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Dermoid Cyst Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jun 06, 2016
 

History

Dermoid cysts that are congenital and localized on the neck, head, or trunk are usually visible at birth. In some instances, careful medical examination may be necessary to identify a dermoid cyst. A tuft of hairs emanating from a midline nasal depression or nodule may represent a nasal dermoid cyst.[3] Unilateral upper eyelid swelling may be the first sign, with imaging studies demonstrating a soft tissue orbital dermoid cyst arising from the lacrimal gland.[4] An eyelid dermoid cyst attached to a tarsus may be evident as a firmly adherent nontender upper-eyelid nodule.[5] A dermoid cyst of the lower lid may be evident as a painless, gradually enlarging swelling of the lower eyelid.[6] Dermoid tumors in the medial canthal area may present as masses adherent to the lacrimal canaliculi.[7] Rarely, a dermoid cyst evident during the newborn period clinically appears, only to become evident years later with full-thickness bone erosion and transcranial extension.[8]

Intracranial, intraspinal, or intra-abdominal dermoid cysts may be suspected after specific or nonspecific neurologic or gynecologic symptoms occur. In these instances, imaging studies may help in distinguishing dermoid cysts from other tumors or organ malformations (see Imaging Studies). A congenital intracranial frontotemporal dermoid cyst may be first evident as a cutaneous fistula, although intracranial extension and cutaneous sinus tract formation are rarely seen with these dermoid cysts.[9]

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Physical

Dermoid cysts can appear as cutaneous cysts on the head, as cysts on the floor of the mouth or elsewhere in the head, within the parotid gland,[10] or as cysts in the testes or penis. They can be quite large.[11]

Specialists in various disciplines may consider dermoid cysts to be different entities.

Head and neck

Cutaneous cysts most commonly occur on the head (forehead), mainly around the eyes. They may be evident as a tadpole-shaped cyst on the eyebrow.[12] Occasionally, they occur on the neck or in a midline region. When on the head, dermoid cysts are often adherent to the periosteum. The usual diameter of the lesions is 1-4 cm.

In one study, 25 benign tumors on the forehead and brow of children and adolescents were successfully removed by means of endoscopic excision. Of these, 6 were classified as dermoid cysts. Dermoid cysts on the forehead and brow are known to cause pressure-related erosion of the underlying bony tissue, and surgical intervention may be helpful.

In 191 children treated for congenital cysts and fistulas of the neck in 1984-1999, 21 dermoid cysts were found. Periauricular fistulas and cystic hygromas were not included in this study.[13]

Occasionally, skin-related dermoid cysts are multiple and develop over periods as long as 20 years. In one unusual case, multiple subcutaneous dermoid cysts were present in the frontal region of a 41-year-old man, none with evident intracranial extension.

In many patients, dermoid cysts occur on the floor of the mouth or elsewhere in the mouth.[14, 15, 16, 17]

Because the term dermoid is frequently used in the literature, some authors believe that this term should be used for all congenital cysts on the floor of the mouth. Three subclasses of congenital mouth cysts are described in the literature: epidermoid (simple) cysts, dermoid (complex) cysts, and teratoid (complex) cysts. Most of these lesions occur in individuals aged 10-30 years. Only a few cases describe dermoid cysts of the mouth in newborns or children.

An unusual case of a carcinomatous transformation of a long-standing sublingual dermoid cyst has been described.[18]

Other rare dermoid cysts in the oral cavity are those on the tongue.[19, 20] As of early 2000, 17 patients with intralingual dermoid cysts are described in the English-language literature. All cases occurred in young patients. Magnetic resonance imaging (MRI) was helpful in establishing the differential diagnosis. Surgical excision corrected deglutition and speech problems in all of these patients.

Dermoid cysts in the eustachian tube are rare.[21] Only 12 patients have been described. In most cases reviewed, cysts affected female patients on the left side. MRI was useful in establishing the correct diagnosis and in selecting the surgical approach.

Reports of nasal dermoid cysts were recently published. Of 36 children with nasal dermoid sinus cysts that were treated from 1974-1994, 10 had only a midline cyst, 8 had only nasal pits, and 18 had combined cysts. Meningeal adherences have been found in only 2 patients.[22]  Nasal dermoid cysts may be evident as a midline nasal pit, fistula, or infected mass from the glabella to nasal columella, sometimes as a midline nasal punctum at birth.[23]

Testes or penis

Dermoid cysts can occur in the testes or penis.

