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Case Report
Sublingual epidermoid cyst - a case report Sant Prakash Kataria, Gajender Singh, Sanjay Kumar, Pooja Gupta1, Pawan Singh2 Department of Pathology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 1 Department of Pathology, Post Graduate Institute of Medical Education and Research, Ram Manohar Lohia Hospital, Delhi, 2Department of Pathology, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Mewat, Haryana, India ABSTRACT
Epidermoid cysts of the floor of the mouth are considered rare which represent less than 0.01% of all oral cavity cysts. Majority of them occur in the sublingual region, but there are rare case reports of occurrence in other sites. The origin of epidermoid cysts is believed to be from the entrapment of epithelial remnants during midline closure of the bilateral first and second branchial arches. A 15‑year‑old female patient presented with complaints of a mass in the oral cavity, difficulty in chewing and swallowing of solid foods. On examination, an unfluctuating mass with normal covering mucosa was observed on the midline of the mouth floor displacing the tongue superiorly and posteriorly. The mass measured 3 × 2 cm in dimensions. Ultrasonography showed a 40 × 35‑mm well‑circumscribed non‑enhancing cystic mass extending from the sublingual area to the level of the thyroid notch. Fine‑needle aspiration cytology (FNAC) showed a cystic lesion. Excision of the cystic mass confirmed the diagnosis of the epidermoid cyst. An epidemoid cyst can usually present with dysphagia, dysphonia, and dyspnea and has a malignant transformation potential. Surgical enucleation is the only effective treatment for these kinds of lesions. Prognosis is very good, with a very low incidence of relapse. Key words: Epidermoid, Fine-needle aspiration cytology, sublingual
Introduction
Address for correspondence: Dr. Sant Prakash Kataria, Flat No. 129, Dharamkunj Apartment, Sector - 9, Rohini, Delhi - 110 085, India. E-mail:
[email protected] Date of Submission: 15‑07‑2014 Date of Acceptance: 25-06-2015
Access this article online Website: www.indjos.com DOI: 10.4103/0976-6944.162661 Quick Response Code:
Epidermoid cysts are rare, slow‑growing, benign, developmental cysts that are derived from abnormally situated ectodermal tissue. It is defined as “a simple cyst lined with stratified squamous epithelium and its lumen is filled with cystic fluid or keratin and no other specialized structure”.[1] Epidermoid cysts are encountered throughout the body, with 7% occurring in the head and neck area and 1.6% within the oral cavity. These cysts represent less than 0.01% of all oral cavity cysts.[2] The pathogenesis of midline cysts of the floor of the mouth is not well established, and dysontogenetic, traumatic, and thyroglossal anomaly theories have been suggested.[3]
Case Report
Fine‑needle aspiration cytology (FNAC) of the mass was done that yielded needle This is an open access article distributed under the terms of Creative Commons Attribution‑NonCommercial‑ShareAlike License, which allows others to remix, tweak, and build upon work non‑commercially, as long as the author is credited and new creations are licensed under the identical terms.
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A 15‑year‑old female patient presented with complaints of a mass in the oral cavity, difficulty in chewing and swallowing of solid 70
foods. On examination, an unfluctuating mass with normal covering mucosa was observed on the midline of the mouth floor displacing the tongue superiorly and posteriorly. The mass measured 35 × 25 mm in dimensions. Ultrasonography showed a 40 × 35‑mm well‑circumscribed non‑enhancing cystic mass extending from the sublingual area to the level of the thyroid notch. All routine investigations performed were within normal limits.
How to cite this article: Kataria SP, Singh G, Kumar S, Gupta P, Singh P. Sublingual epidermoid cyst - a case report. Indian J Oral Sci 2015;6:70-2.
© 2015 Indian Journal of Oral Sciences | Published by Wolters Kluwer - Medknow
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blocking scanty whitish material. Smears prepared revealed mainly anucleated squames against an amorphous background [Figure 1]. A possibility of cystic lesion was suggested. Surgical excision of the mass was done, which revealed a cystic cavity lined with keratin flakes and stratified squamous epithelium with prominent stratum granulosum [Figure 2], confirming the diagnosis of an epidermoid cyst.
