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Pseudocyst of the Auricle Workup

  • Author: William P Baugh, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Nov 12, 2014
 

Imaging Studies

In several reports, magnetic resonance images revealed a serous fluid collection within the auricular cartilage, further enhancing the diagnosis.[8, 12]

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Histologic Findings

Histologically, pseudocysts of the auricle lack pathognomonic features, but they can typically be characterized by an intracartilaginous cavity lacking an epithelial lining. They contain thinned cartilage and hyalinizing degeneration along the internal border of the cystic space. The epidermis and dermis overlying the pseudocyst are usually normal. However, a dermal perivascular lymphocytic infiltrate is commonly found, along with inflammatory cells within the cystic space.

In one of study, calcification of the auricular cartilage was identified at least 7 days after initial clinical presentation.[13] Although contrary to literature reports,[10, 14, 15] one study postulated that an inflammatory response is crucial to the development of pseudocysts. This theory is based on a consistent perivascular inflammatory response seen in all 16 specimens studied.[13] Eosinophilic degeneration and necrosis of the cartilage is also present in some areas.[12] Intracartilaginous fibrosis and granulation tissues are manifestations of later stages of pseudocysts.[13] A slide of an auricular pseudocyst is shown below.

Low magnification of this pseudocyst reveals a mucLow magnification of this pseudocyst reveals a mucin-containing cystic cavity.
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Contributor Information and Disclosures
Author

William P Baugh, MD Assistant Clinical Professor of Dermatology, Western University of Health Sciences; Medical Director, Full Spectrum Dermatology; Consulting Staff, Department of Dermatology, St Jude Medical Center

William P Baugh, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Laser Medicine and Surgery, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Coauthor(s)

Cynthia L Chen, DO, DO Intern, Pacific Hospital of Long Beach, California

Cynthia L Chen, DO, DO is a member of the following medical societies: American Osteopathic Association, California Medical Association, American Osteopathic College of Dermatology, Los Angeles County Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kelly M Cordoro, MD Assistant Professor of Clinical Dermatology and Pediatrics, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Medical Society of Virginia, Society for Pediatric Dermatology, Women's Dermatologic Society, Association of Professors of Dermatology, National Psoriasis Foundation, Dermatology Foundation

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Mark L. Welch, MD, and Hon Pak, MD, to the development and writing of this article.

References
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  2. Miyamoto H, Okajima M, Takahashi I. Lactate dehydrogenase isozymes in and intralesional steroid injection therapy for pseudocyst of the auricle. Int J Dermatol. 2001 Jun. 40(6):380-4. [Medline].

  3. Chen PP, Tsai SM, Wang HM, Wang LF, Chien CY, Chang NC, et al. Lactate dehydrogenase isoenzyme patterns in auricular pseudocyst fluid. J Laryngol Otol. 2013 May. 127(5):479-82. [Medline].

  4. Kopera D, Soyer HP, Smolle J, Kerl H. "Pseudocyst of the auricle", othematoma and otoseroma: three faces of the same coin?. Eur J Dermatol. 2000 Aug. 10(6):451-4. [Medline].

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  8. Pereira FC, Chinelli PA, Takahashi MD, Nico MM. Bilateral pseudocyst of the auricle in a man with pruritus secondary to lymphoma. Int J Dermatol. 2003 Oct. 42(10):818-21. [Medline].

  9. Stankevice D, Nielsen KO. [Two cases of auricular pseudocyst]. Ugeskr Laeger. 2009 Mar 9. 171(11):907. [Medline].

  10. Glamb R, Kim R. Pseudocyst of the auricle. J Am Acad Dermatol. 1984 Jul. 11(1):58-63. [Medline].

  11. Devlin J, Harrison CJ, Whitby DJ, David TJ. Cartilaginous pseudocyst of the external auricle in children with atopic eczema. Br J Dermatol. 1990 May. 122(5):699-704. [Medline].

  12. Tuncer S, Basterzi Y, Yavuzer R. Recurrent auricular pseudocyst: a new treatment recommendation with curettage and fibrin glue. Dermatol Surg. 2003 Oct. 29(10):1080-3. [Medline].

