Cysts Flashcards by Malindi Haggett

What is the difference between a cyst and a pseudocyst?

Cyst = epithelial lining
Pseudocyst = No lining

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What are the histological features of a Epidermoid Cyst?

Cyst filled with laminated Keratin

Stratified squamous epithelium with a granular layer

+/- inflammatory infiltrate if ruptured

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What conditions may cause multiple epidermoid cysts?

Gardners syndrome (Familial adenomatous papulosis)

Basal call navues syndrome

Acne Vulgaris

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What is a Dilated Pore of Winer?

A single dilated pore, often on the face of adults.

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What are the histological features of a dilated pore of Winer?

Stratified squamous epithelium with a granular layer

Dilated follicular opening

Keratin debris

Finger like projections of the lining

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What is the histology of Milia?

Same as epidermoid Cyst

Stratified squamous epithelium with a granular layer

Laminated keratin

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What is Milia en Plaque?

Multiple grouped Milia on an erythematous plaque

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Rx options for Milia

Incision and expression
Laser Ablation
Electrocautery

Topical retinoid if there are many

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Which part of the hair follicle to epidermoid cysts arise?

The follicular infundibulum

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What is the histology of a Tricholemmal cyst and how does it differ from a epidermoid cyst?

Stratified squamous epithelium
- NO granular Layer
- cells near cyst cavity are swollen and pale

Cystic cavity filled with dense eosinophilic keratin
- often with calcification

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What gene is ass with Trichilemmal cysts?

PLCD1 (AD inheritance)

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Where do trichilemmal cysts normally occur?

The scalp, often multiple

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How do you treat a trichilemmal cyst?

Excision (often pop out easily)

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How does a vellus hair cyst present clinically?

Numerous dome shaped papules

Normally on the trunk

Can be skin coloured or hyper pigmented

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What are the histological features of a vellus hair cyst?

Stratified squamous epithelium

Epidermoid keratinisation

Vellus hairs in the cyst cavity

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What do you see on histology for a ruptured epidermoid cyst?

Fragments or absence of the epithelial lining
Neutrophilic and histolytic infiltrate
Fragments of keratin / Keratin flakes

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What is a steatocystoma?

A benign cyst with squamous epithelial lining and associated sebaceous glands

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How does a steatocystoma present?

single or multiple flesh coloured papules with oily contents

Tend to occur on the chest, axillae and groin

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What is steatocystoma multiplex?

Autosomal Dominant condition characterised by multiple steatocystomas

Gene affected = Keratin 17 (KRT17)

What do you see on histology of a steatocystoma?

dermal cyst
lined by a thin stratified squamous epithelium
WITHOUT a granular layer.

Epithelium is surrounded by an irregular, corrugated eosinophilic cuticle

What is a follicular hybrid cyst?

Represent a histologic variant

Dermal cysts with stratified squamous lining in which there is transition in the wall between epidermoid keratinization and tricholemmal or matrical keratinization

What is a pigmented follicular cyst?

Dermal cysts
Often with a connection to the epidermis

Lined by stratified squamous epithelium with a granular layer

contains pigmented terminal hair shafts.

What is a dermoid cyst?

Benign cutaneous cyst that arises from the entrapment of ectodermal elements along the lines of embryonic closure

They contain other normal cutaneous structures such as hair, sebaceous lobules, eccrine glands, apocrine glands, and/or smooth muscle.

What precaution should be taken prior to excision of a dermoid cyst?

Imaging

the differential diagnosis includes neural heterotopias, imaging to exclude connection to the CNS

What is an ear pit?

A congenital defect the ear is formed by the fusion of six tubercles: three each from the first two branchial arches. Preauricular cysts reflect defective embryologic fusion with epithelial entrapment. may present as a true cystic nodule or an invagination in the preauricular area Unilateral, Right sided

What is the histology of an ear pit?

epidermal-lined cyst with stratified squamous epithelium and a granular layer

List the types of cysts with stratified squamous epithelium and a granular layer?

Epidermoid cyst Proliferating epidermoid cyst Milia Ear Pit Pilonidal cyst Vellus hair cyst Pigmented follicular cyst Pore of Wine

List the cysts with stratified squamous epithelium and NO granular layer

Tricholemmal cyst Proliferating tricholemmal cyst

What is a pilonidal cyst?

inflamed, painful, cystic swelling upper gluteal cleft or sacrococcygeal area

What is the aetiology of pilonidal cysts?

Some authors believe they are congenital, essentially representing a dermoid cyst most authors now believe that the vast majority of lesions are acquired, representing a foreign body response to entrapped hair.

Pilonidal cysts may be seen in which clinical tetrad?

Follicular occlusion tetrad Acne Conglobata HS Dissecting cellulitis Pilonidal cyst

What is the histology of a pilonidal cyst?

Epidermal-lined cyst or sinus tract. Cyst cavities contain hair and keratin debris and are surrounded by fibrosis, granulation tissue, and mixed inflammation.

What is a hydrocystoma?

benign cystic tumors that arise from apocrine or eccrine sweat glands. present as translucent, skin-colored to bluish cysts on the face

What is the histology of apocrine Hidrocystoma?

unilocular to multi- locular dermal cysts l lined by two layers of epithelial cells that show luminal bulbous protrusions (“snouting”) and decapitation secretion

What is the histology of eccrine Hidrocystoma?

uniloculate cyst containing clear fluid, lined by two layers of cuboidal to flattened epithelium

Where are Bronchogenic cysts located?

Suprasternal notch Rarely anterior neck / chin

What is a bronchogenic cyst?

A rare congenital malformation Arise from abnormal budding of the foregut during early embryonic development typically occurring along the tracheobronchial tree

What is the histology of bronchogenic cyst?

pseudostratified, ciliated, columnar epithelium with interspersed goblet cells. The cyst wall often contains smooth muscle and mucous glands and rarely cartilage.

What is a thyroglossal duct cyst?

A cyst that arises from remnants of the thyroglossal duct Often moves with swallowing (attaches to the hyoid bone)

Lists the cysts without an epidermal lining? (4)

Mucocele Digital mucous cyst Ganglion Pseudocysts (of the auricle and synovial)

What are the three main categories of cutaneous cysts?

Cysts with stratified squamous epithelial lining Cysts with non-stratified squamous epithelial lining Cysts without an epithelial lining

What two cysts may occur on the umbilicus?

1. Omphalomesenteric duct cyst - remnant of the omphalomesenteric duct = fetal connection between midgut and yolk sac) - lined by gastric mucosa 2. Urachal cyst - due to incomplete closure of the urachus = fetal bladder connection to umbilicus - Uroepithelial lining or cuboidal or columnar cells

What is the name of cyst that commonly occurs on the ventral aspect of the penis? and why does it occur? What is the key histology finding?

Median Raphe Cyst This is due to aberrant urethral epithelium Stratified columnar epithelium (1 - 4 cells thick)

What is the name of the cyst that occurs on the labia majoa? and the ass histology?

Cutaneous Ciliated Cyst Histology: Unilocular or multiloculated, lined by ciliated cuboidal/columnar epithelium with papillary projections.

Where do branchial cleft cysts occur?

Pre-auricular region, mandibular region or along the sternocleidomastoid muscle

Treatment options for hydrocystomas?

Excision (if single) 1% atropine (if multiple, recurs when stops) Botox can flatten