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| '''Dermal cysts''', also '''skin cysts''', are common in [[dermatopathology]]. Dermatopathologists can diagnose 'em. | | '''Dermal cysts''', also '''skin cysts''', are common in [[dermatopathology]]. Dermatopathologists can diagnose 'em. |
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| ==Cysts== | | =Overview= |
| Common types:<ref name=Ref_TN2007_D5>{{Ref TN2007| D5}}</ref> | | Common types:<ref name=Ref_TN2007_D5>{{Ref TN2007| D5}}</ref> |
| *[[Epidermal cyst]] (sebaceous cyst) -- most common. | | *[[Epidermal cyst]] (sebaceous cyst) -- most common. |
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| *This may be cystic. It is covered in the ''[[epidermal necrosis]]'' article, which covers [[erythema multiforme]], [[Steven-Johnson syndrome]] and [[toxic epidermal necrolysis]]. | | *This may be cystic. It is covered in the ''[[epidermal necrosis]]'' article, which covers [[erythema multiforme]], [[Steven-Johnson syndrome]] and [[toxic epidermal necrolysis]]. |
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| | =Common cysts= |
| ==Venous lake== | | ==Venous lake== |
| ===General===
| | {{Main|Venous lake}} |
| *Dilated vein.
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| Clinical:
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| *Blanch with pressure.<ref>URL: [http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=-969536424 http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=-969536424]. Accessed on: 13 August 2012.</ref>
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| ===Gross===
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| *Purple/blue spot.
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| Images:
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| *[http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=-969536424 Venous lake (jhmi.edu)].<ref name=jhmi_vl>URL: [http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=605386295 http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=605386295]. Accessed on: 13 August 2012.</ref>
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| *[http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=-881531868 Venous lake (jhmi.edu)].<ref name=jhmi_vl>URL: [http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=605386295 http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=605386295]. Accessed on: 13 August 2012.</ref>
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| ===Microscopic===
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| Features:<ref>Weedon's Skin Pathology. 3rd Ed. P.895.</ref>
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| *Lined by endothelium.
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| *Blood in lumen.
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| *+/-Fibrin in lumen.
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| *+/-Solar elastosis - very common.<ref name=Ref_Derm551>{{Ref Derm|551}}</ref>
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| DDx:
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| *[[Angiokeratoma]].
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| **Ectatic superficial dermal vessels.
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| **Irregular acanthosis.
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| **Longer rete ridges.
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| *[[Cherry hemangioma]].<ref name=Ref_Derm551>{{Ref Derm|551}}</ref>
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| Images:
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| *[http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=1982738883 Venous lake (jhmi.edu)].<ref name=jhmi_vl>URL: [http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=605386295 http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=605386295]. Accessed on: 13 August 2012.</ref>
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| ==Epidermal inclusion cyst== | | ==Epidermal inclusion cyst== |
| *[[AKA]] ''epidermal cyst''.
| | {{Main|Epidermal inclusion cyst}} |
| ===General===
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| *Very common.
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| ===Microscopic===
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| Features:
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| *Cyst lining has a granular layer - '''key feature'''.<ref>URL: [http://emedicine.medscape.com/article/1058907-diagnosis http://emedicine.medscape.com/article/1058907-diagnosis]. Accessed on: 18 March 2011.</ref>
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| *Trapped collagen bundles at edge of lesion with surrounded by fibroblasts.
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| *Keratin.
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| Image:
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| *[http://www.flickr.com/photos/euthman/5517587941/in/photostream/ Epidermal inclusion cyst (flickr.com)].
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| *[http://www.ajronline.org/content/184/3_supp/S47/F4.expansion.html Epidermal inclusion cyst (ajronline.org)].<ref name=pmid15728019>{{Cite journal | last1 = Crystal | first1 = P. | last2 = Shaco-Levy | first2 = R. | title = Concentric rings within a breast mass on sonography: lamellated keratin in an epidermal inclusion cyst. | journal = AJR Am J Roentgenol | volume = 184 | issue = 3 Suppl | pages = S47-8 | month = Mar | year = 2005 | doi = | PMID = 15728019 |URL = http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=15728019}}</ref>
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| DDx:
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| *[[Pilar cyst]] - no granular layer.
