UNEXPECTED LOCALIZATION OF DERMOID CYST

Acta Medica Mediterranea, 2014, 30: 101
UNEXPECTED LOCALIZATION OF DERMOID CYST: IN PREAURICULAR REGION
SELVET ERDOGAN*, MURAT TOPDAG*, CIGDEM VURAL**, FATIH SARI*, MURAT OZTURK*
*Kocaeli University Medical Faculty, Otorhinolaryngology Department, Kocaeli, **Kocaeli University Medical Faculty, Pathology
Department, Kocaeli, Turkey
ABSTRACT
Purpose of the study: Dermoid cysts are cysts are asymptomatic, slowly expanding, unilocular, cystic congenital masses. They
are rare congenital benign tumors in head and neck region, with only less than 7 percent of all dermoids presenting in this area. Half
of head and neck dermoids have been located in the orbit and no lesion has been specifically identified in the preauricular region.
With this report, we aimed to describe that dermoid cysts can be seen unexpected localization such as in preauricular region.
Procedures: Case report
Results: With the current report, the dermoid cysts could be added to differential diagnosis of preauricular region mass.
Conclusions and message of the paper: In this paper, we present a case of dermoid cyst located in preauricular region and
discussed clinical presentations, imaging, and treatment of dermoids. As far as we know it is the first dermoid cyst case in preauricular region in English Medical Literature.
Key words: dermoid cysts, preauricular region, head and neck.
Received Septemper 18, 2013; Accepted October 24, 2013
Introduction
Dermoid tumors of the head and neck are rare.
They especially occur in the nasal, orbital and oral
regions of the face, and preauricular region involvement is uncommon. The exact etiology of these
neoplasms is unknown though the most likely theories are embryological incomplete closure at lines
of fusion or traumatic implantation of skin elements (1). We report a case of dermoid tumor of
preauricular region in a 33-year-old man with
preauricular and lateral of external ear fistula tract
since 20 years. The embryology, clinical features,
evaluation, and treatment are discussed.
symptoms, such as pain or fever. His past medical
history was insignificant. On examination, a 2x1
cm cystic and non-tendered mass with fistula
between cavum concha and preauricular region was
revealed. Magnetic Resonance Imaging (MRI)
showed hypodense mass in preauricular
region15x15x8 mm in size. It was attached to the
subcutaneous lipoid tissue on T2-weighted images
(Figure 1).
Case Report
A 33-year-old male patient was referred to our
outpatient clinic, complained with slow growing
mass placed in right preauricular region for 20
years. Occasionally purulent discharge was
occurred from fistula tract. He had no associated
Figure 1: Post-contrast MRI of the head and neck
showing hyperintensity of the right subcutaneus tissue
(white arrow) in preauricular region.
102
Complete blood count, comprehensive metabolic and serologic panel, chest radiography, and
electrocardiography showed no abnormality. The
patient underwent surgery to excise this mass
(Figure 2). Histopathologic evaluation showed that
the lesion was a dermoid cyst (Figure 3).
Figure 2: The fistula was running from the external ear
canal (A, black arrow head) to preauricular region (B,
black arrow).
Figure 3: The dermoid cyst. It is lined by stratified squmaous epithelium, with matured sebaceous glands (SC),
ecrine glands (EC). A chondroid island (Ch) is being
seen in the wall of the cyst (H&E x 12,5).
Discussion
Dermoid cysts are asymptomatic, slowly
expanding, unilocular, cystic, and congenital masses. They are seen during the second and third
decades of life(2). They are rare in head and neck
region, with only less than 7 percent of all dermoids
present in this area(3). According to New and Erich,
less than half of head and neck dermoids are seen in
the periorbital region, 25% are presented in the oral
cavity, and 13% occur in the nasal cavity(4).
Dermoid cysts originate during early embryogenesis, and include both ectodermal and mesodermal elements. The etiology is unclear, but the most
likely theories are incomplete closure at lines of
fusion or traumatic implantation of skin elements(5).