  13. Lim CM, Goh YH, Chao SS, Lim LH, Lim L. Pseudocyst of the auricle: a histologic perspective. Laryngoscope. 2004 Jul. 114(7):1281-4. [Medline].

  14. Lazar RH, Heffner DK, Hughes GB, Hyams VK. Pseudocyst of the auricle: a review of 21 cases. Otolaryngol Head Neck Surg. 1986 Mar. 94(3):360-1. [Medline].

  15. Hoffmann TJ, Richardson TF, Jacobs RJ, Torres A. Pseudocyst of the auricle. J Dermatol Surg Oncol. 1993 Mar. 19(3):259-62. [Medline].

  16. Job A, Raman R. Medical management of pseudocyst of the auricle. J Laryngol Otol. 1992 Feb. 106(2):159-61. [Medline].

  17. Miyamoto H, Oida M, Onuma S, Uchiyama M. Steroid injection therapy for pseudocyst of the auricle. Acta Derm Venereol. 1994 Mar. 74(2):140-2. [Medline].

  18. Kim TY, Kim DH, Yoon MS. Treatment of a recurrent auricular pseudocyst with intralesional steroid injection and clip compression dressing. Dermatol Surg. 2009 Feb. 35(2):245-7. [Medline].

  19. Patigaroo SA, Mehfooz N, Patigaroo FA, Kirmani MH, Waheed A, Bhat S. Clinical characteristics and comparative study of different modalities of treatment of pseudocyst pinna. Eur Arch Otorhinolaryngol. 2011 Oct 29. [Medline].

  20. Lim CM, Goh YH, Chao SS, Lynne L. Pseudocyst of the auricle. Laryngoscope. 2002 Nov. 112(11):2033-6. [Medline].

  21. Khan NA, Ul Islam M, Ur Rehman A, Ahmad S. Pseudocyst of pinna and its treatment with surgical deroofing: an experience at tertiary hospitals. J Surg Tech Case Rep. 2013 Jul. 5(2):72-7. [Medline]. [Full Text].

  22. Salgado CJ, Hardy JE, Mardini S, Dockery JM, Matthews MS. Treatment of auricular pseudocyst with aspiration and local pressure. J Plast Reconstr Aesthet Surg. 2006. 59(12):1450-2. [Medline].

  23. Oyama N, Satoh M, Iwatsuki K, Kaneko F. Treatment of recurrent auricle pseudocyst with intralesional injection of minocycline: a report of two cases. J Am Acad Dermatol. 2001 Oct. 45(4):554-6. [Medline].

  24. Cohen PR, Katz BE. Pseudocyst of the auricle: successful treatment with intracartilaginous trichloroacetic acid and button bolsters. J Dermatol Surg Oncol. 1991 Mar. 17(3):255-8. [Medline].

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  27. Cohen PR. Successful treatment of auricular pseudocyst using a surgical bolster. Cutis. 2007 Oct. 80(4):274. [Medline].

  28. Shan Y, Xu J, Cai C, Wang S, Zhang H. Novel Modified Surgical Treatment of Auricular Pseudocyst Using Plastic Sheet Compression. Otolaryngol Head Neck Surg. 2014 Sep 12. [Medline].

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Asymptomatic nodule on the left ear.
Low magnification of this pseudocyst reveals a mucin-containing cystic cavity.
Table. Comparison of Characteristics of 4 Auricular Conditions.
 Pseudocyst of the auricle Chondrodermatitis chronica helices Relapsing polychondritis Subperichondrial hematoma
SwellingLocalizedLocalizedDiffuseLocalized
Skin involvementRareYes, crusting/ulcerationYes, erythematousRare
PainRareCommon (from ulceration)Common (extremely tender)Common
Systemic SymptomsNoNoYes (involvement of other cartilage)No
Histologyracartilaginous, cystic defect, granulation tissueSubperichondrial granulation tissue, cystic dilatation rareAcute inflammable cells seen; antibody deposition on basement membrane during immunofluorescenceInflammatory cells with degraded blood products
Adapted from Lim CM, et al. “Pseudocyst of the Auricle.” 2002.
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