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| *[[Eccrine hidrocystoma]] - eyelid lesion; same histology.<ref name=pmid10065300>{{Cite journal | last1 = Adams | first1 = SP. | title = Dermacase. Eccrine hydrocystoma. | journal = Can Fam Physician | volume = 45 | issue = | pages = 297, 306 | month = Feb | year = 1999 | doi = | PMID = 10065300 |PMC = 2328272 }}</ref>
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| *[[Dermoid cyst]] - has adnexal structures, i.e. hair follicle, sebaceous glands, sweat glands.
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| *[[Dermatofibrosarcoma protuberans]] - if lesion is large.
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| ==Pilar cyst== | | ==Pilar cyst== |
| *[[AKA]] trichilemmal cyst. | | *[[AKA]] ''trichilemmal cyst''. |
| ===General===
| | {{Main|Pilar cyst}} |
| *Very common.
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| ===Gross===
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| *Classic location: head ~90%.<ref>URL: [http://emedicine.medscape.com/article/1058907-overview http://emedicine.medscape.com/article/1058907-overview]. Accessed on: 15 April 2012.</ref>
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| ===Microscopic===
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| Features:
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| *Keratin.
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| *Cyst lining has no granular layer - '''key feature'''.
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| *Trapped collagen bundles at edge of lesion with surrounded by fibroblasts.
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| DDx:
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| *[[Epidermal cyst]] - has a granular layer.
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| Images:
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| *www:
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| **[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=69966366 Trichilemmal cyst (dermatlas.med.jhmi.edu)].
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| **[http://www.flickr.com/photos/40764007@N08/3881846034/in/photostream/ Trichilemmal cyst (flickr.com)].
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| *[[WC]]:
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| **[http://commons.wikimedia.org/wiki/File:Trichilemmal_cyst_-_intermed_mag.jpg Trichilemmal cyst - intermed. mag. (WC)].
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| **[http://commons.wikimedia.org/wiki/File:Trichilemmal_cyst_-_very_high_mag.jpg Trichilemmal cyst - very high mag. (WC)].
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| ==Steatocystoma==
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| ===General===
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| *Benign.
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| *Typically adults.
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| *Usually on the trunk.
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| *May be genetic; known as ''steatocystoma multiplex''.<ref name=omim184500>{{OMIM|184500}}</ref>
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| **Classically autosomal dominant.<ref>URL: [http://path.upmc.edu/cases/case674/dx.html http://path.upmc.edu/cases/case674/dx.html]. Accessed on: 29 January 2012.</ref>
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| ===Microscopic===
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| Features:<ref name=Ref_Derm312>{{Ref Derm|312}}</ref>
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| *Cyst lined by squamous epithelium with:
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| *#Corrugated eosinophilic lining - '''key feature'''.
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| *#*Similar appearance to compact keratin (hyperkeratosis).
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| *#*Described as a ''hyaline cuticle''.<ref>URL: [http://path.upmc.edu/cases/case674/dx.html http://path.upmc.edu/cases/case674/dx.html]. Accessed on: 29 January 2012.</ref>
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| *#'''No''' granular cell layer.
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| Images:
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| *www:
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| **[http://www.flickr.com/photos/santoshpath/4788590105/in/photostream/ Steatocystoma - low mag. (flickr.com)].
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| **[http://www.flickr.com/photos/santoshpath/4788590109/ Steatocystoma - high mag. (flickr.com)].
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| **[http://path.upmc.edu/cases/case674/images/fig03.jpg Steatocystoma (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case674.html http://path.upmc.edu/cases/case674.html]. Accessed on: 29 January 2012.</ref>
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| *[[WC]]:
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| **[http://commons.wikimedia.org/wiki/File:SkinTumors-P6260388.JPG Steatocystoma (WC)].
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| **[http://commons.wikimedia.org/wiki/File:Steatocystoma_-_low_mag.jpg Steatocystoma - low mag. (WC)].
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| **[http://commons.wikimedia.org/wiki/File:Steatocystoma_-_intermed_mag.jpg Steatocystoma - intermed. mag. (WC)].
