Dermoid cysts masquerading as pilonidal sinus disease

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Abstract

BACKGROUND: Dermoid cysts (DC) are benign cystic tumors formed because of impaired embryogenesis processes when ectodermal rudiments are immersed in tissues and organs along the lines of their embryonic fusion. DC is most often localized in the head and neck (84%). Rarer localizations areas are as follows: 1) ovaries; 2) retroperitoneal space; 3) mediastinum; 4) pancreas and spleen; 5) spinal canal. In case of retroperitoneal localization of DC, the presacral location occurs more often, then location in soft tissues of the sacrococcygeal region. Moreover, the clinical pattern may be similar to that of pilonidal disease, which may cause difficulties in diagnosis at the preoperative diagnostics and further determination of the surgical techniques.

CLINICAL CASES DESCRIPTION: In the Clinic of colorectal and minimally invasive surgery, two clinical cases of dermoid cysts masquerading as pilonidal sinus disease were encountered. In both cases, Bascom II surgery was performed. Macroscopic examination of the specimens revealed pathognomonic signs of dermoid cysts: a hair growth site on the epithelial lining of the cyst in the first case and the presence of sebum in the cyst cavity in the second case. The early postoperative period in both patients proceeded smoothly, and no data were obtained for recurrence in the 6- and 18-month follow-up period.

CONCLUSION: Because of the similar clinical picture of pilonidal cysts and DC of the sacrococcygeal region, differential diagnosis is crucial. A wide range of minimally invasive methods are available for treating pilonidal disease; however, they are not appropriate for the treatment of DC. At present, the only radical method of treating DCs of the sacrococcygeal region is excision of the cyst without rupturing the capsule to prevent disease recurrence.

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About the authors

Shlyk D. Darya

I.M. Sechenov First Moscow State Medical University

Email: shlikdarya@gmail.com
ORCID iD: 0000-0002-9232-6520
SPIN-code: 4948-3550

MD, Cand. Sci. (Med.), associate professor

Russian Federation, 1/1 Pogodinskaya street, 119435, Moscow

Sergey I. Barkhatov

I.M. Sechenov First Moscow State Medical University

Email: barsiv@mail.ru
ORCID iD: 0000-0003-4702-5558

MD, Cand. Sci. (Med.), associate professor

Russian Federation, 1/1 Pogodinskaya street, 119435, Moscow

Lev A. Safyanov

I.M. Sechenov First Moscow State Medical University

Author for correspondence.
Email: uulevsafyanov@gmail.com
ORCID iD: 0009-0008-6273-230X
Russian Federation, 1/1 Pogodinskaya street, 119435, Moscow

Maria N. Pikuza

I.M. Sechenov First Moscow State Medical University

Email: mashenkapikuza@gmail.com
ORCID iD: 0000-0002-2680-9372
Russian Federation, 1/1 Pogodinskaya street, 119435, Moscow

Roman N. Kostin

I.M. Sechenov First Moscow State Medical University

Email: oman.kostin.2002@gmail.com
ORCID iD: 0009-0004-1132-1288
Russian Federation, 1/1 Pogodinskaya street, 119435, Moscow