In a review of cystic testicular lesions in the pediatric population, dermoid cysts were noted.[24] Other diagnoses for these cysts include epidermoid cyst, prepubertal teratoma, juvenile granulosa cell tumor, cystic dysplasia of the rete testis, testicular cystic lymphangioma, simple cyst, and cystic degeneration after torsion. An understanding of potentially cystic testicular lesions in children leads to the best treatment choices and often to the preservation of a substantial portion of the affected testis.

Dermoid cysts in the penis are extremely rare. Tomasini et al[4] described the first in 1997. The patient was a young white male who had significant penile swelling for several months.

Spine and cranium

For neurosurgeons, dermoid cysts are associated with congenital cysts of the spine or intracranial cysts.

Several cases involve ruptured cysts and generalized subarachnoid and ventricular spread of the contents (mostly fatty masses).[25, 26, 27]

In some patients, spinal dermoid cysts, especially those connected to dermal sinus tract, lead to severe neurologic complications such as secondary spinal subdural abscesses caused by the spread of the infection in the dermoid cyst.

Ovary

For gynecologists and general pathologists a dermoid cyst is primarily associated with a cystic tumor of the female ovary.

Cystic teratoma is a relatively rare tumor that most often occurs in females aged 15-40 years. A cystic teratoma consists of a thick leatherlike capsule that covers amorphous fatty masses and poorly to fully differentiated structures derived from the ectoderm. Most ovarian dermoid cysts contain skin and skin adnexa, including prominent sebaceous glands, hairs, and nails, but also teeth or eyes. Melanotic changes may also occur. Rare cases of multiple dermoid cysts of the omentum have been reported.[28] Dermoid cysts of the ovary are usually benign and easy to remove.

Malignant melanomas may originate from melanocytes in ovarian cystic teratomas. Two new cases and 17 older cases in the literature (reported from 1903-1995) are described and were critically reviewed. The present authors found 17 additional cases of benign and malignant melanotic ovarian lesions that were not associated with a dermoid cyst, including 4 melanomas, 3 benign nevi, 5 benign melanosis, and 4 benign and malignant retinal anlage tumors. The extremely rare primary ovarian melanoma was differentiated from the more common melanoma metastatic cyst of the ovary by its unilaterality, the presence of junctional change, and detailed history taking and physical examination, the findings of which excluded other primary sites.[29]

Three patients with metastasizing squamous cell carcinoma from a dermoid cyst of the ovary are described.[30] Malignant transformation in a dermoid cyst is a rare complication and mainly occurs in older individuals. Although the prognosis is poor, aggressive therapy may result in long-term remission.

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Causes

Dermoid cysts are true hamartomas. Dermoid cysts occur when skin and skin structures become trapped during fetal development.

Histogenetically, dermoid cysts are a result of the sequestration of skin along the lines of embryonic closure.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Zbigniew Ruszczak, MD, PhD Consultant Dermatologist and Allergist, Department of Medicine, Division of Dermatology, Sheikh Khalifa Medical City, Abu Dhabi, UAE; Consultant in Pediatric Dermatology, Wound Healing and On-Site-Drug Delivery Systems; Visiting Consultant in Dermatology and Dermatopathology, UMDNJ-New Jersey Medical School, Newark

Zbigniew Ruszczak, MD, PhD is a member of the following medical societies: American Academy of Dermatology, New York Academy of Sciences, Sigma Xi

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.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

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

Albert C Yan, MD Section Chief, Associate Professor, Department of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine

Albert C Yan, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology, Society for Pediatric Dermatology, American Academy of Pediatrics

Disclosure: Nothing to disclose.

References
  1. Yan J, Li Y, Chen Q, Ye X, Li J. Rare orbital cystic lesions in children. J Craniomaxillofac Surg. 2015 Mar. 43(2):238-43. [Medline].

  2. Xu XL, Li B, Sun XL, Li LQ, Ren RJ, Gao F. [Clinical and pathological analysis of 2639 cases of eyelid tumors]. Zhonghua Yan Ke Za Zhi. 2008 Jan. 44(1):38-41. [Medline].

  3. Madke B, Nayak C, Giri A, Jain M. Nasal dermoid sinus cyst in a young female. Indian Dermatol Online J. 2013 Oct. 4(4):380-1. [Medline]. [Full Text].

