Management of Perineal Epidermoid Cyst in a 20-year-old Female

Abstract

Epidermoid cysts are cutaneous or subcutaneous masses caused by the implantation of epidermal elements into the dermis. This case report presented an epidermal cyst of the perineum clinically mimicking endometriosis in a female patient. A 20-year-old virgo female patient was admitted to our clinic with complaints of severe pain, especially in the right leg, and postmenstrual bleeding for three years. In the transrectal ultrasound, a 54*39 mm cystic lesion with dense internal echo was detected in the medial neighborhood of the pelvic floor right obturator internus muscle. Since the cystic lesion detected in the contrast-enhanced pelvic MRI was evaluated as an epidermoid cyst and no significant endometrioma or endometriosis focus was detected, an operation was planned. Surgical excision should be performed not only for symptom relief and diagnosis but also to exclude rare malignancy. However, it is vital to master the pelvic and perineal anatomy along with careful surgery.

Keywords

• Epidermoid cyst
• perineum
• surgery

20 Yaşında Bir Kadında Perineal Epidermoid Kist Tedavisi

Abstract

Epidermoid kistler, epidermal elemanların dermise implantasyonundan kaynaklanan deri veya deri altı kitlelerdir. Bu vaka raporunda, bir kadın hastada, klinik olarak endometriozisi taklit eden bir perine epidermal kisti sunulmaktadır. 20 yaşında virgo kadın hasta kliniğimize üç yıldır devam eden özellikle sağ bacakta şiddetli ağrı ve adet sonrası kanama şikayeti ile başvurdu. Transrektal ultrasonda, pelvik taban sağ obturator internus kas medial komşuluğunda 54*39 mm boyutlarında yoğun internal ekolu kistik lezyon saptandı. Kontrastlı pelvik MRG'de saptanan kistik lezyonun ön planda epidermoid kist olarak değerlendirilmesi ve belirgin bir endometrioma veya endometriozis odağı saptanmaması üzerine operasyon planlandı. Cerrahi eksizyon sadece semptomların giderilmesi ve tanı için değil, aynı zamanda nadir görülen maligniteyi dışlamak için de yapılmalıdır. Ancak, dikkatli cerrahi ile birlikte pelvik ve perineal anatomiye hâkim olmak hayati önem taşır.

Keywords

• Epidermoid kist
• perine
• cerrahi

References

1. Nigam JS, Bharti JN, Nair V, Gargade CB, Deshpande AH, Dey B, et al. Epidermal cysts: A clinicopathological analysis with emphasis on unusual findings. Int J Trichology. 2017;9(3):108-12.
2. Kirkham N. Tumors and cysts of the epidermis. In: Elder DE, editor. Lever's histopathology of the skin. 8th ed. Philadelphia: Lippincott-Raven; 1997. p.685-746.
3. Ali SA, Tahir SM, Memon AS, Dahri AA. Epidermoid inclusion cyst of the perineum--a rare case report in a 50 years old male. J Ayub Med Coll Abbottabad. 2009;21(3):179-80.
4. Dahan H, Arrivé L, Wendum D, Docou le Pointe H, Djouhri H, Tubiana JM. Retrorectal developmental cysts in adults: clinical and radiologic-histopathologic review, differential diagnosis and treatment. Radiographics. 2001;21(3):575-84.
5. Briggs RM, Miller FW. Pigmented nevi and epidermal cysts: cause and effect. Plast Reconstr Surg. 1968;41(5):456-61.
6. Morgan MB, Stevens GL, Somach S, Tannenbaum M. Carcinoma arising in epidermoid cyst: a case series and aetiological investigation of human papillomavirus. Br J Dermatol. 2001;145(3):505-6.
7. Sakurai T, Mukai T, Kawachi H, Hiyoshi Y, Yamaguchi T, Nagasaki T, et al. Laparoscopic resection for a relapsed presacral epidermoid cyst penetrating the ischiorectal fossa. Asian J Endosc Surg. 2022;15(3):656-9.
8. Sumi Y, Yamamoto N, Kiyosawa T. Squamous cell carcinoma arising in a giant epidermal cyst of the perineum: a case report and literature review. J Plast Surg Hand Surg. 2012;46(3-4):209-11.

9. Sciaudone G, Di Stazio C, Guadagni I, Pellino G, De Rosa M, Selvaggi F. Retrorectal epidermoid cyst--a rare entity: the effectiveness of a transperineal posterior approach. Acta Chir Belg. 2009;109(3):392-5.
10. Al-Khattabi M, Chouillard E, Louboutin A, Fauconnier A, Bader G. Giant pararectal epidermoid tumor mimicking ovarian cyst: combined laparoscopic and perineal surgical approach. J Minim Invasive Gynecol. 2010;17(1):113-5.
11. Fedele L, Fontana E, Bianchi S, Frontino G, Berlanda N. An unusual case of clitoromegaly. Eur J Obstet Gynecol Reprod Biol. 2008;140(2):287-8.
12. Schmidt A, Lang U, Kiess W. Epidermal cyst of the clitoris: A rare cause of clitorimegaly. Eur J Obstet Gynecol Reprod Biol. 1999;87(2):163-5.
13. Karaman E, Çim N, Akdemir Z, Elçi E, Akdeniz H. Giant vulvar epidermoid cyst in an adolescent girl. Case Rep Obstetr Gynecol. 2015;2015:942190.
14. Kısa Karakaya B, Kansu Çelik H, Keçecioğlu M, Evliyaoğlu Ö, Sarıkaya E, Erkaya S. Retrospective analysis of benign vaginal cysts. J Gynecol Obstet Neonatal. 2016;13(4):168-9. Turkish.