Difference between revisions of "Dermal cysts"

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=Common cysts=
=Common cysts=
==Venous lake==
==Venous lake==
===General===
{{Main|Venous lake}}
*Dilated vein.
 
Clinical:
*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>
 
===Gross===
*Purple/blue spot.
 
Images:
*[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>
*[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>
 
===Microscopic===
Features:<ref>Weedon's Skin Pathology. 3rd Ed. P.895.</ref>
*Lined by endothelium.
*Blood in lumen.
*+/-Fibrin in lumen.
*+/-[[Solar elastosis]] - very common.<ref name=Ref_Derm551>{{Ref Derm|551}}</ref>
 
DDx:
*[[Angiokeratoma]].
**Ectatic superficial dermal vessels.
**Irregular [[acanthosis]].
**Longer rete ridges.
*[[Cherry hemangioma]].<ref name=Ref_Derm551>{{Ref Derm|551}}</ref>
 
Images:
*[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>
*[http://www.dermpedia.org/case-type/9?page=63 Venous lake (dermpedia.org)].<ref>URL: [http://www.dermpedia.org/case/70-year-old-woman-with-nose-lesion http://www.dermpedia.org/case/70-year-old-woman-with-nose-lesion]. Accessed on: 21 June 2013.</ref>
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?s=20080802172033945 Venous lake (surgical pathologyatlas.com)].
 
===Sign out===
<pre>
SKIN LESION, RIGHT CHEEK, BIOPSY:
- VENOUS LAKE.
- SOLAR ELASTOSIS.
- NEGATIVE FOR NEVUS.
</pre>


==Epidermal inclusion cyst==
==Epidermal inclusion cyst==
*Abbreviated ''EIC''.
{{Main|Epidermal inclusion cyst}}
*[[AKA]] ''epidermal cyst''.
*[[AKA]] ''epidermoid cyst''.<ref name=Ref_Derm302>{{Ref Derm|302}}</ref>
*[[AKA]] ''follicular cyst, infundibular type''.
===General===
*Very common.
*The clinical term is ''[[sebaceous cyst]]''.
**This is a misnomer as they contain keratin (not sebum).<ref name=dermis36946>URL: [http://www.dermis.net/dermisroot/en/36946/diagnose.htm http://www.dermis.net/dermisroot/en/36946/diagnose.htm]. Accessed on: 2 November 2012.</ref><ref name=pmid18201468>{{Cite journal  | last1 = Venus | first1 = MR. | last2 = Eltigani | first2 = EA. | last3 = Fagan | first3 = JM. | title = Just another sebaceous cyst? | journal = Ann R Coll Surg Engl | volume = 89 | issue = 6 | pages = W19-21 | month = Sep | year = 2007 | doi = 10.1308/147870807X227791 | PMID = 18201468 | PMC = 2121251 }}.</ref>
**The term may be used to refer to a [[pilar cyst]].
 
===Gross===
Features:<ref>URL: [http://dermatlas.med.jhmi.edu/derm/result.cfm?diagnosis=128 http://dermatlas.med.jhmi.edu/derm/result.cfm?diagnosis=128]. Accessed on: 2 November 2012.</ref>
*[[Nodule]].
*+/-Yellowish colour.
 
DDx:
*[[Pilar cyst]] - indistinguishable on gross.<ref name=dermis36946>URL: [http://www.dermis.net/dermisroot/en/36946/diagnose.htm http://www.dermis.net/dermisroot/en/36946/diagnose.htm]. Accessed on: 2 November 2012.</ref>
*[[Melanoma]].<ref name=pmid18201468/>
 
====Image====
<gallery>
Image:Inflamed_epidermal_inclusion_cyst.jpg |Epidermal inclusion cyst. (WC)
</gallery>
===Microscopic===
Features:
*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>
*Trapped collagen bundles at edge of lesion with surrounded by fibroblasts.
*Keratin.
*+/-[[granuloma|Granulomatous inflammation]] due to rupture.
 
DDx:
*[[Pilar cyst]] - no granular layer.
*[[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>
*[[Dermoid cyst]] - has adnexal structures, i.e. hair follicle, sebaceous glands, sweat glands.
*Cystic [[squamous cell carcinoma of the skin|squamous cell carcinoma]].<ref name=pmid12079164>{{Cite journal  | last1 = Lin | first1 = CY. | last2 = Jwo | first2 = SC. | title = Squamous cell carcinoma arising in an epidermal inclusion cyst. | journal = Chang Gung Med J | volume = 25 | issue = 4 | pages = 279-82 | month = Apr | year = 2002 | doi =  | PMID = 12079164 }}</ref>
*[[Keratoacanthoma]].<ref name=Ref_Derm302>{{Ref Derm|302}}</ref>
*[[Dermatofibrosarcoma protuberans]] - if lesion is large.
*Hybrid epidermoid and trichilemmal cyst.<ref name=pmid6643785>{{Cite journal  | last1 = Brownstein | first1 = MH. | title = Hybrid cyst: a combined epidermoid and trichilemmal cyst. | journal = J Am Acad Dermatol | volume = 9 | issue = 6 | pages = 872-5 | month = Dec | year = 1983 | doi =  | PMID = 6643785 }}</ref>
 
