Posttraumatic intraosseous epidermoid inclusion cyst. A case report and short literature review

Abstract

Epidermoid bone inclusion cysts are pathological structures bordered by a layer of stratified squamous epithelium containing keratin debris. They are also called epidermal bone cysts. Intraosseous epidermoid cysts are rare entities; these lesions may occur as a result of trauma (puncture wound or pressure erosion).They appear to be well defined, translucent lytic lesions with sclerotic margins on imaging studies. The most frequent sites affected are: the distal phalanx and the calvaria - intradiploic, but a few cases of larger bone involvement have been reported. The imagistic differential diagnosis of this lesion includes intraosseous extension of a glomus tumor, enchondroma, osteoid osteoma, acral metastases, some primary vascular bone tumors, giant cell reparative granuloma, subungual nodular melanoma or other lytic non-neoplastic lesions such as osteomyelitis. We present the case of a 70-year-old man experiencing anxiety and pain due to distal phalanx expansion of the IV digit, following hand trauma. An X-ray was performed, showing a radiotransparent lesion located in the distal phalanx. An intramedullary inclusion cyst must be taken into account as a clinical differential diagnosis. Due to the extensive destruction of the distal phalanx, amputation was necessary. Gross examination of the surgical specimen revealed a cystic lesion that contained whitish, creamy material with extensive necrotic areas. Microscopic examination revealed a ruptured intraosseous epidermoid inclusion cyst, which was successfully excised.

Intraosseous epidermoid cyst of distal phalanx—Report of two cases

“…Its occurrence is three times higher in males than in females 8 . This might be because males are prone to be exposed to the danger of injury 9 . Patients usually have no pain.…”

“… 8 This might be because males are prone to be exposed to the danger of injury. 9 Patients usually have no pain. They go to see a doctor for enlargement of the fingertip.…”

Distal phalanx intraosseous epidermoid inclusioncyst: A rare thing!

“…Despite its limited ability to define bone abnormalities, MRI is beneficial in identifying secondary injuries and determining how invasive the injury is to the surrounding tissue. 2 Epidermoid bone cysts can be difficult to diagnose clinically and radiologically. A chondroma, intraosseous ganglion, bone cyst, giant cell tumour, or even a metastatic lesion are examples of differential diagnoses.…”

“…1 Manual labourers frequently develop intraosseous epidermoid inclusion cysts, which are typically caused by prior trauma. 2 Nodular, fluctuant, subcutaneous lesions that are limited to a single anatomical location are called epidermoid cysts. There might or might not be a connection to inflammation.…”

“…Depending on the clinical presentation, the treatment choices are either curettage or excision. 2 It is challenging to make the right diagnosis prior to surgery due to the disease's rarity. In the distal phalanx of the right middle finger, an epidermoid cyst is a rare condition that is described in this paper.…”