Cysts Flashcards
What cysts have a granular layer?
EIC dialted pore of Winer, milia, pilar sheath acanthoma, dermoid cyst, eruptive vellus hair cyst, verrucous epidermal cyst, pigmented follicular cyst +/- steatocytoma
Differentiation between EIC and millia?
<3mm = milia
Pathology of EIC?
Cystic cavity w/ laminated keratin w/ stratified squamous epithelium w/ granular layer. NO ADNEXAL STRUCTURES IN WALL like vellus hair cyst or dermoid cyst
Associations with EIC?
Gardners syndrome, Basal Cell Nevus Syndrome, multiple cysts can lead to scrotal calcinosis
What meds lead to EIC?
BRAF inhibitor
Pathology of a dilated pore of Winer?
Lined by a granular layer, ancathotic finger-like projections pushing into the dermis. Squamous epithelium.
Difference between pilar sheath acanthoma and dilated pore of Winer?
Thicker epithelium with the pilar sheath acanthoma that extends further and deeper than a dilated pore of Winer.
Name of milia on the hard palate of an infant?
Epstein’s pearls (Bohns nodules are more lateral at the buccal and lingual dental ridges)
Describe Epstein’s pearls?
Keratin-filled cysts with squamous epithelial lining (like an epidermal inclusion cyst) that are often found on the palate.
What dz can lead to EIC?
Blistering dz like EBA and PCT –> scarring dz, going to trap some follicular structures
Path of milia?
Same as EIC but smaller <3
Pathology of a pilar sheath cyst?
They do not have granular layer, compact, keratinization analogous to that of outer root sheath of the hair follicle at the isthmus, homogenous material w/ freq foci of cacification
What are 2 categories of milia?
Scarring vs non scarring
Why do scarring cause milia?
Traps eccrine gland, contents can’t get out
Histology of a proliferating pilar cyst?
Proliferating trichilemmal tumor. broad anastomosing bands and nodules of squamous epithelium, proliferation… like pilar cysts that are together
Histology of a vellus hair cyst?
Has granular layer, loose laminated keratinizing with numerous vellus hairs
What are the most common locations of vellus hair cysts?
Trunk
Associated things with hair cyst?
Eruptive vellus hair cysts / a/w steatocystoma multiplex
Histology of steatocystoma?
Shark tooth lining (serrated appearing), associated w/ sebaceous gland in the wall (not always visible), loose material in the center, decapitative secretion.
Sometimes no granular layer (sources vary on this)
What associations are seen with steatocystoma?
Steatocystoma multiplex, associated with pachyonychia congenita type 2.
Mutation in steatocystoma multiplex?
Keratin 17
Another name for pachyonychia congenita type 2?
Jackson-Lawler
What is the difference on histology between steatocystoma and cutaneous keratocyst?
Similar path to steatocystoma but w/ no sebaceous gland associated w/ it
Most common location of dermoid cyst?
Located around the eyes in an infant, lateral eyebrow is the m/c place
May be a/w underlying skull defect in embryonic fusion planes **don’t bx w/o imaging
Pathology of a dermoid cyst?
Has granular layer, stratified squamous epithelium, contains other normal cutaneous structures such as hair (terminal hairs not vellus hairs), sebaceous lobules, eccrine, apocrine glands, smooth muscle
Where do ear pits come from?
Incomplete fusion of 3 tubercles from the first 2 branchial arches
What is the follicular occlusion tetrad?
- acne congloblata
- hidradenitis suppuratie
- dissecting cellulits of scalp
- pilonidal cyst ask about other sx’s present
What epidermal cysts have non-stratified squamous epithelium?
Hidrocystoma (eccrine, apocrine), bronchogenic cyst, thyroglossal duct cyst, branchial cleft cyst, cutaneous ciliated cyst, ciliated cyst of the vulva, median raphe cyst, omphalomesenteric duct cyst.
What is the most common non-granular layer cyst?
Pilar cyst
What is the most common granular layer containing cyst?
EIC
What is the differentiation of a cyst if it doesn’t have a granular layer?
3 choices from squamous epi: pilonidal, ear pit cyst, steatocystoma (sort of) or developmental cysts
What are the cutaneous manifestations of Schopf-Schulz-Passarge syndrome?
Apocrine hidrocystomas, palmoplantar keratoderma, hypotrichosis, and onychodystrophy
Clinical of hidrocystoma?