====Images====
www:
*[http://www.flickr.com/photos/euthman/5517587941/in/photostream/ Epidermal inclusion cyst (flickr.com)].
*[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>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627164/figure/F1/ Ruptured epidermal inclusion cyst (nih.gov)].
 
===Sign out===
<pre>
SKIN CYST, BACK, EXCISION:
- EPIDERMAL INCLUSION CYST.
</pre>
 
====Ruptured====
<pre>
SKIN LESION, RIGHT CHEEK, EXCISION:
- RUPTURED EPIDERMAL INCLUSION CYST.
</pre>
 
====Micro====
The sections show hair-bearing skin with a cyst that is lined by squamous epithelium with a granular layer.  The cyst contains keratin. The overlying epithelium is unremarkable.
 
=====Ruptured=====
The sections show hair-bearing skin with a cyst that is lined by squamous epithelium with a granular layer. The cyst contains keratin. A mixed inflammatory infiltrate (predominantly lymphocytes and plasma cells) surround the cyst. Neutrophils infiltrate the cyst lining and are admixed with the keratin within its core. 
 
The lesion appears to be completely excised in the plane of section.  Hair follicles are adjacent to the lesion; however, they are not inflamed. The overlying epithelium is unremarkable.
 
=====Ruptured without epithelium=====
The section shows a dermal collection of neutrophils with acellular keratin-like material surrounded by histiocytes and fibrosis.  The lesion is completely excised in the plane of section.  Hair follicles are adjacent to the abscess; however, they are not inflamed.


==Pilar cyst==
==Pilar cyst==
*[[AKA]] ''trichilemmal cyst''.
*[[AKA]] ''trichilemmal cyst''.
===General===
{{Main|Pilar cyst}}
*Very common.
 
===Gross===
*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>
 
===Microscopic===
Features:<ref name=Ref_Derm309>{{Ref Derm|309}}</ref>
*Keratin.
*Cyst lining:
**Has no granular layer - '''key feature'''.
***Keratohyaline granules (as seen in the granular layer) may be seen focally.
**Inner most cyst lining cells are large cells with abundant eosinophilic cytoplasm.
 
DDx:
*[[Epidermal cyst]] - has a granular layer.
 
====Images====
<gallery>
Image:Trichilemmal_cyst_-_intermed_mag.jpg | Trichilemmal cyst - intermed. mag. (WC)
Image:Trichilemmal_cyst_-_very_high_mag.jpg | Trichilemmal cyst - very high mag. (WC)
</gallery>
www:
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=69966366 Trichilemmal cyst (dermatlas.med.jhmi.edu)].
*[http://www.flickr.com/photos/40764007@N08/3881846034/in/photostream/ Trichilemmal cyst (flickr.com)].
===Sign out===
<pre>
SCALP (CYST), EXCISION:
- TRICHILEMMAL CYST (PILAR CYST).
</pre>
 
<pre>
SKIN CYST, LEFT FLANK, EXCISION:
- TRICHILEMMAL CYST (PILAR CYST).
</pre>
 
<pre>
SCALP (CYST), ANTERIOR, EXCISION:
- TRICHILEMMAL CYST (PILAR CYST), RUPTURED.
</pre>
====Micro====
The sections show a cyst that is lined by squamous epithelium without a granular layer. Focally, keratohyaline granules are seen in the cyst lining cells. The innermost cyst lining cells are large and have abundant eosinophilic cytoplasm. The cyst contains keratin.


==Dermoid cyst==
==Dermoid cyst==
Line 187: Line 42:
===Sign out===
===Sign out===
<pre>
<pre>
OVARY AND UTERINE TUBE, LEFT, UNILATERAL SALPINGO-OOPHORECTOMY:
SKIN CYST, RIGHT LATERAL ORBIT, EXCISION:
- MATURE TERATOMA.
- DERMOID CYST
- UTERINE TUBE WITHIN NORMAL LIMITS.
- NEGATIVE FOR MALIGNANCY.
- NEGATIVE FOR MALIGNANCY.
</pre>
</pre>
Line 196: Line 50:
*[[AKA]] ''pilonidal sinus''.
*[[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>
*[[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}}
===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.
 
