Difference between revisions of "Dermal cysts"

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Dermal cysts (view source)

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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==
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===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>
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*[[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>
 
<pre>
LESION (PILONIDAL SINUS), EXCISION:
- SKIN WITH PILONIDAL SINUS, CHRONIC INFLAMMATION AND SCARRING.
- 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.
 
=====Sinus versus cyst=====
The section shows hair-bearing skin with a cyst/sinus lined by benign squamous epithelium containing keratin. The surrounding dermis has a mixed inflammatory infiltrate, predominantly consisting of plasma cells and lymphocytes. Multinucleated giant cells are present. No significant nuclear atypia is identified.


=Less common=
=Less common=
Michael
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