Dermoid cyst pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]Associate Editor(s)-in-Chief: Soujanya Thummathati, MBBS [3]
Overview
Dermoid cyst arises from the entrapped embryonal ectodermal cells during the fetal development and are generally formed of skin, hair follicles, teeth, and sebaceous glands.[1] Acquired dermoid cysts may result from iatrogenic or traumatic implantation of the epithelial cells that subsequently grow.[2][1] On gross pathology, uniloculated cysts lined by skin, containing sebaceous glands, hair follicles, and teeth are characteristic findings of dermoid cysts.[1] On microscopic histopathological analysis, fibro collagenous cysts lined by stratified squamous epithelium, with epidermal appendages such as hair follicles, sweat and sebaceous glands are characteristic findings of dermoid cysts.[3][4]
Pathogenesis
- Dermoid cyst arises from the entrapped embryonal ectodermal cells during the fetal development and are generally formed of skin, hair follicles, teeth, and sebaceous glands.[1]
- Dermoid cysts occur in the embryonic lines of fusion. The majority of cases are reported in the midline of the body, particularly in the ovaries and testis.[2]
Spinal Dermoid Cysts
- Spinal dermoid cysts arise from the embryonal ectodermal cells that are arrested within the spinal canal at the time of neural tube closure during development.[4]
- Spinal dermoid cysts are usually located in the lumbosacral region (60%) and rarely located in the upper thoracic (10%) and cervical regions (5%).[5]
Intracranial Dermoid Cysts
- Intracranial dermoid cysts are usually located in the midline, although they can occur on any side.
- The most common locations include:
- Posterior fossa / vermis
- Suprasellar / subfrontal
Dermoid cysts of the floor of the mouth
- The pathogenesis of dermoid cysts of the floor of the mouth is hypothesized into the following three theories:[2][1]
- Dermoid cysts of the floor of the mouth arise from the entrapped embryonic ectodermal cells in the third or fourth week of embryonic life during the midline fusion of the first and second branchial arches.
- The second theory is that the acquired cysts may result from iatrogenic or traumatic implantation of the epithelial cells that subsequently grow.
- The last theory is that the cysts of the floor of the mouth are a thyroglossal anomaly with predominantly ectodermal components.
Gross pathology
- On gross pathology, uniloculated cysts lined by skin, containing sebaceous glands, hair follicles, and teeth are characteristic findings of dermoid cysts.[1]
Gallery
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![Mature cystic teratoma of the ovary.[6]](/images/1/1c/Mature-cystic-teratoma-of-the-ovary.jpg)
Mature cystic teratoma of the ovary.[6]
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![Mature cystic teratoma of the ovary.[6]](/images/9/91/Mature-cystic-teratoma-of-the-ovary_%282%29.jpg)
Mature cystic teratoma of the ovary.[6]
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![The macroscopic image of the surgical extract of a submental dermoid cyst with clear evidence of cystic formation containing smegma and hair, indicative of a dermoid cyst.[2]](/images/4/42/Dermoid_cyst1.jpg)
The macroscopic image of the surgical extract of a submental dermoid cyst with clear evidence of cystic formation containing smegma and hair, indicative of a dermoid cyst.[2]
![Mature cystic teratoma of the ovary.[6]](/index.php/File:Mature-cystic-teratoma-of-the-ovary.jpg)
![Mature cystic teratoma of the ovary.[6]](/index.php/File:Mature-cystic-teratoma-of-the-ovary_(2).jpg)
![The macroscopic image of the surgical extract of a submental dermoid cyst with clear evidence of cystic formation containing smegma and hair, indicative of a dermoid cyst.[2]](/index.php/File:Dermoid_cyst1.jpg)
Microscopic Pathology
On microscopic histopathological analysis, fibro collagenous cysts lined by stratified squamous epithelium, with epidermal appendages such as hair follicles, sweat and sebaceous glands are characteristic findings of dermoid cysts.[7][4]
Gallery
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![Cyst with keratinized squamous epithelium and adnexal structures in wall.[2]](/images/f/f8/Dermoid_cyst_HPE1.jpg)
Cyst with keratinized squamous epithelium and adnexal structures in wall.[2]
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![Keratinizing squamous epithelium with distinct granular layer with a sebaceous gland in the cyst wall.[2]](/images/e/e2/Dermoid_cyst_HPE2.jpg)
Keratinizing squamous epithelium with distinct granular layer with a sebaceous gland in the cyst wall.[2]
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![Pathology of a sublingual cyst showing orthokeratinized stratified squamous epithelium with a flat epithelial-connective tissue interface lining the cystic cavity, sebaceous glands, and hair, along with copious sebaceous material.[8]](/images/7/76/Sublingual_dermoid_cyst_HPE.jpg)
Pathology of a sublingual cyst showing orthokeratinized stratified squamous epithelium with a flat epithelial-connective tissue interface lining the cystic cavity, sebaceous glands, and hair, along with copious sebaceous material.[8]
![Cyst with keratinized squamous epithelium and adnexal structures in wall.[2]](/index.php/File:Dermoid_cyst_HPE1.jpg)
![Keratinizing squamous epithelium with distinct granular layer with a sebaceous gland in the cyst wall.[2]](/index.php/File:Dermoid_cyst_HPE2.jpg)
![Pathology of a sublingual cyst showing orthokeratinized stratified squamous epithelium with a flat epithelial-connective tissue interface lining the cystic cavity, sebaceous glands, and hair, along with copious sebaceous material.[8]](/index.php/File:Sublingual_dermoid_cyst_HPE.jpg)
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Elsheikh, Tarik (2002), Dermoid Cyst (Mature Cystic Teratoma) of the Cecum, Muncie, IN: Archives of Pathology & Laboratory Medicine, p. 97-99, retrieved February 2, 2016
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Makos C, Noussios G, Peios M, Gougousis S, Chouridis P (2011). "Dermoid cysts of the floor of the mouth: two case reports". Case Rep Med. 2011: 362170. doi:10.1155/2011/362170. PMC 3172983. PMID 21922020.
- ↑ Intracranial dermoid cyst. Radiopedia. http://radiopaedia.org/articles/intracranial-dermoid-cyst-1 Accessed on February 18, 2016.
- ↑ 4.0 4.1 4.2 Sharma M, Mally R, Velho V (2013). "Ruptured conus medullaris dermoid cyst with fat droplets in the central canal [corrected]". Asian Spine J. 7 (1): 50–4. doi:10.4184/asj.2013.7.1.50. PMC 3596585. PMID 23508636.
- ↑ Altay H, Kitiş O, Calli C, Yünten N (2006). "A spinal dermoid tumor that ruptured into the subarachnoidal space and syrinx cavity". Diagn Interv Radiol. 12 (4): 171–3. PMID 17160798.
- ↑ 6.0 6.1 Image courtesy of Frank GaillardRadiopaedia (original filehere). [1] CreativeCommons BY-SANC
- ↑ Intracranial dermoid cyst. Radiopedia. http://radiopaedia.org/articles/intracranial-dermoid-cyst-1 Accessed on February 18, 2016.
- ↑ Ohta N, Watanabe T, Ito T, Kubota T, Suzuki Y, Ishida A; et al. (2012). "A case of sublingual dermoid cyst: extending the limits of the oral approach". Case Rep Otolaryngol. 2012: 634949. doi:10.1155/2012/634949. PMC 3465894. PMID 23056976.