  4. Kiratli H, Bilgic S, Sahin A, Tezel GG. Dermoid cyst of the lacrimal gland. Orbit. 2005 Jun. 24(2):145-8. [Medline].

  5. Koreen IV, Kahana A, Gausas RE, Potter HD, Lemke BN, Elner VM. Tarsal dermoid cyst: clinical presentation and treatment. Ophthal Plast Reconstr Surg. 2009 Mar-Apr. 25(2):146-7. [Medline].

  6. Gonsalves SR, Lobo GJ, Mendonca N. Dermoid cyst: an unusual location. BMJ Case Rep. 2013 Nov 8. 2013:[Medline].

  7. Kim NJ, Choung HK, Khwarg SI. Management of dermoid tumor in the medial canthal area. Korean J Ophthalmol. 2009 Sep. 23(3):204-6. [Medline]. [Full Text].

  8. Maurice SM, Burstein FD. Disappearing dermoid: fact or fiction?. J Craniofac Surg. 2012 Jan. 23(1):e31-3. [Medline].

  9. Scolozzi P, Lombardi T, Jaques B. Congenital intracranial frontotemporal dermoid cyst presenting as a cutaneous fistula. Head Neck. 2005 May. 27(5):429-32. [Medline].

  10. Tas A, Yagiz R, Altaner S, Karasalihoglu AR. Dermoid cyst of the parotid gland: first pediatric case. Int J Pediatr Otorhinolaryngol. 2010 Feb. 74(2):216-7. [Medline].

  11. Kahraman A, Kahveci R. A giant dermoid cyst. Dermatol Surg. 2008 Sep. 34(9):1273-5. [Medline].

  12. Choi HJ, Kim SH, Lee JH. Unusual Presenting Tadpole-Shaped Dermoid Cyst on Eyebrow. J Craniofac Surg. 2016 May. 27 (3):e281-2. [Medline].

  13. Nicollas R, Guelfucci B, Roman S, Triglia JM. Congenital cysts and fistulas of the neck. Int J Pediatr Otorhinolaryngol. 2000 Sep 29. 55(2):117-24. [Medline].

  14. Acree T, Abreo F, Smith BR, Bagby J, Heard JS. Diagnosis of dermoid cyst of the floor of the mouth by fine-needle aspiration cytology: a case report. Diagn Cytopathol. 1999 Feb. 20(2):78-81. [Medline].

  15. Bonilla JA, Szeremeta W, Yellon RF, Nazif MM. Teratoid cyst of the floor of the mouth. Int J Pediatr Otorhinolaryngol. 1996 Dec 5. 38(1):71-5. [Medline].

  16. Vargas Fernandez JL, Lorenzo Rojas J, Aneiros Fernandez J, Sainz Quevedo M. [Dermoid cyst of the floor of the mouth]. Acta Otorrinolaringol Esp. 2007 Jan. 58(1):31-3. [Medline].

  17. Zeltser R, Milhem I, Azaz B, Hasson O. Dermoid cysts of floor of the mouth: report of four cases. Am J Otolaryngol. 2000 Jan-Feb. 21(1):55-60. [Medline].

  18. Devine JC, Jones DC. Carcinomatous transformation of a sublingual dermoid cyst. A case report. Int J Oral Maxillofac Surg. 2000 Apr. 29(2):126-7. [Medline].

  19. Miles LP, Naidoo LC, Reddy J. Congenital dermoid cyst of the tongue. J Laryngol Otol. 1997 Dec. 111(12):1179-82. [Medline].

  20. Myssiorek D, Lee J, Wasserman P, Lustrin E. Intralingual dermoid cysts: a report of two new cases. Ear Nose Throat J. 2000 May. 79(5):380-3. [Medline].

  21. Sichel JY, Dano I, Halperin D, Chisin R. Dermoid cyst of the eustachian tube. Int J Pediatr Otorhinolaryngol. 1999 Apr 25. 48(1):77-81. [Medline].

  22. Carroll CM, Gaffney R, McShane D. Congenital nasal dermoids in children. Ir J Med Sci. 1997 Jul-Sep. 166(3):149-51. [Medline].

  23. Min HJ, Hong SC, Kim KS. The Usefulness of Three-Dimensional Reconstruction Computed Tomography in the Nasal Dermoid Cyst. J Craniofac Surg. 2016 May. 27 (3):819-20. [Medline].