Dermoid cysts are subcutaneous tumors lined
by stratified squamous epithelium(6), and may contain smooth and stratified muscle, cartilage, bone,
minor salivary glands, nerves, and lymph nodes(1).
In our patient, histopathology showed a cystic
lesion in subepitelial region, which lined by an epi-
Selvet Erdogan, Murat Topdag et Al
dermis that possesses various epidermal
appendages that are fully matured. The dermis of
cyst contains sebaceous glands, eccrine glands, hair
follicles, and mature chondroid elements. The histologic diagnosis was “dermoid cyst”.
Clinical presentation varies and usually
depends on the location of the tumor such as otitis
media with effusion, facial nerve paralysis, pain,
mass, hearing loss, headache or dysphagia. Raphael
reported a case with dermoid cyst in facial nerve
with facial paralysis (7). An 18-year-old female
patient has described diagnosed dermoid cyst with
otitis media effusion by Hamad S et al (1). Shah
reported a dermoid cyst case with submental
mass (2). Our case presented as swelling mass in
preauricular area. As far as we know, it is the first
dermoid cyst case in preauricular region in English
Medical Literature.
Computed Tomography (CT), Magnetic
Resonance Imaging (MRI), Ultrasound (USG) provide information regarding the cyst location and
densities, and may help making the differential
diagnosis of the lesion. On MRI imaging, dermoid
tumors are hyperintense on T1-weighted sequences,
and are variable from hypo- to hyper-intense on T2weighted sequences due to their high fat content(1).
A cystic mass in the preauricular region is
mostly Warthin tumor, lymphoepithelial cyst, epidermal keratinous cyst, cystic lymphangioma, lipoma, teratoma, branchial cyst, and abscess. The differential diagnosis of these preauricular masses
should be confirmed with histopathological evaluation. With the current report, the dermoid cysts
should be added to this list.
Total surgical excision, for the treatment of
dermoid cysts, reduces the risk of recurrence. The
prognosis of dermoids in the head and neck region
is favorable. Malignant transformation in a longstanding dermoid cyst is a rare complication. About
5% of dermoid cysts undergo malignant degeneration into squamous cell carcinoma(2).
Conclusion
Radiographic studies may lead to suspicion of
the anomaly, but are not diagnostic. The diagnosis
of dermoid cyst is confirmed histopathologically.
Complete surgical excision is the best treatment of
choice. With this report, we aimed to describe that
dermoid cysts can be seen in unexpected localization such as preauricular region, and could be added
the differential diagnosis of this regions’ masses.
Unexpected localization of dermoid cyst: In Preauricular Region
103
References
1)
2)
3)
4)
5)
6)
7)
Al-Muhaimeed HS, Abdelwahed HY, Elgamal EA,
Alokby GM, Binnasser AM, Ashraf MM. Extradural
Dermoid Cyst of Mastoid Bone: A Case Report. Case
Reports in Otolaryngology. 2012; 2012: 548340.
Shah SP, Quiroz F, Shah CJ. Dermoid cyst. Ultrasound
Quarterly. 2012; 28: 215-217.
Gourin CG, Sofferman RA. Dermoid of the eustachian
tube. Otolaryngol Head Neck Surg. 1999;120:772-775.
New G.B., J.B. Erich, Surg. Dermoid cysts of the head
and neck, Gynecol. Obstet. 1937; 65: 48-55.
Farris PE, Meyerhoff WL, Vuitch F. Congenital dermoid cyst of the middle ear. Skull Base Surg. 1998; 8:
77-80.
De Souza BA, Dey C, Carver N. A rare case of dermoid cyst behind the ear. Plast Reconstr Surg. 2003;
112: 1972.
Nwojo R, Roy S, Chang CY. Dermoid cyst in the facial
nerve-a unique diagnosis. Int J Pediatr
Otorhinolaryngol. 2011; 75: 874-876.
________
Request reprints from:
FATIH SARI
Kocaeli Universitesi Tip Fakultesi, KBB Anabilim Dali, 41380
Umuttepe, Kocaeli
(Turkey)