Epidermal cyst, proliferating L72.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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History
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Sau, Graham and Helwig, 1995

Definition
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Slowly growing, skin-coloured tumour corresponding to the proliferating tricholemic cyst, located deep dermally, with epidermal keratinisation of the cyst wall (clearly visible keratohyalin granules in the stratum granulosum).

Etiopathogenesis
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Not clear.

Manifestation
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Men are more frequently affected than women.

Localization
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Capillitium (about 20%), anogenital (30-40%), extremities (10-20%), buttocks, trunk (10-15%).

Clinical features
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Rare, solitary or multiple, slowly growing, skin-coloured, 0.4-15 cm large, solid or cystic nodule.

Histology
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Predominantly subepidermally located cystic tumor with central horny masses. Broad wall epithelium keratinizing over a stratum corneum, infiltrating the surrounding tissue in clumsy, ripe cell proliferations. Detection of onion skin-like epithelial rosettes. Increasing cell and nuclear polymorphism and numerous mitoses indicate transition to squamous cell carcinoma.

Complication(s)
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Recurrence after surgical removal in over 20% of cases; risk of carcinomatous degeneration.

Therapy
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Surgical removal with careful margin control.

Aftercare
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Subtle clinical follow-up as in spinocellular carcinoma.

Note(s)
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Apart from the primary publication, which lists 33 cases, the follow-up literature is sparse. Its independence as an entity appears questionable and requires further confirmation.

Literature
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  1. Cameron DS et al (2003) Squamous cell carcinoma in an epidermal inclusion cyst: case report. Otolaryngol Head Neck Surgery 129: 141-143
  2. Debaize S et al (2002) Squamous cell carcinoma arising in a giant epidermal cyst: a case report. Acta Chir Belg 102: 196-198
  3. Folpe AL et al (2003) Proliferating trichilemmal tumors: clinicopathologic evaluation is a guide to biological behavior. J Cutan Pathol 30: 492-498
  4. Perwein E et al (1986) Proliferating epidermal cyst. Dermatologist 37: 102-106
  5. Riemann H et al (1999) Proliferating trichilemmal cyst with focal segments of metastatic squamous epithelial carcinoma. dermatologist 50: 42-46
  6. Sau P, Graham JH, Helwig EB (1995) Proliferating epithelial cysts. Clinicopathological analysis of 96 cases. J Cutan Pathol 22: 394-406

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Last updated on: 29.10.2020