HighlightsPerineal inclusion cysts may harbor clinically occult malignant degeneration.Histological analysis of large inclusion cysts required to rule out occult malignancy.Perineal cysts with malignant degeneration are diagnostic, reconstructive challenge.Risk of malignancy in perineal inclusion cysts helps treatment decisions.Large perineal cyst requires multidisciplinary surgical team for excision and closure.Colostomy as adjunct of perineal reconstruction after excision of inclusion cyst.Perineal inclusion cysts may present as atypical, cavitating lesions.
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