Skin cysts: Difference between revisions

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==Microscopic evaluation==
==Microscopic evaluation==
The main initial clue is the lining of the cyst, being either stratified squamous epithelium, non-stratified squamous epithelium, or absence of epithelium (pseudocysts):<ref name=Bolognia>[https://books.google.se/books?id=Ufw6DwAAQBAJ&pg=PA1917 page 1917] in: {{cite book | last=Bolognia | first=Jean | title=Dermatology | publisher=Elsevier | publication-place=Philadelphia, Pa | year=2018 | isbn=978-0-7020-6342-8 | oclc=1011508489 | language=de | ref=harv}}</ref>
Major initial clues are:
*Whether the lining of the cyst is stratified squamous epithelium, non-stratified squamous epithelium, or absence of epithelium (pseudocysts):<ref name=Bolognia>[https://books.google.se/books?id=Ufw6DwAAQBAJ&pg=PA1917 page 1917] in: {{cite book | last=Bolognia | first=Jean | title=Dermatology | publisher=Elsevier | publication-place=Philadelphia, Pa | year=2018 | isbn=978-0-7020-6342-8 | oclc=1011508489 | language=de | ref=harv}}</ref>
*Location of the cyst.<ref name=Bolognia/>


===Stratified squamous epithelium===
===Stratified squamous epithelium===
[[File:Relative incidence of cutaneous cysts.jpg|thumb|Relative incidence of cutaneous cysts.<ref>Pakistan: {{cite journal|last1=Kamyab|first1=Kambiz|last2=Kianfar|first2=Nika|last3=Dasdar|first3=Shayan|last4=Salehpour|first4=Zahra|last5=Nasimi|first5=Maryam|title=Cutaneous cysts: a clinicopathologic analysis of 2,438 cases|journal=International Journal of Dermatology|year=2020|issn=0011-9059|doi=10.1111/ijd.14808}}</ref>]]
[[File:Relative incidence of cutaneous cysts.jpg|thumb|Relative incidence of cutaneous cysts.<ref>Pakistan: {{cite journal|last1=Kamyab|first1=Kambiz|last2=Kianfar|first2=Nika|last3=Dasdar|first3=Shayan|last4=Salehpour|first4=Zahra|last5=Nasimi|first5=Maryam|title=Cutaneous cysts: a clinicopathologic analysis of 2,438 cases|journal=International Journal of Dermatology|year=2020|issn=0011-9059|doi=10.1111/ijd.14808}}</ref>]]
{|class="wikitable"
{|class="wikitable"
! Location !! Main diagnoses
! Location !! Main diagnoses<ref name=Bolognia/>
|-
|-
! Face
! Face
|
|
*Epidermoid cyst  
*'''[[Epidermoid cyst ]]'''
*Milium
*Milium
*Pigmented follicular cyst (men)
*Pigmented follicular cyst (men)
Line 22: Line 24:
! Scalp
! Scalp
|
|
*Epidermoid cyst
*'''[[Epidermoid cyst]]'''
*Trichilemmal cyst
*Trichilemmal cyst
:*Proliferating tricholemmal cyst
:*Proliferating trichilemmal cyst
|-
|-
! Trunk
! Trunk
|
|
*Epidermoid cyst
*'''[[Epidermoid cyst]]'''
*Vellus hair cyst (chest)
*Vellus hair cyst (chest)
*Steatocystoma
*Steatocystoma
Line 37: Line 39:
*Proliferating epidermoid (infundibular) cyst
*Proliferating epidermoid (infundibular) cyst
|-
|-
! Axilla and groin
|
*Steatocystoma
*'''[[Epidermoid cyst]]'''
|-
! Preauricular
|
*Ear pit cyst
*'''[[Epidermoid cyst]]'''
|-
! Upper gluteal cleft and sacrococcygeal area
|
*Pilonidal cyst
|}
===Non-stratified squamous epithelium===
{|class="wikitable"
! Location !! Main diagnoses<ref name=Bolognia/>
|-
! Face
|
*Hidrocystoma
:*Eccrine at lower eyelid and cheek
:*Apocrine at eyelid margin
|-
! Suprasternal notch
|
*Bronchogenic cyst (infants)
|-
! Midline anterior neck
|
*Thyroglossal duct cyst
|-
! Lateral neck, preauricular, mandibular
|
*Brachial cleft cyst (teenagers and young adults)
|-
! Lower extremities
|
*Cutaneous ciliated cyst (young women)
|-
! Labia majora
|
*Ciliated cyst of the vulva
|-
! Ventral glans and penile shaft
|
*Median raphe cyst
|-
! Umbilical or periumbilical
|
*Omphalomesenteric duct cyst
|}
|}


