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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]].
*[[Dermoid cyst]].
*[[Dermoid cyst]].
*Ganglion cyst.
*[[Ganglion cyst]].
*Milicem.
*Milicem.


Line 12: Line 12:
*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==
*Dilated vein.
{{Main|Venous lake}}


===Microscopic===
==Epidermal inclusion cyst==
Features:<ref>Weedon's Skin Pathology. 3rd Ed. P.895.</ref>
{{Main|Epidermal inclusion cyst}}
*Lined by endothelium.
*Blood in lumen.
*+/-Fibrin in lumen.


DDx:
==Pilar cyst==
*[[Angiokeratoma]].
*[[AKA]] ''trichilemmal cyst''.
**Ectatic superficial dermal vessels.
{{Main|Pilar cyst}}
**Irregular acanthosis.
**Longer rete ridges.


==Epidermal inclusion cyst==
==Dermoid cyst==
*[[AKA]] ''epidermal cyst''.
===General===
===General===
*Very common.
*Benign.
*Congenital [[choristoma]]s.<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>
*May be found in the [[ovary]].


===Microscopic===
===Microscopic===
Features:
Features:<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><ref name=Ref_PCPBoD8_596>{{Ref PCPBoD8|596}}</ref>
*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>  
*Cyst lined by normal (keratinized) skin with adnexal structure (hair follicles, sweat glands, sebaceous glands).
*Trapped collagen bundles at edge of lesion with surrounded by fibroblasts.
*Keratin.


Image:
DDx:
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/epidermal_follicular_cyst.jpg Epidermal follicular cyst (ucsf.edu)].
*[[Epidermal cyst]] - no adnexal structures.


DDx:  
Images:
*[[Dermatofibrosarcoma]] - if lesion is large.
*[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>
*[[Pilar cyst]] - no granular layer.
*[http://webeye.ophth.uiowa.edu/eyeforum/cases-i/case115/larger/Figure4.jpg Dermoid cyst - intermed. mag. (uiowa.edu)].
*[[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>
 
==Pilar cyst==
*[[AKA]] trichilemmal cyst.
===General===
*Very common.


===Microscopic===
===Sign out===
Features:
<pre>
*Keratin.
SKIN CYST, RIGHT LATERAL ORBIT, EXCISION:
*Cyst lining has no granular layer - '''key feature'''.
- DERMOID CYST
*Trapped collagen bundles at edge of lesion with surrounded by fibroblasts.
- NEGATIVE FOR MALIGNANCY.
</pre>


DDx:
==Pilonidal cyst==
*[[Epidermal cyst]] - has a granular layer.
*[[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==
==Steatocystoma==
{{Main|Steatocystoma}}
==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===
*Benign.
*Dome-shaped [[papule]].
*Typically adults.
*Usually on the trunk.


===Microscopic===
===Microscopic===
Features:<ref name=Ref_Derm312>{{Ref Derm|312}}</ref>
Features:<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>
*Cyst lined by squamous epithelium with:
*Mucous in superficial dermis - '''key feature'''.
*#Corrugated eosinophilic lining - '''key feature'''.
*No epithelial lining; it is a pseudocyst.
*#*Similar appearance to compact keratin (hyperkeratosis).
 
*#'''No''' granular cell layer.
Note:
*Mucin = glycolated proteins; may be part of mucous.
*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>
 
DDx:
*[[Focal cutaneous mucinosis]].
*[[Ganglion cyst]].


Images:
Images:
*[http://www.flickr.com/photos/santoshpath/4788590105/in/photostream/ Steatocystoma - low mag. (flickr.com)].
*[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.flickr.com/photos/santoshpath/4788590109/ Steatocystoma - high mag. (flickr.com)].
*[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>


==Dermoid cyst==
==Apocrine cystadenoma==
===General===
===General===
*Benign.
*Uncommon.
*Congenital [[choristoma]]s.<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>
*May be found in the [[ovary]].


===Microscopic===
===Microscopic===
Features:<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><ref name=Ref_PCPBoD8_596>{{Ref PCPBoD8|596}}</ref>
Features:<ref name=Ref_Derm316>{{Ref Derm|316}}</ref>
*Cyst lined by normal (keratinized) skin with adnexal structure (hair follicles, sweat glands, sweat ducts).
*Multiloculated.
 
*Apocrine differentiation: columnar epithelium +/- apical snouts.
DDx:
*Solid areas of epithelial proliferation.
*[[Epidermal cyst]] - no adnexal structures.
*Papillary projections into the cyst.


Images:
Images:
*[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://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=7292 Apocrine cystadenoma (unibas.ch)].
*[http://webeye.ophth.uiowa.edu/eyeforum/cases-i/case115/larger/Figure4.jpg Dermoid cyst - intermed. mag. (uiowa.edu)].
*[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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