mortality. Histopathology demonstrated 17 soft tissue tumors (3 malignant), 2 GI stromal tumors, 1 neuroendocrine tumor, 1 Merkel cell carcinoma, 1 basaloid carcinoma, 1 epidermal cyst, and 1 lipoma. R0 resection was achieved in 75%. All patients were alive after a median follow-up of 33 months. Four patients developed recurrence at a median 10 months postoperatively. All recurrences were malignant, and 75% had had a R1 resection. LIMITATIONS: This study is limited by its small numbers. The quaternary institution source may introduce bias. CONCLUSIONS: Ischiorectal fossa tumors are heterogeneous and more likely to be malignant than presacral tumors. Biopsy can be useful if a malignant diagnosis is suspected and changes management in 50% of cases. Preoperative embolization may be useful for large vascular tumors. R0 resection is important to minimize recurrence. See Video Abstract at http://links.lww.com/DCR/A779.

Epidermoid Cyst of the Cerebellopontine Angle Presenting with Contralateral Trigeminal Neuralgia: Extremely Rare Case and Review of Literature.

BACKGROUND: An epidermoid cyst is a rare tumor of the cerebellopontine angle region. It usually presents with ipsilateral compressive symptoms. The contralateral trigeminal neuralgia is an unusual presentation in such cases. We did not find such case reports in the literature. CASE DESCRIPTION: Here, we report a case of a 62-year-old female with a right cerebellopontine angle epidermoid cyst presenting with right hearing impairment and the contralateral trigeminal neuralgia. CONCLUSION: The possible mechanism leading to the contralateral trigeminal neuralgia is discussed here along with the diagnosis and management of the case.

Impact of Perioperative Voice Therapy on Outcomes in the Surgical Management of Vocal Fold Cysts.

INTRODUCTION: Vocal fold cysts are benign mid-membranous lesions of the true vocal fold, classified as mucus retention or epidermal inclusion cysts. Treatment is surgical excision with or without postoperative voice therapy. METHODS: A retrospective review was performed of the demographics, treatment approach, and outcomes of patients treated for vocal fold cysts between 2009 and 2014. Voice Handicap Index (VHI)-10 scores before and after treatment were compared using the Wilcoxon Rank-Sum test and the two-tailed Student's t test. Videostroboscopy examinations were reviewed for posttreatment changes in vibratory characteristics of the vocal folds. RESULTS: Twenty-five patients were identified, and one was excluded for incomplete records. Mean age was 41.9 years (66.7% female), and mean follow-up time was 5.58 months. Microflap excision was pursued by 21/24 (87.5%) patients, with 14 patients (58.3%) undergoing perioperative voice therapy. One cyst recurred. Two patients elected for observation, and their cysts persisted. VHI-10 decreased from 23.8 to 6.6 (P < 0.001) overall. There was a statistically significant reduction in VHI-10 in patients undergoing surgery with and without postoperative voice therapy (P < 0.004 and 0.001), but there was no significant difference between these two groups. Mucosal wave was classified as normal or improved in the majority. Cysts were characterized as mucus retention cysts in 19/21 (90%) and as epidermal inclusion cysts in 2/21 (10%). CONCLUSIONS: Vocal fold cysts impact mucosal wave and glottic closure. Surgical excision resulted in low rates of recurrence, and in improvement in the mucosal wave and VHI-10. Perioperative voice therapy did not offer a significant benefit. Mucus retention cysts were the majority, in contrast to other published studies.

Repeated recurrent epidermoid cyst with atypical hyperplasia: A case report and literature review.

