Difference between revisions of "Dermal cysts"
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Submitted as "Pilonidal Sinus", Excision: | |||
- Consistent with pilonidal sinus. | |||
- NEGATIVE for malignancy. | |||
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SKIN LESION (PILONIDAL SINUS), EXCISION: | SKIN LESION (PILONIDAL SINUS), EXCISION: | ||
Revision as of 12:58, 27 April 2016
Dermal cysts, also skin cysts, are common in dermatopathology. Dermatopathologists can diagnose 'em.
Overview
Common types:[1]
- Epidermal cyst (sebaceous cyst) -- most common.
- Pilar (trichilemmal) cyst.
- Dermoid cyst.
- Ganglion cyst.
- Milicem.
Epidermal necrosis
- 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
General
- Dilated vein.
Clinical:
- Blanch with pressure.[2]
Gross
- Purple/blue spot.
Images:
Microscopic
Features:[4]
- Lined by endothelium.
- Blood in lumen.
- +/-Fibrin in lumen.
- +/-Solar elastosis - very common.[5]
DDx:
- Angiokeratoma.
- Ectatic superficial dermal vessels.
- Irregular acanthosis.
- Longer rete ridges.
- Cherry hemangioma.[5]
Images:
- Venous lake (jhmi.edu).[3]
- Venous lake (dermpedia.org).[6]
- Venous lake (surgical pathologyatlas.com).
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SKIN LESION, RIGHT CHEEK, BIOPSY: - VENOUS LAKE. - SOLAR ELASTOSIS. - NEGATIVE FOR NEVUS.
Epidermal inclusion cyst
Pilar cyst
- AKA trichilemmal cyst.
Dermoid cyst
General
- Benign.
- Congenital choristomas.[7]
- May be found in the ovary.
Microscopic
- Cyst lined by normal (keratinized) skin with adnexal structure (hair follicles, sweat glands, sebaceous glands).
DDx:
- Epidermal cyst - no adnexal structures.
Images:
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SKIN CYST, RIGHT LATERAL ORBIT, EXCISION: - DERMOID CYST - NEGATIVE FOR MALIGNANCY.
Pilonidal cyst
General
- Benign.
- Young adults (late teens, early twenties) - usu. men.[10]
Gross
- Usually at gluteal folds.
- Uncommon: axilla, genital region, umbilicus, scalp.[11]
Microscopic
Features:[11]
- Cyst or pseudocyst into the deep dermis.
- May be lined by squamous epithelium with inflammation +/-pseudoepitheliomatous hyperplasia.
- Neutrophils.
- Granulomatous inflammation.
DDx:
- Squamous cell carcinoma of the skin with inflammation.[12]
- Infection.
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Submitted as "Pilonidal Sinus", Excision: - Consistent with pilonidal sinus. - NEGATIVE for malignancy.
Block letters
SKIN LESION (PILONIDAL SINUS), EXCISION: - PILONIDAL SINUS. - NEGATIVE FOR MALIGNANCY.
LESION (PILONIDAL SINUS), EXCISION: - SKIN WITH PILONIDAL SINUS, CHRONIC INFLAMMATION AND SCARRING. - NEGATIVE FOR MALIGNANCY.
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
Steatocystoma
Digital mucous cyst
General
- Dome-shaped papule.
Microscopic
Features:[13]
- 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.
DDx:
Images:
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LESION, LEFT INDEX FINGER, EXCISION: - DIGITAL MUCOUS CYST.
Apocrine cystadenoma
General
- Uncommon.
Microscopic
Features:[17]
- Multiloculated.
- Apocrine differentiation: columnar epithelium +/- apical snouts.
- Solid areas of epithelial proliferation.
- Papillary projections into the cyst.
Images:
See also
References
- ↑ 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.
- ↑ URL: http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=-969536424. Accessed on: 13 August 2012.
- ↑ 3.0 3.1 3.2 URL: http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=605386295. Accessed on: 13 August 2012.
- ↑ Weedon's Skin Pathology. 3rd Ed. P.895.
- ↑ 5.0 5.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 551. ISBN 978-0443066542.
- ↑ URL: http://www.dermpedia.org/case/70-year-old-woman-with-nose-lesion. Accessed on: 21 June 2013.
- ↑ 7.0 7.1 7.2 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.
- ↑ 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.
- ↑ URL: http://emedicine.medscape.com/article/788127-overview. Accessed on: 10 September 2012.
- ↑ URL: http://www.nhs.uk/conditions/Pilonidal-sinus/Pages/Introduction.aspx. Accessed on: 10 September 2012.
- ↑ 11.0 11.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 326. ISBN 978-0443066542.
- ↑ Chatzis, I.; Noussios, G.; Katsourakis, A.; Chatzitheoklitos, E.. "Squamous cell carcinoma related to long standing pilonidal-disease.". Eur J Dermatol 19 (4): 408-9. doi:10.1684/ejd.2009.0705. PMID 19482585.
- ↑ 13.0 13.1 13.2 13.3 URL: http://www.dermpedia.org/dermpedia-textbook/digital-mucous-myxoid-cyst. Accessed on: 17 January 2012.
- ↑ URL: http://dictionary.reference.com/browse/mucous. Accessed on: 8 January 2012.
- ↑ URL: http://dictionary.reference.com/browse/mucus. Accessed on: 8 January 2012.
- ↑ URL: http://www.dermpedia.org/case/digital-mucous-cyst-ganglion-type. Accessed on: 5 July 2013.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 316. ISBN 978-0443066542.