Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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Intramuscular epidermal cyst in the masticator space: a case report

  • Sang Woo Han (Department of Plastic and Reconstructive Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Jiye Kim (Department of Plastic and Reconstructive Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Sug Won Kim (Department of Plastic and Reconstructive Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Minseob Eom (Department of Pathology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Chae Eun Yang (Department of Plastic and Reconstructive Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
  • Received : 2023.03.26
  • Accepted : 2023.08.20
  • Published : 2023.08.20
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Abstract

An epidermal cyst, also known as an epidermoid cyst or epidermal inclusion cyst, is the most prevalent type of cutaneous cyst. This non-cancerous lesion can appear anywhere on the body, typically presenting as an asymptomatic dermal nodule with a visible central punctum. In the case presented herein, an epidermal cyst with uncommon features was misdiagnosed as a lymphatic malformation based on preoperative magnetic resonance imaging (MRI). A 61-year-old man came to us with a swollen left cheek that had been present for 11 months. The preoperative MRI revealed a 3×3.8×4.6 cm lobulated cystic lesion with thin rim enhancement in the left masticator space. The initial differential diagnosis pointed toward a lymphatic malformation. We proceeded with surgical excision of the lesion via an intraoral approach, and the specimen was sent to the pathology department. The pathological diagnosis revealed a ruptured epidermal cyst, indicating that the initial diagnosis of a lymphatic malformation based on preoperative MRI was incorrect. Epidermal cysts located under the muscle with no visible central punctum are uncommon, but should be considered if a patient presents with facial swelling.

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References

  1. Kim CS, Na YC, Yun CS, Huh WH, Lim BR. Epidermoid cyst: a single-center review of 432 cases. Arch Craniofac Surg 2020;21:171-5.  https://doi.org/10.7181/acfs.2020.00248
  2. Baykal C, Yazganoglu KD. Clinical atlas of skin tumors. Springer; 2014. 
  3. Koca H, Seckin T, Sipahi A, Kazanc A. Epidermoid cyst in the floor of the mouth: report of a case. Quintessence Int 2007;38:473-7. 
  4. Rajayogeswaran V, Eveson JW. Epidermoid cyst of the buccal mucosa. Oral Surg Oral Med Oral Pathol 1989;67:181-4.  https://doi.org/10.1016/0030-4220(89)90326-5
  5. Kandogan T, Koc M, Vardar E, Selek E, Sezgin O. Sublingual epidermoid cyst: a case report. J Med Case Rep 2007;1:87. 
  6. Hemaraju N, Nanda SK, Medikeri SB. Sub-lingual dermoid cyst. Indian J Otolaryngol Head Neck Surg 2004;56:218-20.  https://doi.org/10.1007/BF02974355
  7. Yim Y, Kim NR, Moon SG. Intramuscular epidermal cyst of the buttock: a case report. J Korean Soc Radiol 2018;79:354-8.  https://doi.org/10.3348/jksr.2018.79.6.354
  8. Chatterjee PK, Chandra AB, Dastidar N. Epidermal cyst in sternomastoid muscle simulating a malignant growth. Indian J Otolaryngol 1976;28:86-7.  https://doi.org/10.1007/BF02990587
  9. Bhosle R, Das S, Sarkar AK, Krishnan P. Bilateral intramuscular epidermal cysts in the erector spinae. J Neurosci Rural Pract 2021;12:798-9.  https://doi.org/10.1055/s-0041-1735820
  10. Shibata T, Hatori M, Satoh T, Ehara S, Kokubun S. Magnetic resonance imaging features of epidermoid cyst in the extremities. Arch Orthop Trauma Surg 2003;123:239-41.  https://doi.org/10.1007/s00402-003-0509-9
  11. Hong SH, Chung HW, Choi JY, Koh YH, Choi JA, Kang HS. MRI findings of subcutaneous epidermal cysts: emphasis on the presence of rupture. AJR Am J Roentgenol 2006;186:961-6.  https://doi.org/10.2214/AJR.05.0044
  12. Romeo V, Maurea S, Mainenti PP, Camera L, Aprea G, Cozzolino I, et al. Correlative imaging of cystic lymphangiomas: ultrasound, CT and MRI comparison. Acta Radiol Open 2015;4:2047981614564911. 
  13. Reiter MJ, Schwope RB, Bui-Mansfield LT, Lisanti CJ, Glasgow SC. Surgical management of retrorectal lesions: what the radiologist needs to know. AJR Am J Roentgenol 2015;204:386-95.  https://doi.org/10.2214/AJR.14.12791
  14. Elluru RG, Balakrishnan K, Padua HM. Lymphatic malformations: diagnosis and management. Semin Pediatr Surg 2014;23:178-85.  https://doi.org/10.1053/j.sempedsurg.2014.07.002
  15. Smith SN. Lymphatic malformations: an overview of pathology, imaging, and treatment. J Radiol Nurs 2019;38:168-73.  https://doi.org/10.1016/j.jradnu.2019.05.017
  16. Jham BC, Duraes GV, Jham AC, Santos CR. Epidermoid cyst of the floor of the mouth: a case report. J Can Dent Assoc 2007;73:525-8. 
  17. Borghesi A, Nardi C, Giannitto C, Tironi A, Maroldi R, Di Bartolomeo F, et al. Odontogenic keratocyst: imaging features of a benign lesion with an aggressive behaviour. Insights Imaging 2018;9:883-97.  https://doi.org/10.1007/s13244-018-0644-z
  18. Yamamoto K, Matsusue Y, Kurihara M, Takahashi Y, Kirita T. A keratocyst in the buccal mucosa with the features of keratocystic odontogenic tumor. Open Dent J 2013;7:152-6.  https://doi.org/10.2174/1874210601307010152
  19. Shear M, Speight PM. Cysts of the oral and maxillofacial regions. 4th ed. Blackwell Munksgaard; 2007. 
  20. Park D, Park S, Baik B, Kim S. A hemangioma in the masseter muscle: a case report. Arch Craniofac Surg 2021;22:218-21. https://doi.org/10.7181/acfs.2021.00283