RATIONALE: Epidermoid cysts are slow-growing, benign tumor which account for less than 1% of all intraspinal tumors and epidermoid cyst with Atypical Hyperplasia is very rare. Surgical resection is the standard treatment of the tumor, but recurrence is not uncommon after incomplete resection. Inappropriate treatment can lead to repeated recurrent. Here, we reported a case of repeated recurrent epidermoid cyst with atypical hyperplasia treated with radiotherapy after surgery. PRESENTING CONCERNS: A 40-year-old female presenting with intraspinal epidermoid cyst showed incomplete paraplegia in lower limbs. DIAGNOSIS: Back pain reappeared 19 months later after surgical treatment. The patient suffered marked weakness in both limbs, along with obvious muscle atrophy and sensation deficiency of warmth and pain in left lower limb. MRI demonstrated a cystic mass with solid content and peripheral strengthen in enhanced scan. INTERVENTIONS: Extended excision with intraoperative local chemotherapy and postoperative radiotherapy was performed and a dramatic reversal of symptoms was gained 4 weeks after surgery, with a total dose of 46 Gy. Postoperative pathological examination revealed epidermoid cyst with mild to moderate atypical hyperplasia. OUTCOMES: No acute side effects of the treatment were reported. Back pain obviously alleviated within 48 hours after surgery, while weakness and numbness of the lower limbs gradually improved and nearly disappeared in the 3-monthly follow-up visit. Until now, no recurrence is found during the 5-years follow-up. LESSONS: Our study highlights that incomplete excision has led to repeated recurrent epidermoid cyst, but its complete removal with adjuvant radiotherapy has achieved remission of symptoms. Atypical hyperplasia discovered by pathological examination reminds us the possibility of malignant transformation and ensures the necessity of adequate treatment.

Epidermoid Cyst of Mandible Ramus: Case Report.

INTRODUCTION: An epidermoid cyst is a benign cyst usually found on the skin. Bone cysts are very rare and if they appear in bone they usually appear in the distal phalanges of the fingers. Epidermoid cysts of the jaws are uncommon. CASE PRESENTATION: We present a case, of a 41 year-old female patient admitted to our department because of pain and swelling in the parotid and masseteric region-left side. There was no trismus, pathological findings in skin, high body temperature level, infra-alveolar nerves anesthesia or lymphadenopathy present. The orthopantomography revealed a cystic lesion and a unilocular lesion that included mandibular ramus on the left side with 3 cm in diameter. Under total anesthesia, a cyst had been reached and was enucleated. Histopathologic findings showed that the pathologic lesion was an epidermoid cyst. DISCUSSION: Epidermoid and dermoid cysts are rare, benign lesions found throughout the body. Only a few cases in literature describe an intraossesus epidermoid cyst. CONCLUSION: Our case is an epidermoid cyst with a rare location in the region of the mandibular ramus. It is not associated with any trauma in this region except medical history reveals there was an operative removal of a wisdom tooth 12 years ago in the same side. These cysts are interesting from the etiological point of view. They should be considered in the differential diagnosis of other radiolucent lesions of the jaws. Surgically they have a very good prognosis, and are non-aggressive lesions.

Diagnosing Common Benign Skin Tumors.

Patients will experience a wide range of skin growths and changes over their lifetime. Family physicians should be able to distinguish potentially malignant from benign skin tumors. Most lesions can be diagnosed on the basis of history and clinical examination. Lesions that are suspicious for malignancy, those with changing characteristics, symptomatic lesions, and those that cause cosmetic problems may warrant medical therapy, a simple office procedure (e.g., excision, cryosurgery, laser ablation), or referral. Acrochordons are extremely common, small, and typically pedunculated benign neoplasms. Simple scissor or shave excision, electrodesiccation, or cryosurgery can be used for treatment. Sebaceous hyperplasia presents as asymptomatic, discrete, soft, pale yellow, shiny bumps on the forehead or cheeks, or near hair follicles. Except for cosmesis, they have no clinical significance. Lipomas are soft, flesh-colored nodules that are easily moveable under the overlying skin. Keratoacanthomas are rapidly growing, squamoproliferative benign tumors that resemble squamous cell carcinomas. Early simple excision is recommended. Pyogenic granuloma is a rapidly growing nodule that bleeds easily. Treatment includes laser ablation or shave excision with electrodesiccation of the base. Dermatofibromas are an idiopathic benign proliferation of fibroblasts. No treatment is required unless there is a change in size or color, bleeding, or irritation from trauma. Epidermal inclusion cysts can be treated by simple excision with removal of the cyst and cyst wall. Seborrheic keratoses and cherry angiomas generally do not require treatment.