BLUISH cysts, mc on face can be by the eye. apocrine or eccrine. solitary (smith) or multiple (robinson) apocrien usually solitary eccrine usually muptole
Histology of hidrocystoma?
Pigmented sweat in the middle, two cell lining, not connected to epidermis usually
What is the clinical presentation of the bronchogenic cyst?
2nd or 3rd decades, most often occurring on the midline near the manubrium sterni. Can present as a cyst or a draining sinus
thyroglossal duct cyst?
movement w/ swallowing (dif from bronchogenic cyst), midline cystic nodules on ontaerior neckline in kids and young adults.
branchial celft cyst clinical
do not move w/ swallowing, mc preauricualr, mandibular, anterior border of SCM, more lateral as compared to thyroglossal duct cyst.
What is the clinical presentation of a median raphe cyst?
Most commonly located near the glans, ventral aspect of the penis, they do not connect to the urethra, can be cut out
What is the clinical presentation of a omphalomesenteric duct cyst?
Vitelline cyst, failure of closure of the connection between midgut and yolk sac, may occur anywhere between intestines and umbilicus
Looks like a polyp-like structure on the umbilicus
What is a urachal cyst?
Connects fetal bladder to the umbilicus, normally closes during development
Urine leakage from incomplete urachal duct remnant occurs
These can be painful, should be ultrasounded
Treatment of urachal cyst?
US and you do want to excise to prevent infxn
Mucocele clinical presentation?
Lower labial mucosa is the most common location, also on the floor of mouth buccal mucosa tongue
Dome-shaped, arise as a result of the disruption of ducts of minor salivary glands.
Clinical presentation of digital mucous cyst?
Filled w/ mucus, on the dorsal surface of the distal finger by nail
Longitudinal depression of the nail plate may be seen distal to the lesion
Clinical presentation of a ganglion cyst?
Can be attached to tendon sheath (often) do not often communicate with the joint space. mc on dorsal surface
What is the clinical presentation of a psedocyst of the auricle?
Cauliflower ear, scaphoid fossa of the ear, middle-aged men, unilateral, chronic trauma is the cause.
What cysts arise from the follicular infundibulum?
EIC, milium, pigmented follicular cyst, vellus hair cyst
What cysts arise from the follicular isthmus?
Pilar cyst
What cysts arise from the sebaceous ducts?
Steatocystoma
What two genetic dz’s are EIC’s associated with?
Gardner’s syndrome and Gorlin syndrome
What is the mutation in steatocystoma multiplex?
Keratin 17
How is steatocystoma multiplex inherited?
AD
What is it called when you have multiple steatocystoma w/ eruptive vellus hair cysts?
Pachyonychia congenita type 2
What is the other name for pachyonychia congenita type 2?
Jackson Lawler
What are the mutations in pachyonychia congenita type 2 or Jackson-Lawler syndrome?
keratin 6b, 17
What syndrome is associated with hybrid cysts with pilomatrical changes?
Gardner’s syndrome
What are the 3 genoderms associated w/ dermoid cysts?
Gorlin Syndrome, klippel-feil syndrome, goldenhar syndrom
What is Goldenhar syndrome?
AR, a/w limbal-epibulbar (ocular) dermoid cysts, which are caused secondary to defects in the 1st and 2nd branchial arches, also a/w accessory tragus, auricular fistula, deafness, Golden”HARd” of hearing
What are the non-stratified squamous epithelium lined cysts?
Hidrocystoma (eccrine/apocrine), bronchogenic cyst, thyroglossal duct cyst, branchial cleft cyst, cutaneous ciliated cyst, ciliated cyst of the vulva, meidan raphe cyst, omphalomesenteric duct cyst
What is a solitary hydrocystoma called?
Smith hydrocystoma
What are multiple hidrocystomas called?
Robinson
What is the pathology of the omphalomesenteric duct cyst?
Looks like gi mucosa, must be distinguished from gi metastasis
What cysts do not have an epithelial lining?
Mucocele, digital mucous cyst, ganglion cyst, pseudocyst of auricle, cutaneous metaplastic synovial cyst
Histology of a branchial cleft cyst?
Pseudostratified columnar or stratified squamous epithelium with surrounding dense lymphoid tissue including lymphoid follicles w/ germianl centers (this prominent lymphoid aggregates and follicles is a key)
