Difference between revisions of "Dermal cysts"

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(+alt. term)
(→‎Digital mucous cyst: +pilonidal cyst)
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Images:
Images:
*[http://www.dermpedia.org/files/images/Digital_mucous_cyst_2.jpg Digital mucous cyst (dermpedia.org)].<ref name=dermpedia>URL: [http://www.dermpedia.org/dermpedia-textbook/digital-mucous-myxoid-cyst http://www.dermpedia.org/dermpedia-textbook/digital-mucous-myxoid-cyst]. Accessed on: 17 January 2012.</ref>
*[http://www.dermpedia.org/files/images/Digital_mucous_cyst_2.jpg Digital mucous cyst (dermpedia.org)].<ref name=dermpedia>URL: [http://www.dermpedia.org/dermpedia-textbook/digital-mucous-myxoid-cyst http://www.dermpedia.org/dermpedia-textbook/digital-mucous-myxoid-cyst]. Accessed on: 17 January 2012.</ref>
==Pilonidal cyst==
*[[AKA]] ''pilonidal sinus''.
===General===
*Benign.
*Young adults (late teens, early twenties) - usu. men.<ref>URL: [http://www.nhs.uk/conditions/Pilonidal-sinus/Pages/Introduction.aspx http://www.nhs.uk/conditions/Pilonidal-sinus/Pages/Introduction.aspx]. Accessed on: 10 September 2012.</ref>
===Gross===
*Usually at gluteal folds.
**Uncommon: axilla, genital region, umbilicus, scalp.<ref name=Ref_Derm326>{{Ref Derm|326}}</ref>
===Microscopic===
Features:<ref name=Ref_Derm326>{{Ref Derm|326}}</ref>
*Cyst or pseudocyst into the deep dermis.
**May be lined by squamous epithelium with inflammation +/-[[pseudoepitheliomatous hyperplasia]].
*Neutrophils.
*[[Granuloma|Granulomatous inflammation]].
DDx:
*[[Squamous cell carcinoma of the skin]] with inflammation.<ref name=pmid19482585>{{Cite journal  | last1 = Chatzis | first1 = I. | last2 = Noussios | first2 = G. | last3 = Katsourakis | first3 = A. | last4 = Chatzitheoklitos | first4 = E. | title = Squamous cell carcinoma related to long standing pilonidal-disease. | journal = Eur J Dermatol | volume = 19 | issue = 4 | pages = 408-9 | month =  | year =  | doi = 10.1684/ejd.2009.0705 | PMID = 19482585 }}</ref>
*Infection.


==See also==
==See also==

Revision as of 21:15, 10 September 2012

Dermal cysts, also skin cysts, are common in dermatopathology. Dermatopathologists can diagnose 'em.

Cysts

Common types:[1]

Epidermal necrosis

Venous lake

General

  • Dilated vein.

Clinical:

  • Blanch with pressure.[2]

Gross

  • Purple/blue spot.

Images:

Microscopic

Features:[4]

  • Lined by endothelium.
  • Blood in lumen.
  • +/-Fibrin in lumen.
  • +/-Solar elastosis - very common.[5]

DDx:

Images:

Epidermal inclusion cyst

  • AKA epidermal cyst.

General

  • Very common.

Microscopic

Features:

  • Cyst lining has a granular layer - key feature.[6]
  • Trapped collagen bundles at edge of lesion with surrounded by fibroblasts.
  • Keratin.

Image:

DDx:

Pilar cyst

  • AKA trichilemmal cyst.

General

  • Very common.

Gross

  • Classic location: head ~90%.[9]

Microscopic

Features:

  • Keratin.
  • Cyst lining has no granular layer - key feature.
  • Trapped collagen bundles at edge of lesion with surrounded by fibroblasts.

DDx:

Images:

Steatocystoma

General

  • Benign.
  • Typically adults.
  • Usually on the trunk.
  • May be genetic; known as steatocystoma multiplex.[10]
    • Classically autosomal dominant.[11]

Microscopic

Features:[12]

  • Cyst lined by squamous epithelium with:
    1. Corrugated eosinophilic lining - key feature.
      • Similar appearance to compact keratin (hyperkeratosis).
      • Described as a hyaline cuticle.[13]
    2. No granular cell layer.

