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Dermal cysts (view source)

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


==Cysts==
=Overview=
Common types:<ref>TN07 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.
*[[pilar cyst|Pilar (trichilemmal) cyst]].
*[[pilar cyst|Pilar (trichilemmal) cyst]].
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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]].


=Common cysts=
==Venous lake==
==Venous lake==
===General===
{{Main|Venous lake}}
*Dilated vein.
 
===Microscopic===
Features:<ref>Weedon's Skin Pathology. 3rd Ed. P.895.</ref>
*Lined by endothelium.
*Blood in lumen.
*+/-Fibrin in lumen.
 
DDx:
*[[Angiokeratoma]].
**Ectatic superficial dermal vessels.
**Irregular acanthosis.
**Longer rete ridges.


==Epidermal inclusion cyst==
==Epidermal inclusion cyst==
*[[AKA]] ''epidermal cyst''.
{{Main|Epidermal inclusion cyst}}
===General===
*Very common.
 
===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.
 
Image:
*[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>
 
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.
*[[Dermatofibrosarcoma protuberans]] - if lesion is large.


==Pilar cyst==
==Pilar cyst==
*[[AKA]] trichilemmal cyst.
*[[AKA]] ''trichilemmal cyst''.
===General===
{{Main|Pilar cyst}}
*Very common.
 
===Microscopic===
Features:
*Keratin.
*Cyst lining has no granular layer - '''key feature'''.
*Trapped collagen bundles at edge of lesion with surrounded by fibroblasts.
 
DDx:
*[[Epidermal cyst]] - has a granular layer.
 
==Steatocystoma==
===General===
*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:
*[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>


==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)].
===Sign out===
<pre>
SKIN CYST, RIGHT LATERAL ORBIT, EXCISION:
- DERMOID CYST
- NEGATIVE FOR MALIGNANCY.
</pre>
==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}}
=Less common=
==Steatocystoma==
{{Main|Steatocystoma}}


==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]].


===Microscopic===
===Microscopic===
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*Mucous = slippery secretion.
*Mucous = slippery secretion.
**Some split hairs over the "u" - "mucus" vs. "mucous".<ref>URL: [http://dictionary.reference.com/browse/mucous http://dictionary.reference.com/browse/mucous]. Accessed on: 8 January 2012.</ref><ref>URL: [http://dictionary.reference.com/browse/mucus http://dictionary.reference.com/browse/mucus]. Accessed on: 8 January 2012.</ref>
**Some split hairs over the "u" - "mucus" vs. "mucous".<ref>URL: [http://dictionary.reference.com/browse/mucous http://dictionary.reference.com/browse/mucous]. Accessed on: 8 January 2012.</ref><ref>URL: [http://dictionary.reference.com/browse/mucus http://dictionary.reference.com/browse/mucus]. Accessed on: 8 January 2012.</ref>
DDx:
*[[Focal cutaneous mucinosis]].
*[[Ganglion cyst]].


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>
===Sign out===
<pre>
LESION, LEFT INDEX FINGER, EXCISION:
- DIGITAL MUCOUS CYST.
</pre>
==Apocrine cystadenoma==
===General===
*Uncommon.
===Microscopic===
Features:<ref name=Ref_Derm316>{{Ref Derm|316}}</ref>
*Multiloculated.
*Apocrine differentiation: columnar epithelium +/- apical snouts.
*Solid areas of epithelial proliferation.
*Papillary projections into the cyst.
Images:
*[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=7292 Apocrine cystadenoma (unibas.ch)].
*[http://www.flickr.com/photos/40764007@N08/6499470691/ Apocrine cystadenoma (flickr.com)].


==See also==
=See also=
*[[Non-malignant skin disease]]
*[[Non-malignant skin disease]]
*[[Dermatopathology introduction]]
*[[Dermatopathology introduction]]


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Non-malignant skin disease]]
[[Category:Non-malignant skin disease]]
[[Category:Dermatopathology]]
[[Category:Dermatopathology]]
Michael
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