{{Bottom}}
===Absence of epithelium (pseudocyst)===
{|class="wikitable"
! Location !! Main diagnoses<ref name=Bolognia/> !! Histology !! Image
|-
! Oral mucosa
| Mucocele (lower labial)
|
|
|-
! Dorsal aspect of distal phalanx of finger or toe
|
*Digital mucous cyst/pseudocyst
|
|
|-
! Wrist (and generally other locations close to joints or tendon sheaths)
|
*'''[[Ganglion cyst]]'''
| Walls composed of bland fibrous tissue.
| [[File:Histopathology of ganglion cyst wall.jpg|190px]]
|-
! Scaphoid fossa of the ear
|
*Pseudocyst of the auricle (adult men)
|
|
|-
! Sites of surgical trauma
|
*Cutaneous metaplastic synovial cyst/pseudocyst
|
|
|}


==Diagnoses==
===Epidermoid cyst===
{{Main|Epidermoid cyst}}
[[File:Histopathology of epidermoid cyst.jpg|thumb|Epidermoid cyst]]
Also known as epidermal inclusion cyst (EIC) and sebaceous cyst.
Typical findings:<ref>{{cite web|url=http://www.pathologyoutlines.com/topic/skintumornonmelanocytickeratinouscystepidermal.html|title=Skin nonmelanocytic tumor - Cysts - Epidermal (epidermoid) type|author= V. Claire Vaughan, M.D., Joshua Wisell, M.D.|website=pathology Outlines}} Topic Completed: 9 May 2019. Revised: 13 December 2019</ref>
*Stratified squamous epithelium with a granular layer
*Cyst wall does not contain eccrine glands, sebaceous glands or hair follicles
*Abundant keratin flakes in cyst lumen
*Often giant cell granuloma in ruptured cysts, similar to foreign body granuloma


===Non-stratified squamous epithelium===
===Trichilemmal cyst===
 
[[File:Histopathology of trichilemmal cyst - annotated.jpg|thumb|Trichilemmal cyst.]]
 
The constitution of a trichilemmal cyst (also called pilar cyst), from external (top) to internal (bottom):<ref>{{cite web|url=https://www.medscape.com/answers/1058907-121502/which-histologic-findings-are-characteristic-of-trichilemmal-cyst-pilar-cyst|title=Which histologic findings are characteristic of trichilemmal cyst (pilar cyst)?|author=Anne Elizabeth Laumann|website=Medscape}} Updated: Jun 11, 2020,</ref>
===Absence of epithelium (pseudocyst)===
*Fibrous capsule
*Small, cuboidal, dark-staining basal epithelial cells in a palisade arrangement, with no distinct intercellular bridging
*Swollen pale keratinocytes, which increase in height closer to the interior
*Solid eosinophilic-staining keratin
There is no granular cell layer (in contrast to an epidermoid cyst).
{{Bottom}}

Latest revision as of 20:40, 29 July 2021

Author: Mikael Häggström [note 1]

Microscopic evaluation

Major initial clues are:

  • Whether the lining of the cyst is stratified squamous epithelium, non-stratified squamous epithelium, or absence of epithelium (pseudocysts):[1]
  • Location of the cyst.[1]