Petr V. Tsarkov

I.M. Sechenov First Moscow State Medical University

Email: tsarkov@kkmx.ru
ORCID iD: 0000-0002-7134-6821
SPIN-code: 7570-0664

MD, Dr. Sci. (Med.), professor

Russian Federation, 1/1 Pogodinskaya street, 119435, Moscow

References

  1. Chang W, Ding Y, Yan Y, et al. Dermoid cyst with a congenital sinus tract over the left sternoclavicular joint: a case report and literature review. J Int Med Res. 2020;48(6):300060520934984. doi: 10.1177/0300060520934984
  2. Shareef S, Ettefagh L. Dermoid cyst. StatPearls. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560573/
  3. Kuyumcu G, Jhaveri M. Ruptured spinal dermoid cyst. Can J Neurol Sci. 2017;44(5):601–602. doi: 10.1017/cjn.2017.26
  4. Chirkov RN, Vakarchuk IV. Origin of extra-organ cysts of retroperitoneal space. Proceedings of the V International Scientific and Practical Conference “Actual issues in science and practice”. In 4 parts. Part 4; 2018 Feb 1; Samara. Available from: https://mdou66lip.ru/files/2018/03/17/03.pdf (In Russ).
  5. Nishie A, Yoshimitsu K, Honda H, et al. Presacral dermoid cyst with scanty fat component: usefulness of chemical shift and diffusion-weighted MR imaging. Comput Med Imaging Graph. 2003;27(4):293–296. doi: 10.1016/s0895-6111(02)00101-5
  6. Nair RR, Shoukrey MN, Whitlow B. Presacral dermoid: now you see it now you don’t. Gynecological Surgery. 2007;4(3):229–231. doi: 10.1007/s10397-007-0278-5
  7. Chand P, Bhatnagar S, Kumar A, Rani N. A rare presentation of lower back swelling as tailgut cyst. Niger J Surg. 2016;22(2): 134–137. doi: 10.4103/1117-6806.189023
  8. Kesici U, Sakman G, Mataraci E. Retrorectal/presacral epidermoid cyst: report of a case. Eurasian J Med. 2013;45(3): 207–210. doi: 10.5152/eajm.2013.40
  9. de Castro Gouveia G, Okada LY, Paes BP, et al. Tailgut cyst: from differential diagnosis to surgical resection-case report and literature review. J Surg Case Rep. 2020;2020(7):rjaa205. doi: 10.1093/jscr/rjaa205
  10. Ohn J, Jang S, Jo SJ, Cho KH. A case of tailgut cyst as a subcutaneous nodule at the coccygeal area. Ann Dermatol. 2016;28(5):641–642. doi: 10.5021/ad.2016.28.5.641
  11. Wu X, Chen C, Yang M, Yuan X, Chen H, Yin L. Squamous cell carcinoma malignantly transformed from frequent recurrence of a presacral epidermoid cyst: report of a case. Front Oncol. 2020;10:458. doi: 10.3389/fonc.2020.00458
  12. Maklad M, Gradhand E, West E. Paramedian chest wall dermoid cyst. BMJ Case Rep. 2019;12(2):e228831. doi: 10.1136/bcr-2018-228831
  13. Litovka VK, Shherbinin AV, Fomenko SA, et al. Epidermoid and dermoid cysts of internal localization in children. Proceedings of the Collection of Scientific Works in Memory of Professor E.M. Vitebsky “Problematic Issues of Pedagogy and Medicine”; 2015 Sept 15; Donetsk. Available from: https://portal.dnmu.ru/fileadmin/EDITDATA/bibl/vitebskiy-2017-_11.pdf (In Russ).
  14. Karaseva OV, Golikov DЕ, Gorelik AL, et al. A rare clinical observation of a dermoid cyst and isolated doubling of the small intenstine in the retroperitoneal space in a 15-year-old girl. Russian Journal of Pediatric Surgery. 2019;23(6):339–343. doi: 10.18821/1560-9510-2019-23-6-339-343
  15. Allam-Nandyala P, Bui MM, Caracciolo JT, Hakam A. Squamous cell carcinoma and osteosarcoma arising from a dermoid cyst — a case report and review of literature. Int J Clin Exp Pathol. 2010;3(3):313–318.
  16. Fujita K, Akiyama N, Ishizaki M, et al. Dermoid cyst of the colon. Dig Surg. 2001;18(4):335–337. doi: 10.1159/000050167
  17. Søndenaa K, Andersen E, Nesvik I, Søreide JA. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis. 1995;10(1):39–42. doi: 10.1007/BF00337585
  18. Chintapatla S, Safarani N, Kumar S, Haboubi N. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol. 2003;7(1):3–8. doi: 10.1007/s101510300001
  19. Dutkiewicz P, Ciesielski P, Kołodziejczak M. Results of surgical treatment of pilonidal sinus in 50 patients operated using Bascom II procedure — prospective study. Pol Przegl Chir. 2019;91(5):21–26. doi: 10.5604/01.3001.0013.5050
  20. Shelygin JuA , Blagodarnyj LA, editors. Coloproctology Handbook. Moscow: Litterra; 2012. 596 p.
  21. Association of Coloproctologists of Russia. Epithelial coccygeal passage: clinical recommendations. 2021.
  22. Kaĭzer AM. Colorectal surgery. Мoscow: Izdatel’stvo BINOM; 2011. 737 p.
  23. Yavuz Y, Aykut Yıldırım M, Çakır M, et al. Classification of pilonidal sinus disease according to physical examination, ultrasonography and magnetic resonance imaging findings. Turkish Journal of Colorectal Disease. 2020;30(4):261–267. doi: 10.4274/tjcd.galenos.2020.2020-3-9
  24. Gaike CV, Kanna RM, Shetty AP, Rajasekaran S. A rare cause of recalcitrant coccydynia: benign dermoid cyst masquerading as coccygeal pain. Eur Spine J. 2016;25 Suppl. 1:194–197. doi: 10.1007/s00586-015-4354-7
  25. Kulyapin AB. About the cause of epithelial coccygeal passages suppuration and the choice of the optimal method of surgical intervention. In: Actual questions of proctology. Theses of the report of the All-Union conference; Kiev
  26. Moscow 1989. 125–126 p.
  27. Patey DH, Scarff RW. Pathology of postanal pilonidal sinus; its bearing on treatment. Lancet. 1946;2(6423):484–486. doi: 10.1016/s0140-6736(46)91756-4
  28. Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery. 1980;87(5):567–572.
  29. Sharma D, Nandini R, Goel D, et al. Retrorectal dermoid cyst in an adult. ANZ J Surg. 2008;78(5):408. doi: 10.1111/j.1445-2197.2008.04488.x
  30. Johnson EK, Vogel JD, Cowan ML, et al. The American Society of Colon and Rectal Surgeons’ Clinical Practice Guidelines for the management of pilonidal disease. Dis Colon Rectum. 2019;62(2): 146–157. doi: 10.1097/DCR.0000000000001237
  31. Stauffer VK, Luedi MM, Kauf P, et al. Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep. 2018;8(1):3058. doi: 10.1038/s41598-018-20143-4

