|Year : 2017 | Volume
| Issue : 2 | Page : 121-122
Postauricular dermoid cyst: An unusual presentation
Metropolis Healthcare; Department of Pathology, Prasad Institute of Medical Sciences and Research; Department of Pathology, Hind Institute of Medical Sciences, Barabanki, Lucknow, Uttar Pradesh, India
|Date of Web Publication||18-May-2017|
521/17C7, Bhairon Prasad Marg, Bara Chand Ganj, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Dermoid cysts are common congenital lesions presenting frequently as midline cysts. In the skin and subcutis, they occur mostly on the face, neck, or scalp. Apart from the skin, dermoid cysts have been described as intracranial, intraspinal, or perispinal lesions. Intra-abdominal cysts, such as cystic tumors of the ovary or omentum, occur as well. However, their presence in the postauricular region is rare and only a few documentations of this entity are found in literature. Fine-needle aspiration cytology can be suggestive of its presence during initial evaluation while histopathology after excision provides confirmatory diagnosis. This unusual presentation of a unilateral dermoid cyst in the postauricular region is described herewith.
Keywords: Dermoid cyst, postauricular, unilateral
|How to cite this article:|
Awasthi N. Postauricular dermoid cyst: An unusual presentation. Int J Health Allied Sci 2017;6:121-2
| Introduction|| |
Dermoid cysts are most frequently midline cysts, resulting possibly from inclusion of skin at the time of embryonic closure. Craniofacial dermoid cysts comprise approximately 7% of all dermoids and 60% of all facial cysts. Postauricular location of this entity is rare and has been described in only few case reports. Although rare, it should always be considered as a possible cause of a postauricular lump. This would ensure proper evaluation to rule out rare complications such as intracranial extension and help in better management of the patient. A case of unilateral postauricular dermoid cyst in a young male is described.
| Case Report|| |
A 25-year-old young male presented in the surgical outpatient department with a gradually increasing, conspicuous swelling behind the left ear for the past 2 years. He was referred to the pathology department for fine-needle aspiration cytology (FNAC). Local examination revealed a soft, cystic, and nontender swelling with restricted mobility, measuring approximately 3 cm × 1.5 cm in size. Overlying skin was free, devoid of any signs of inflammation, pointing punctum or sinus. There was no bruit or pulsation in the swelling. History and family history were unremarkable.
Multiple passes during FNAC yielded clear yellowish material. Alcohol-fixed smears were stained using hematoxylin and eosin. Microscopic examination showed the presence of benign foamy cells with multinucleated giant cells against a clean background [Figure 1]a and [Figure 1]b. Diagnosis of a benign cystic lesion was rendered on FNAC, following which the swelling was excised under general anesthesia and sent for histopathological examination. Gross examination of the specimen showed a cystic soft-tissue mass measuring 3 cm × 1.5 cm × 1 cm. Cut surface showed a unilocular cavity containing yellowish pultaceous material [Figure 1]c. Sections from the cyst wall were taken and routine processing was done. Microscopic examination of the hematoxylin and eosin-stained sections showed a unilocular cystic cavity lined by stratified squamous epithelium and reticular dermis with hair follicles and sebaceous glands [Figure 1]d. Histomorphological findings were consistent with a diagnosis of dermoid cyst. The postoperative period was uneventful and the patient was doing well after 2 months of surgery.
|Figure 1: (a) Multinucleated giant cells, few squamous cells, and foamy sebocytes on fine-needle aspiration cytology smears (H and E, ×400). (b) A cluster of foamy sebocytes on fine-needle aspiration cytology smears (H and E, ×400). (c) Gross appearance of the cut section of the excised cyst. (d) Cyst wall composed of stratified squamous epithelium and reticular dermis containing sebaceous glands and hair follicle (H and E, ×100)|
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| Discussion|| |
Dermoid cysts are benign congenital anomalies, originating from inclusion of ectodermal elements in the deeper tissues at the time of embryonic fusion. These lesions have been described in persons of all ages without any sex predilection, except in ovaries. Among the craniofacial sites of occurrence of dermoid cysts, most common is periorbital followed by nasal, intraoral, scalp, and postauricular. These lesions have also been infrequently reported in the auricle  and posterior auriculocephalic sulcus. A careful review of literature yielded only few case reports describing postauricular dermoids.,,,,, Patients with postauricular dermoids usually seek medical attention for cosmetic reasons and the young male patient described in the current report also presented in our center for the very same reason.
FNAC can be used as an initial modality for narrowing down the possibilities in differential diagnosis which include lymphadenopathy, epidermoid cyst, sebaceous cyst, mastoiditis, subperiosteal abscess, and hematoma. The presence of sebaceous cells can be a clue to diagnosis on cytology, but these can be misinterpreted at times as foamy macrophages [Figure 1]b. Nevertheless, possibility of a benign cystic lesion can always be suggested on cytology which prompts the surgeon to go for excision. Complete excision forms the mainstay of the treatment. Gross picture of the cut section of the cyst can indicate the diagnosis of dermoid cyst by the presence of hair; however, in the present case, this classical macroscopic feature was not very prominent. Diagnosis was established on microscopic examination by the presence of stratified squamous epithelium, numerous sebaceous glands, and few hair follicles. These lesions showed low postsurgical recurrence rates due to their limited growth potential; however, a few case reports of recurrent postauricular dermoids have been described. Rare complications such as intracranial or intracalvarial extension have been documented by few authors.,
| Conclusion|| |
Dermoid cysts although uncommon in the postauricular region are being encountered in clinical practice and must always be considered in the differential diagnosis of swellings/lumps in this area. FNAC can suggest the diagnosis and the need of imaging studies to rule out intracranial/calvarial extension. Since only few case reports of this entity are available in literature with none describing cytrological findings of the same, I feel that this case warrants reporting.
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