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| ==Dermoid cyst== | | ==Dermoid cyst== |
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| *[http://webeye.ophth.uiowa.edu/eyeforum/cases-i/case115/larger/Figure3.jpg Dermoid cyst - low mag. (uiowa.edu)].<ref name=dc_uiowa>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 http://www.EyeRounds.org/cases/115-dermoid-cyst.htm]. Accessed on: 22 September 2011.</ref> | | *[http://webeye.ophth.uiowa.edu/eyeforum/cases-i/case115/larger/Figure3.jpg Dermoid cyst - low mag. (uiowa.edu)].<ref name=dc_uiowa>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 http://www.EyeRounds.org/cases/115-dermoid-cyst.htm]. Accessed on: 22 September 2011.</ref> |
| *[http://webeye.ophth.uiowa.edu/eyeforum/cases-i/case115/larger/Figure4.jpg Dermoid cyst - intermed. mag. (uiowa.edu)]. | | *[http://webeye.ophth.uiowa.edu/eyeforum/cases-i/case115/larger/Figure4.jpg Dermoid cyst - intermed. mag. (uiowa.edu)]. |
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| | ===Sign out=== |
| | <pre> |
| | SKIN CYST, RIGHT LATERAL ORBIT, EXCISION: |
| | - DERMOID CYST |
| | - NEGATIVE FOR MALIGNANCY. |
| | </pre> |
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| | ==Pilonidal cyst== |
| | *[[AKA]] ''pilonidal sinus''. |
| | *[[AKA]] ''pilonidal disease''.<ref>URL: [http://emedicine.medscape.com/article/788127-overview http://emedicine.medscape.com/article/788127-overview]. Accessed on: 10 September 2012.</ref> |
| | {{Main|Pilonidal sinus}} |
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| | =Less common= |
| | ==Steatocystoma== |
| | {{Main|Steatocystoma}} |
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| ==Digital mucous cyst== | | ==Digital mucous cyst== |
| | *[[AKA]] ''digital synovial cyst''.<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> |
| | *[[AKA]] ''digital myxoid pseudocyst''.<ref name=dermpedia/> |
| ===General=== | | ===General=== |
| *Dome-shaped papule. | | *Dome-shaped [[papule]]. |
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| ===Microscopic=== | | ===Microscopic=== |
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| DDx: | | DDx: |
| *[[Focal cutaneous mucinosis]]. | | *[[Focal cutaneous mucinosis]]. |
| | *[[Ganglion 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> |
| | *[http://www.dermpedia.org/files/images/Untitled89.jpg Digital mucous cyst (dermpedia.org)].<ref>URL: [http://www.dermpedia.org/case/digital-mucous-cyst-ganglion-type http://www.dermpedia.org/case/digital-mucous-cyst-ganglion-type]. Accessed on: 5 July 2013.</ref> |
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| ==Pilonidal cyst== | | ===Sign out=== |
| *[[AKA]] ''pilonidal sinus''.
| | <pre> |
| *[[AKA]] ''pilonidal disease''.<ref>URL: [http://emedicine.medscape.com/article/788127-overview http://emedicine.medscape.com/article/788127-overview]. Accessed on: 10 September 2012.</ref>
| | LESION, LEFT INDEX FINGER, EXCISION: |
| | - DIGITAL MUCOUS CYST. |
| | </pre> |
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| | ==Apocrine cystadenoma== |
| ===General=== | | ===General=== |
| *Benign.
| | *Uncommon. |
| *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>
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| ===Gross===
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| *Usually at gluteal folds.
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| **Uncommon: axilla, genital region, umbilicus, scalp.<ref name=Ref_Derm326>{{Ref Derm|326}}</ref>
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| ===Microscopic=== | | ===Microscopic=== |
| Features:<ref name=Ref_Derm326>{{Ref Derm|326}}</ref> | | Features:<ref name=Ref_Derm316>{{Ref Derm|316}}</ref> |
| *Cyst or pseudocyst into the deep dermis. | | *Multiloculated. |
| **May be lined by squamous epithelium with inflammation +/-[[pseudoepitheliomatous hyperplasia]]. | | *Apocrine differentiation: columnar epithelium +/- apical snouts. |
| *Neutrophils. | | *Solid areas of epithelial proliferation. |
| *[[Granuloma|Granulomatous inflammation]]. | | *Papillary projections into the cyst. |
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| DDx:
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| *[[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> | | *[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=7292 Apocrine cystadenoma (unibas.ch)]. |
| *Infection.
| | *[http://www.flickr.com/photos/40764007@N08/6499470691/ Apocrine cystadenoma (flickr.com)]. |
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| ==See also==
| | =See also= |
| *[[Non-malignant skin disease]] | | *[[Non-malignant skin disease]] |
| *[[Dermatopathology introduction]] | | *[[Dermatopathology introduction]] |
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| ==References==
| | =References= |
| {{reflist|2}} | | {{reflist|2}} |
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| [[Category:Non-malignant skin disease]] | | [[Category:Non-malignant skin disease]] |
| [[Category:Dermatopathology]] | | [[Category:Dermatopathology]] |