Stratified squamous epithelium

File:Relative incidence of cutaneous cysts.jpg
Relative incidence of cutaneous cysts.[2]
Location Main diagnoses[1]
Face
  • Epidermoid cyst
  • Milium
  • Pigmented follicular cyst (men)
  • Dermoid cyst (along embryonic fusion planes such as lateral eyebrows in infants)
  • Verrucous cyst
Scalp
  • Proliferating trichilemmal cyst
Trunk
Pelvic, anogenital
  • Proliferating epidermoid (infundibular) cyst
Axilla and groin
Preauricular
Upper gluteal cleft and sacrococcygeal area
  • Pilonidal cyst

Non-stratified squamous epithelium

Location Main diagnoses[1]
Face
  • Hidrocystoma
  • Eccrine at lower eyelid and cheek
  • Apocrine at eyelid margin
Suprasternal notch
  • Bronchogenic cyst (infants)
Midline anterior neck
  • Thyroglossal duct cyst
Lateral neck, preauricular, mandibular
  • Brachial cleft cyst (teenagers and young adults)
Lower extremities
  • Cutaneous ciliated cyst (young women)
Labia majora
  • Ciliated cyst of the vulva
Ventral glans and penile shaft
  • Median raphe cyst
Umbilical or periumbilical
  • Omphalomesenteric duct cyst

Absence of epithelium (pseudocyst)

Location Main diagnoses[1] Histology Image
Oral mucosa Mucocele (lower labial)
Dorsal aspect of distal phalanx of finger or toe
  • Digital mucous cyst/pseudocyst
Wrist (and generally other locations close to joints or tendon sheaths) Walls composed of bland fibrous tissue. File:Histopathology of ganglion cyst wall.jpg
Scaphoid fossa of the ear
  • Pseudocyst of the auricle (adult men)
Sites of surgical trauma
  • Cutaneous metaplastic synovial cyst/pseudocyst

Diagnoses

Epidermoid cyst

Main article: Epidermoid cyst
File:Histopathology of epidermoid cyst.jpg
Epidermoid cyst

Also known as epidermal inclusion cyst (EIC) and sebaceous cyst. Typical findings:[3]

  • Stratified squamous epithelium with a granular layer
  • Cyst wall does not contain eccrine glands, sebaceous glands or hair follicles
  • Abundant keratin flakes in cyst lumen
  • Often giant cell granuloma in ruptured cysts, similar to foreign body granuloma

Trichilemmal cyst

File:Histopathology of trichilemmal cyst - annotated.jpg
Trichilemmal cyst.

The constitution of a trichilemmal cyst (also called pilar cyst), from external (top) to internal (bottom):[4]

  • Fibrous capsule
  • Small, cuboidal, dark-staining basal epithelial cells in a palisade arrangement, with no distinct intercellular bridging
  • Swollen pale keratinocytes, which increase in height closer to the interior
  • Solid eosinophilic-staining keratin

There is no granular cell layer (in contrast to an epidermoid cyst).

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 page 1917 in: Bolognia, Jean (2018) (in de). Dermatology . Philadelphia, Pa: Elsevier. ISBN 978-0-7020-6342-8. OCLC 1011508489. 
  2. ↑ Pakistan: Kamyab, Kambiz; Kianfar, Nika; Dasdar, Shayan; Salehpour, Zahra; Nasimi, Maryam (2020). "Cutaneous cysts: a clinicopathologic analysis of 2,438 cases ". International Journal of Dermatology. doi:10.1111/ijd.14808. ISSN 0011-9059. 
  3. ↑ V. Claire Vaughan, M.D., Joshua Wisell, M.D.. Skin nonmelanocytic tumor - Cysts - Epidermal (epidermoid) type. pathology Outlines. Topic Completed: 9 May 2019. Revised: 13 December 2019
  4. ↑ Anne Elizabeth Laumann. Which histologic findings are characteristic of trichilemmal cyst (pilar cyst)?. Medscape. Updated: Jun 11, 2020,

Image sources


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