Large Epidermal Cyst

SavageGlow · #1 ● 01-30-2023, 02:53 AM

Source with paragraphs added for clarity. This case is out of India:

A 31-year-old female, a laborer by profession, reported to the outpatient clinic with complaints of swelling over the left buttock for two years, which was insidious in onset and slow-growing. The patient eventually described a discomfort that made it impossible for her to sit for long hours or sleep in the supine position. There was no significant past history related to trauma or iatrogenic injury. Clinical examination revealed a huge, soft-to-firm, regularly circumscribed mass over the left gluteal region (Figure 1), and the overlying skin looked glossy and discolored with no visible punctum on it. No local rise in temperature was noted, so an acute abscess was ruled out. There was no underlying communication with the rectum or anal canal on proctoscopic examination.

Clinically, a diagnosis of giant lipoma was made, but due to its large size and involvement of the whole left buttock, it was considered important to perform an ultrasound examination to reinforce the diagnosis, which revealed a smooth-walled collection in the subcutaneous plane. As the definitive management, surgery proceeded with the excision of the swelling, which was extracted into toto and was identified as a cyst (Figure 2). An extensive elliptical skin incision over the summit of the swelling was made. Fine dissection was done to remove all fibrous attachments of the cyst to adjacent tissue. The well-encapsulated swelling was excised in toto without rupturing it. The excess skin was excised, and primary closure was achieved with mattress suturing. The excessive skin was scraped, and the edges of the residual skin were sutured together.

Postoperatively, the cyst was opened, which contained an odorless, purulent, whitish-creamy material, and the cyst wall was lined by stratified squamous epithelium, which was evidently visible on histopathology.