Supplementary files

Supplementary Files
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2. Fig. 1. Appearance of the patient’s A. sacrococcygeal region (27 years old).

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3. Fig. 2. Ultrasound imagination of the mass in soft tissues of the sacrococcygeal region.

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4. Fig. 3. Steps of surgery: a, b — wound appearance after excision; c — final view after suturing.

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5. Fig. 4. Removed specimen: a — cyst cavity; b — a tuft of hair in the cyst cavity; c — a region of the «skin» with growing hair, indicated by an arrow.

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6. Fig. 5. External view of the sacrococcygeal region (patient’s B; 66 years old).

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7. Fig. 6. Ultrasound imagination of the mass in soft tissues of the sacrococcygeal region measuring 4×3 cm.

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8. Fig. 7. Magnetic resonance imaging of the pelvic organs with intravenosus contrast: a — sagittal view; the arrow indicates a mass not fixed to the coccyx; b — axial view; the arrow indicates the mass located in the subcutaneous fat on the left.

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9. Fig. 8. Intraoperative photo: a — mobilized cyst, the arrow indicates the place of fixation to the sacrum; b — postoperative wound after specimen removal; c — the final view after suturing the wound.

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10. Fig. 9. The specimen: a — removed specimen, without cystic sac damage; b — cyst cavity filled with sebum; c — the inner surface of the cavity of the cystic mass.

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