Cutaneous Columnar Cysts Clinical Presentation

Updated: Aug 27, 2018
  • Author: Niels Holm, MB, BCh, MMEd(Derm), FCDerm(SA); Chief Editor: William D James, MD  more...
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Presentation

History

Patients with dermal or subcutaneous nodules are usually asymptomatic and present with an enlarging swelling cyst.

If cysts are secondarily infected, inflamed, or ruptured, they may be symptomatic, causing pain and tenderness. Carcinomas may also arise within cysts and cause pain or other complications of enlarging tumors.

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Physical Examination

Physical findings are limited to the skin.

Thyroglossal cysts may occur anywhere along the thyroglossal duct from the base of the tongue to the anterior part of the neck. In the neck, they present as asymptomatic, gradually enlarging, round, midline or off-midline masses that move with swallowing because of their attachment to the hyoid bone. Sinuses or fistulae that drain clear or purulent fluid may be associated with the anterior part of the neck.

Thymic cysts are rare lesions found in the mediastinum or the neck. In children, the cervical lesions present as painless swellings. These lesions are most often found posterior of the lateral lobe of the thyroid, more often on the left side. They are 1-15 cm in diameter.

Bronchogenic cysts are present at or shortly after birth in the suprasternal notch. They have also been reported on the neck, the scapular area, and the chin. [40] Cysts may increase in size, form sinuses, and drain mucoid fluid.

Cutaneous ciliated cysts occur primarily on the legs of female patients, but they also have been seen in other locations. They present as subcutaneous swellings without a central pore.

Median raphe cysts present as midline developmental cysts on the ventral aspect of the penis and the scrotum on the raphe connecting the external urethral meatus to the anus. They are most often observed close to the meatus on the glans.

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Complications

Infrequently, cysts may be associated with a malignant neoplasm, such as papillary thyroid carcinoma in the thyroglossal duct cyst. Branchial cleft cysts may also develop malignancies, such as carcinoma, in their wall. [41] Infection, inflammation, rupture, fistulation or sinus formation, and drainage are further problems that may be encountered. These complications are the reasons why these cysts are surgically removed.

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