Case report of complicated epidermoid cyst of the floor of the mouth: Radiology-histopathology correlation

Abstract

Epidermoid cysts, true dermoid cysts and teratoid cysts compose the spectrum of cystic teratomas, which are defined as neoplasms whose tissue are derivatives of more than one germ layer, foreign to that part of the body from which the tumor arises. Epidermoid cysts of the floor of the mouth are rare lesions and are much less common than dermoid cysts in the head and neck. This case reports a 43-year-old male patient who presented with a longstanding midline swelling in the submental region. Initial imaging was done using ultrasound followed by computed tomography (CT) scan. Biopsy was taken and revealed a cyst wall lined with epidermal squamous epithelium along with areas of focal ulceration suggesting chronic inflammatory changes of the wall of the epidermoid cyst.There are characteristic and even pathognomonic imaging features of epidermoid cysts at the floor of the mouth in ultrasound and CT scan. Imaging has an important role in the surgical management plan according to the size and location of the cyst in relation to geniohyoid and mylohyoid muscles.

Unusual Presentation of Intralingual Dermoid Cyst with Review of the Literature

“…Ultrasound imaging may help differentiate cysts from other entities such as vascular, cystic, or solid lesions [6]. The appearance of dermoid cyst on ultrasound will demonstrate multiple echogenic nodules within the cyst [8]. A CT and/or MRI scan provides characteristics of the lesion as well as size and anatomical relationships to surrounding structures.…”

“…These masses appear well-defined and unilocular [9]. Furthermore, these cysts may contain fat, calcifications, or mixed-density fluid, and may appear as a "sack of marbles," which is pathognomonic for dermoid cyst [8]. Given the extensive differential diagnosis, fine needle aspiration is an important part of the initial work-up to provide insight into the pathological nature of the lesion, thus allowing for adequate pre-operative planning for excision of the mass.…”

A Large Extension of Epidermoid Cyst in Maxilla: Case Report

“…It is important not to rupture the cyst during surgery because intraluminal substance may damage fibrovascular structures which may lead to postoperative inflammation. 2 Recurrence is rare after complete surgical excision. 3 In our case, lesion was removed surgically.…”

“…Histologically all type of cystic teratomas show close proximity with each other. 1,2 Epidermoid cysts are benign soft tissue malformations originated from ectoderm. 3,4 Most of (80%) these cysts are observed in ovaries and sacral region of the body, whereas 7% of them have been informed in head and neck region.…”

Oral Pathology in Paediatric Patients

“…Surgical enucleation is the treatment of choice and recurrence is rare [26,27]. The prevalence in head and neck patients is 7% and in the oral cavity is 1.6% [28].…”