  24. Garrett JE, Cartwright PC, Snow BW, Coffin CM. Cystic testicular lesions in the pediatric population. J Urol. 2000 Mar. 163(3):928-36. [Medline].

  25. Calabrò F, Capellini C, Jinkins JR. Rupture of spinal dermoid tumors with spread of fatty droplets in the cerebrospinal fluid pathways. Neuroradiology. 2000 Aug. 42(8):572-9. [Medline].

  26. Carvalho GA, Cervio A, Matthies C, Samii M. Subarachnoid fat dissemination after resection of a cerebellopontine angle dysontogenic cyst: case report and review of the literature. Neurosurgery. 2000 Sep. 47(3):760-3; discussion 763-4. [Medline].

  27. Karabulut N, Oguzkurt L. Tetraventricular hydrocephalus due to ruptured intracranial dermoid cyst. Eur Radiol. 2000. 10(11):1810-1. [Medline].

  28. Mazumdar A, Vaiphei K, Verma GR. Multiple dermoid cysts of omentum. J Postgrad Med. 1997 Apr-Jun. 43(2):41-2. [Medline].

  29. Davis GL. Malignant melanoma arising in mature ovarian cystic teratoma (dermoid cyst). Report of two cases and literature analysis. Int J Gynecol Pathol. 1996 Oct. 15(4):356-62. [Medline].

  30. Ayhan A, Tuncer ZS, Bilgin F, Kucukali T. Squamous cell carcinoma arising in dermoid cyst. Eur J Gynaecol Oncol. 1996. 17(2):144-7. [Medline].

  31. Ro EY, Thomas RM, Isaacson GC. Giant dermoid cyst of the neck can mimic a cystic hygroma: using MRI to differentiate cystic neck lesions. Int J Pediatr Otorhinolaryngol. 2007 Apr. 71(4):653-8. [Medline].

  32. Thway K, Polson A, Pope R, Thomas JM, Fisher C. Extramammary Paget disease in a retrorectal dermoid cyst: report of a unique case. Am J Surg Pathol. 2008 Apr. 32(4):635-9. [Medline].

  33. Arishima H, Takeuchi H, Kitai R, Yamauchi T, Kikuta KI. Vascular Leiomyoma of the Scalp with a Small Deformity on the Skull Mimicking a Dermoid Cyst. Pediatr Dermatol. 2012 Feb 22. [Medline].

  34. Gleizal A, Abouchebel N, Lebreton F, Beziat JL. Dermoid cyst of the tongue: an association of dermoid cyst with bronchogenic epithelium. J Craniomaxillofac Surg. 2006 Mar. 34(2):113-6. [Medline].

  35. Fernandez-Miranda JC, Engh JA, Pathak SK, et al. High-definition fiber tracking guidance for intraparenchymal endoscopic port surgery. J Neurosurg. 2009 Nov 27. [Medline].

  36. Lin SD, Lee SS, Chang KP, Lin TM, Lu DK, Tsai CC. Endoscopic excision of benign tumors in the forehead and brow. Ann Plast Surg. 2001 Jan. 46(1):1-4. [Medline].

  37. Cozzi DA, Mele E, d'Ambrosio G, Totonelli G, Frediani S, Spagnol L. The eyelid crease approach to angular dermoid cysts in pediatric general surgery. J Pediatr Surg. 2008 Aug. 43(8):1502-6. [Medline].

  38. Agrawal V, Acharya H, Agarwal P, Sekhon V, Sharma D. Subcutaneoscopic excision of external angular dermoid cyst in children without conspicuous scarring. Asian J Endosc Surg. 2013 Aug. 6(3):241-4. [Medline].

  39. Nelson KE, Mishra A, Duncan C. Upper blepharoplasty approach to frontozygomatic dermoid cysts. J Craniofac Surg. 2011 Nov. 22(6):e41-4. [Medline].

  40. Jacquin A, Bejot Y, Hervieu M, et al. [Rupture of intracranial dermoid cyst with disseminated lipid droplets.]. Rev Neurol (Paris). 2009 Oct 19. [Medline].

  41. Tatlidede S, Egemen O, Ozkaya O, Erol O. Witch nose: an embarassing metaphor for nasal tip dermoid cysts. J Craniofac Surg. 2011 Sep. 22(5):1948-51. [Medline].

 
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