Images:

Dermoid cyst

General

Microscopic

Features:[15][16]

  • Cyst lined by normal (keratinized) skin with adnexal structure (hair follicles, sweat glands, sebaceous glands).

DDx:

Images:

Digital mucous cyst

General

  • Dome-shaped papule.

Microscopic

Features:[17]

  • Mucous in superficial dermis - key feature.
  • No epithelial lining; it is a pseudocyst.

Note:

  • Mucin = glycolated proteins; may be part of mucous.
  • Mucous = slippery secretion.
    • Some split hairs over the "u" - "mucus" vs. "mucous".[18][19]

DDx:

Images:

Pilonidal cyst

  • AKA pilonidal sinus.

General

  • Benign.
  • Young adults (late teens, early twenties) - usu. men.[20]

Gross

  • Usually at gluteal folds.
    • Uncommon: axilla, genital region, umbilicus, scalp.[21]

Microscopic

Features:[21]

DDx:

See also

References

  1. Greenwald, J.; Heng, M. (2007). Toronto Notes for Medical Students 2007 (2007 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. D5. ISBN 978-0968592878.
  2. URL: http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=-969536424. Accessed on: 13 August 2012.
  3. 3.0 3.1 3.2 URL: http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=605386295. Accessed on: 13 August 2012.
  4. Weedon's Skin Pathology. 3rd Ed. P.895.
  5. 5.0 5.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 551. ISBN 978-0443066542.
  6. URL: http://emedicine.medscape.com/article/1058907-diagnosis. Accessed on: 18 March 2011.
  7. Crystal, P.; Shaco-Levy, R. (Mar 2005). "Concentric rings within a breast mass on sonography: lamellated keratin in an epidermal inclusion cyst.". AJR Am J Roentgenol 184 (3 Suppl): S47-8. PMID 15728019.
  8. Adams, SP. (Feb 1999). "Dermacase. Eccrine hydrocystoma.". Can Fam Physician 45: 297, 306. PMC 2328272. PMID 10065300. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2328272/.
  9. URL: http://emedicine.medscape.com/article/1058907-overview. Accessed on: 15 April 2012.
  10. Online 'Mendelian Inheritance in Man' (OMIM) 184500
  11. URL: http://path.upmc.edu/cases/case674/dx.html. Accessed on: 29 January 2012.
  12. Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 312. ISBN 978-0443066542.
  13. URL: http://path.upmc.edu/cases/case674/dx.html. Accessed on: 29 January 2012.
  14. URL: http://path.upmc.edu/cases/case674.html. Accessed on: 29 January 2012.
  15. 15.0 15.1 15.2 Gandhi N, Syed NA, Alen R. Dermoid Cyst. EyeRounds.org. posted July 26, 2010; Available from: http://www.EyeRounds.org/cases/115-dermoid-cyst.htm. Accessed on: 22 September 2011.
  16. Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 596. ISBN 978-1416054542.
  17. 17.0 17.1 URL: http://www.dermpedia.org/dermpedia-textbook/digital-mucous-myxoid-cyst. Accessed on: 17 January 2012.
  18. URL: http://dictionary.reference.com/browse/mucous. Accessed on: 8 January 2012.
  19. URL: http://dictionary.reference.com/browse/mucus. Accessed on: 8 January 2012.
  20. URL: http://www.nhs.uk/conditions/Pilonidal-sinus/Pages/Introduction.aspx. Accessed on: 10 September 2012.
  21. 21.0 21.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 326. ISBN 978-0443066542.
  22. Chatzis, I.; Noussios, G.; Katsourakis, A.; Chatzitheoklitos, E.. "Squamous cell carcinoma related to long standing pilonidal-disease.". Eur J Dermatol 19 (4): 408-9. doi:10.1684/ejd.2009.0705. PMID 19482585.