and/or endoderm. All three histological types contain a thick, greasy‑looking material.[6]
Discussion
Although floor of the mouth in the midline is the most favored site, an occasional occurrence involving the buccal mucosa, tongue, lips, uvula, temporomandibular joint dermal graft, intradiploic, intracranial, and intraosseous location within the mandible and maxilla also have been cited in the literature.[8] Patients usually present with dysphagia, dysphonia, and dyspnea, due to upward displacement the tongue by sublingual swellings. Further more growth in the inferior direction may give rise to appearance of characteristic “double chin.”[9]
Epidermoid cysts may be classified as congenital or acquired, even if there is no difference between the two on presentation or histologically. Many etiopathogenetical theories have been proposed. Congenital cysts are dysembryogenetic lesions that arise from ectodermic elements entrapped during the midline fusion of the first and second branchial arches between the third and fourth weeks of intrauterine life. Alternatively, they may arise from the tuberculum impar of His which, with each mandibular arch, forms the floor of the mouth and the body of the tongue. Acquired cysts derive from traumatic or iatrogenic inclusion of epithelial cells or from the occlusion of a sebaceous gland duct. Moreover, others authors proposed that midline cysts may represent a variant form of a thyroglossal duct cyst.[4‑7] Based on histopatholgical findings, Meyer divided the floor of the mouth cysts into three histological variants: The true dermoid cyst, the epidermoid cyst and the teratoid variant. True dermoid cysts are cavities lined with epithelium showing keratinization and with identifiable skin appendages such as pilous follicles, and sudoriparous and sebaceous glands on the cyst wall. Epidermoid cysts are lined with simple squamous epithelium with a fibrous wall and no attached structures. The lining of teratoid cysts varies from simple squamous to a ciliate respiratory epithelium containing derivates of ectoderm, mesoderm
Figure 1: Sheets of anucleate squames. MGG ×200
Indian Journal of Oral Sciences Vol. 6 Issue 2 May-Aug 2015
Epidermoid cysts may be found in any age group but are more common between 10 and 35 years of age with no gender predilection, while others have found predominance of women.[3]
The differential diagnosis of sublingual lesions includes: Infectious process, ranula, lymphatic malformation, dermoid cyst, epidermoid cyst, heterotopic gastrointestinal cyst, cystic hygroma, cervical lymphoepithelial cyst and duplication foregut cyst. It is necessary to use ultrasonography, computed tomography, or magnetic resonance imaging together with cytologic examination by a fine‑needle aspiration biopsy.[10] Our patient also had clinical manifestations like dysphagia and dysphonia. A cyst was surgically excised and there was no recurrence at follow up. Surgical enucleation is the only effective treatment for these kinds of lesions. Prognosis is very good, with a very low incidence of relapse.
Figure 2: Stratified squamous epithelium with a prominent granular layer and a lumen containing abundance of keratin material. H and E ×200
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Conflicts of interest
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References 1. 2.
3.
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Shafer WG, Levy BM, Hine MG. A Text Book of Oral Pathology. 4th ed. Philadelphia: WB Saunders; 1993. p. 67. Turetschek K, Hospodka H, Steiner E. Case report: Epidermoid cyst of the floor of the mouth: Diagnostic imaging by sonography, computed tomography and magnetic resonance imaging. Br J Radiol 1995;68:205‑7. Koca H, Seckin T, Sipahi A, Kaznac A. Epidermoid cyst in the floor of the mouth: Report of a case. Quintessence Int 2007;38:473‑7.
4.
Howell CJ. The sublingual dermoid cyst: Report of five cases and review of the literature. Oral Surg Oral Med Oral Pathol 1985;59:578‑80. 5. Longo F, Maremonti P, Mangone GM, De Maria G, Califano L. Midline (dermoid) cysts of the floor of the mouth: Report of 16 cases and review of surgical techniques. Plast Reconstr Surg 2003;112:1560‑5. 6. Meyer I. Dermoid cysts of the floor of mouth. Oral Surg Oral Med Oral Pathol 1955;8:1149. 7. De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg 2002;13:308‑10. 8. Shear M, Speight P. From developmental cysts of head and neck. In: Shear M, Speight P, editors. Cysts of the Oral and Maxillofacial Regions. 4th ed. Singapore: Blackwell Munksgaard; 2007. p. 181‑3. 9. Kandogan T, Koç M, Vardar E, Selek E, Sezgin O. Sublingual epidermoid cyst: A case report. J Med Case Rep 2007;1:87. 10. Walstad WR, Solomon JM, Schow SR, Ochs MW. Midline cystic lesion of the floor of the mouth. J Oral Maxillofac Surg 1998;56:70‑4.
Indian Journal of Oral Sciences Vol. 6 Issue 2 May-Aug 2015