===Sign out===
<pre>
SKIN LESION (PILONIDAL SINUS), EXCISION:
- PILONIDAL SINUS.
- NEGATIVE FOR MALIGNANCY.
</pre>
====Micro====
The section shows hair-bearing skin with a deep sinus tract containing large clusters of neutrophils, abundant plasma cells, hemosiderin-laden macrophages, eosinophils and multinucleated giant cells.  The core of the lesion is, focally, well-vascularized. At the edge of the lesion is fibrotic tissue with plump fibroblasts.  Benign, fibrofatty tissue with scant inflammation completely surrounds the tract, in the plane of section; however, it is focally fragmented. There is no squamous lining within the sinus.  No nuclear atypia is identified.
 
=====Alternate=====
The section shows hair-bearing skin with a deep sinus containing large clusters of neutrophils, abundant plasma cells, hemosiderin-laden macrophages and multinucleated giant cells. Benign fibrofatty tissue with scant inflammation completely surrounds the lesion in the plane of section. There is no squamous lining within the sinus.  No nuclear atypia is identified.


=Less common=
=Less common=
==Steatocystoma==
==Steatocystoma==
===General===
{{Main|Steatocystoma}}
*Benign.
*Typically adults.
*Usually on the trunk.
*May be genetic; known as ''steatocystoma multiplex''.<ref name=omim184500>{{OMIM|184500}}</ref>
**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>
===Microscopic===
Features:<ref name=Ref_Derm312>{{Ref Derm|312}}</ref>
*Cyst lined by squamous epithelium with:
*#Corrugated eosinophilic lining - '''key feature'''.
*#*Similar appearance to compact keratin (hyperkeratosis).
*#*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>
*#'''No''' granular cell layer.


====Images====
<gallery>
Image:SkinTumors-P6260388.JPG | Steatocystoma. (WC)
Image:Steatocystoma_-_low_mag.jpg | Steatocystoma - low mag. (WC/Nephron)
Image:Steatocystoma_-_intermed_mag.jpg | Steatocystoma - intermed. mag. (WC/Nephron)
</gallery>
www:
*[http://www.flickr.com/photos/santoshpath/4788590105/in/photostream/ Steatocystoma - low mag. (flickr.com)].
**[http://www.flickr.com/photos/santoshpath/4788590109/ Steatocystoma - high mag. (flickr.com)].
*[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>
==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 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>

Latest revision as of 17:22, 26 August 2016

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

Overview

Common types:[1]

Epidermal necrosis

Common cysts

Venous lake

Main article: Venous lake

Epidermal inclusion cyst

Main article: Epidermal inclusion cyst

Pilar cyst

  • AKA trichilemmal cyst.
Main article: Pilar cyst

Dermoid cyst

General

Microscopic

Features:[2][3]

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

DDx:

Images:

Sign out

SKIN CYST, RIGHT LATERAL ORBIT, EXCISION:
- DERMOID CYST
- NEGATIVE FOR MALIGNANCY.

Pilonidal cyst

  • AKA pilonidal sinus.
  • AKA pilonidal disease.[4]
Main article: Pilonidal sinus

Less common

Steatocystoma

Main article: Steatocystoma

Digital mucous cyst

  • AKA digital synovial cyst.[5]
  • AKA digital myxoid pseudocyst.[5]

General

Microscopic

Features:[5]

  • 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".[6][7]

DDx:

Images:

Sign out

LESION, LEFT INDEX FINGER, EXCISION:
- DIGITAL MUCOUS CYST.

Apocrine cystadenoma

General

  • Uncommon.

Microscopic

Features:[9]

  • Multiloculated.
  • Apocrine differentiation: columnar epithelium +/- apical snouts.
  • Solid areas of epithelial proliferation.
  • Papillary projections into the cyst.

Images:

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. ↑ 2.0 2.1 2.2 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.
  3. ↑ 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.
  4. ↑ URL: http://emedicine.medscape.com/article/788127-overview. Accessed on: 10 September 2012.
  5. ↑ 5.0 5.1 5.2 5.3 URL: http://www.dermpedia.org/dermpedia-textbook/digital-mucous-myxoid-cyst. Accessed on: 17 January 2012.
  6. ↑ URL: http://dictionary.reference.com/browse/mucous. Accessed on: 8 January 2012.
  7. ↑ URL: http://dictionary.reference.com/browse/mucus. Accessed on: 8 January 2012.
  8. ↑ URL: http://www.dermpedia.org/case/digital-mucous-cyst-ganglion-type. Accessed on: 5 July 2013.
  9. ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 316. ISBN 978-0443066542.
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