Utility of Sonoelastography in Differentiating Ruptured From Unruptured Epidermal Cysts and Implications for Patient Care.

OBJECTIVES: This study aimed to evaluate the correlation of sonoelastographic features between ruptured and unruptured epidermal cysts. METHODS: We performed a prospective survey of 27 patients with clinically suspected epidermal cysts diagnosed by excisional biopsy with prebiopsy sonography and real-time sonoelastography. We statistically evaluated the correlation between elastographic and histopathologic features. To measure the relative hardness on elastography, the Rinside/Routside ratio was used to show the ratio of the elasticity inside and outside the cyst, where the random value R was defined as the median red pixel intensity/(median red pixel intensity + median green pixel intensity + median blue pixel intensity). RESULTS: Only 24 of the 27 patients were enrolled. Among the 24 diagnosed epidermal cysts, 13 were unruptured cysts, and 11 were ruptured cysts based on histopathologic examination. There was no correlation between sonographically and histopathologically measured cyst diameters. The Rinside/Routside ratio was significantly higher in unruptured cysts than ruptured cysts (mean ± SD, 1.16 ± 0.15 versus 1.04 ± 0.13; P = .047). All values below the cutoff point were considered to indicate ruptured cysts, and the cutoff value was set to 1.0919, which afforded sensitivity of 83.3% and specificity of 66.7%. CONCLUSIONS: Real-time sonoelastography is able to detect differences in tissue elasticity between ruptured and unruptured epidermal cysts. This study shows the utility of real-time sonoelastography, which has important implications for treatment planning.

Large epidermoids of the quadrigeminal cistern: an experience of 15 consecutive cases and review of literature.

BACKGROUND: Large epidermoids of the quadrigeminal cistern (LEQCs) of more than 4 cm in size are benign intracranial tumours and present with diverse clinical manifestations. Fifteen cases of LEQC have been treated in our institute over last 10 years. METHODS: This is a retrospective study of the 15 LEQCs treated in our institute from January 2001 to May 2011. We classified these epidermoids into three types, based on the location of the major bulk of the epidermoid, to tailor surgical approaches to these tumours. RESULTS: Fifteen patients (age range 14-45 years, mean age 27.2 years) were operated upon after clinicoradiological evaluation. Eight were females and seven were males. The mean duration of symptoms was 9.2 months. Symptoms of raised intracranial pressure were present in ten patients. Surgical approaches included infratentorial-supracerebellar approach in nine cases, the occipital transtentorial approach in five cases and subtemporal approach one case. Complete excision was possible in ten (66.6 %) cases, near total in four (26.6 %) and subtotal excision in one case. Six patients underwent cerebrospinal fluid (CSF) diversion by ventriculoperitoneal (VP) shunt. Twelve patients improved with surgery and are functionally active. One patient developed hemiparesis. There were two deaths in our series. CONCLUSION: LEQC may present with hydrocephalus, unlike epidermoids at other intracranial locations. Complete surgical excision is possible in most of the patients and it helps in re-establishing the CSF pathway. Early surgery in these patients prevents postoperative shunt dependence. Most of the patients improve after surgery.

[Observation of dirofilariosis in the practical work of the otorhinolaryngologist].

A case of dirofilariosis is reported. The disease is believed to be caused by the contact with the cat that the patient brought in from Uzbekistan. The authors emphasize the importance of analysis of the medical history of the patients presenting with the pathology being considered, their medical examination, and correct interpretation of X-ray images of the paranasal sinuses taking into account the possibility of distribution of rare helminth species beyond their usual ranges.