Epidermal Inclusion Cyst On The Right Thumb In A 10 Year Old Boy: An Unusual LocationCorrespondence Address :
Dr. Rajendra K Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor, Department of Pediatric Surgery
Gandhi Medical College & Associated Kamla Nehru & Hamidia Hospitals
Bhopal, Madhya Pradesh 462 001 (INDIA)
Phone No: + 91-755 - 4050571(R), 4050261(O)
We would like to report an interesting case of an epidermal inclusion cyst of the terminal phalanx of the right thumb as diagnosed by histopathology. A 10 year-old boy presented to us with the complaint of a progressive painful swelling at the terminal phalanx of his right thumb for one year. There was no history of trauma, or foreign body injury to the involved thumb. Clinical examination revealed a swelling of the terminal phalanx [palmer aspect] of the right thumb. It was smooth, firm, mildly tender and non compressible. The movement of the involved thumb was normal. Under anaesthesia; a small incision was made and a well encapsulated, well defined, cyst was dissected out [ Table / Fig 1] (Table/Fig 1a and Table/Fig 1 b) and the wound was repaired. The cyst contained thick, white, foul-smelling, cheesy material. Epidermal inclusion cyst was confirmed by doing histopathological studies of the specimen [ Table / Fig 2].
Epidermoid cysts may occur at any age, sex and any where on the body, but most frequently on the face, trunk, neck, extremities and scalp (1). Rare cases of epidermoid cysts occurring in bone, breast and various intracranial locations have also been reported (1). Epidermal cysts within a finger / toe phalanx are extremely rare conditions (2), (3), (4), (5). Epidermal cysts can be either congenital or acquired. The congenital ones develop during the fusion of the embryo when the ectodermal tissue gets trapped in the line of fusion. The acquired cysts; which are also known as the epidermal inclusion cysts, arise from the inclusion / implantation of the epidermal structures in the dermis and other deeper tissues after trauma [blunt or penetrating], needle biopsy, or even after a surgical procedure (1), (4), (5). Historically; epidermoid cysts have been referred to by various terms, including follicular infundibular cysts, epidermal cysts and epidermal inclusion cysts. The term â€˜epidermal inclusion cystâ€™ refers specifically to an epidermoid cyst that is the result of the implantation of epidermal elements in the dermis. The term â€˜sebaceous cystâ€™ should be avoided, because it implies that the cyst is of sebaceous origin (1). They are benign lesions; however very rare cases of various malignancies developing in epidermoid cysts have been reported (1), (6). Less frequently, the cysts can become inflamed or infected, resulting in pain and tenderness. Asymptomatic epidermoid cysts do not need to be treated. Intralesional injection with triamcinolone may hasten the resolution of the inflammation. Epidermal cysts involving soft tissues may be removed via simple excision or incision, with removal of the cyst and the cyst wall. Incision and drainage may be performed if a cyst is infected, but this may only facilitate the clearing of infection; however, it will not eradicate the cyst. If the entire cyst wall is not removed, the lesion may recur (1). In intraosseous epidermoid cysts, curettage with or without bone grafting is adequate (3), (4), (5). On rare occasions, amputation of the involved thumb may be needed (7).
All Photographs displayed in this article were obtained after informed consent by the parents of the child.
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