Dermoid cyst pictures
Dermoid cyst pictures
Dermoid cyst is a cystic teratoma/cyst that is lined with the skin and lies deep to the skin. The dermoid cyst is lined by stratified squamous epithelium . Besides that the dermoid cyst may also contain functioning epidermal appendages that includes thyroid tissue, cartilages, fat, blood, bone, teeth, hair follicle, sebaceous gland and sweat gland. The present of these epidermal appendages differentiates dermoid cyst from sebaceous cyst.
Dermoid cyst can be divided into congenital dermoid cyst and implanted or acquired dermoid cyst.
Congenital dermoid cyst develops in utero and occur as a result skin/epidermis entrapment during fetal development stage that involves the fusion of facial planes. Congenital dermoid cyst can also be classified according to the location of the cyst. The angular dermoid cyst is common and can be divided into internal and external angular dermoid cyst that present on the medial and lateral sides of the orbit. The central dermoid cyst may have a cranial extension and present along the midline between the forehead and nasal tips. Other sites of congenital dermoid cyst may include the midline of the neck, sublingual and midline of the trunk, most commonly in the sacrum and perineum. The congenital dermoid cyst may also present on the midline of the nose which is known as nasal dermoid.
In terms of duration, the dermoid cyst may have present since birth. However the dermoid cyst may become more obvious a few years later when the dermoid cyst become distended.
The congenital dermoid cyst may present in the neck and the head and causing a cosmetic disfigurement. Rarely, dermoid cyst may be infected and increase in size which is large enough and later causing mechanical instability. The congenital dermoid cyst may present as a single lesion and rarely multiple in numbers.
On examination, congenital dermoid cyst is spherical or ovoid in shape with a diameter around 1cm - 2cm . The surface of the dermoid cyst is smooth, The dermoid cyst is not tense or hard. It is soft especially if the dermoid cyst present on the face. The dermoid cyst will not transilluminate unless it contains clear fluid rather than opaque, thick mixture of desquamated epithelial cells, sweats gland and sebum. The large congenital dermoid cyst is dull to percussion and able to conduct fluid thrill. The dermoid cyst is not reducible, compressible or pulsatile. The congenital dermoid cyst is not like sebaceous cyst . The dermoid cyst is not attached to the skin but lies deep in the skin in the subcutaneous tissue.
The complication of congenital dermoid cyst may include the presence of the small superficial pit that represent the nasal dermoid. The small superficial pit may become an extensive cyst which later passes between the nasal bone towards the sphenoid sinus. The dermoid cyst may also penetrate the dura and causing bone depression . A Midline dermoid cyst may lead to meningeal perforation if it is present along the cranio - spinal axis.
The investigation technique may include CT scan and MRI scan. CT scan and MRI scan are performed in case of a central dermoid cyst that present with intracranial extension.
CT scan and skull X ray are performed pre operatively. The congenital dermoid cyst may be left alone as it is not infectious and troublesome. However, surgical excision is still performed and the technique varies according to the location of the lesion. An experienced surgeon is required in case of deep excision of the congenital dermoid cyst. Simple excision is required in case of acquired dermoid while endoscopic or open excision is required for angular dermoid cyst. Complex excision which requires the help of neurosurgeon and craniofacial surgeon is needed to detect the presence of intracranial extension in case of a central dermoid cyst.
Implantation /acquired dermoid cyst is caused by a sharp injury such as stab injury or small deep cut which breach the skin. The piece of the skin will later forcibly implanted into the subcutaneous tissue, The patient may not remember the injury. The sites of the injury are variable and most commonly present in an area with repeated trauma such as fingers. The implantation of the dermoid cyst is mostly found beneath the skin that is prone to injury (fingers). The dermoid cyst will interfere with the function of the part affected. The dermoid cyst is tender and painful. However, the dermoid cysts are rarely formed in the sites of surgical incision.
The dermoid cyst is small, smooth and spherical with diameter about 0.5cm -1.0cm. There may be scar overlying the skin. The cyst may present within the scar or tether to the deep aspect of the scar. The dermoid cyst is mobile over the deeper structure and the deep structure is normal unless it is involved in the initial injury. The dermoid cyst may appear tense and hard and in some cases are stony hard. It is impossible to detect any fluid thrill or fluctuation of the dermoid cyst (cystic nature) due to the dermoid cyst small size. The dermoid cyst that is implanted may become infected. The regional lymph node around the dermoid cyst may be normal. Sebaceous cyst is known as one of the differential diagnosis of the implanted dermoid cyst. The most important diagnostic features of implanted dermoid cyst may include the presence of old scar with previous history of injury. Implantation of dermoid cyst is tethered to the skin while sebaceous cyst arises from the skin. Dermoid cyst is rarely to be infected than sebaceous cyst. Besides that dermoid cyst is mostly not transilluminate as it filled with a mixture of opaque desquamated epithelial cell and thick mixture of the sebum.
X ray and MRI scan are the most common investigation to detect the present of the implanted dermoid cyst. Radiological imaging is important in case of an implanted dermoid cyst that present on the digit as any underlying erosion of the bone may be excluded. This imaging technique is also important to exclude giant cell tumor. Generally, surgical excision is the main treatment option for implanted dermoid cyst.
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