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Epidermoid Cyst of Buccal Mucosa
Asian Epidermoid J OralCyst Maxillofac Surg. 2007;19:42-4.
CASE REPORT
Epidermoid Cyst of Buccal Mucosa Ryuji Uchida, Masayoshi Miura, Satoru Ozeki Department of Oral and Maxillofacial Surgery, Fukuoka Dental College, Fukuoka, Japan
Abstract Dermoid and epidermoid cysts in the mouth are uncommon, and are extremely rare at other sites. An epidermoid cyst of the buccal mucosa in a 28-year-old Japanese woman is reported. Key words: Buccal mucosa, Epidermal cyst, Magnetic resonance imaging, Ultrasonography
Introduction Dermoid and epidermoid cysts in the mouth are uncommon and account for less than 0.01% of all oral cysts.1 When they do occur, they are usually located in the midline of the floor of the mouth, but they are extremely rare at other sites. The following case report is a rare case of an epidermoid cyst that appeared submucosally in the cheek.
Case Report The patient, a 28-year-old healthy Japanese woman, presented with a 1-year history of a slight swelling in the right cheek. On clinical examination, a swelling measuring approximately 1.5 × 2 cm was seen in the right buccal mucosa. It had a dough-like consistency, and was freely mobile between the buccal mucosa and the buccinator muscle. The overlying mucosa was normal in colour and texture (Figure 1). No submental or submandibular lymph nodes were palpable. Magnetic resonance imaging (MRI) and ultrasound (US) demonstrated a mass of homogeneous low signal intensity on T1-weighted images (T1WI) and an extremely high signal intensity on T2-weighted images (T2WI), with well-defined margins in both sequences. A mass was found between the buccal mucosa and the buccinator muscle. US demonstrated a cystic lesion (Figure 2). After clinical and radiological examination, a preliminary diagnosis of dermoid or epidermoid cyst was proposed. The treatment consisted of total surgical removal of the lesion under local anaesthesia. The lesion was encapsuled with fibrous connective tissue and was easily dissected from the surrounding tissue. The cyst was localised between the mucosa of the cheek and the buccinator muscle. Correspondence: Ryuji Uchida, 2-15-1 Tamura, Sawara-ku, Fukuoka 814 0193, Japan. Tel: (81 92) 801 0411; Fax: (81 92) 801 1288; E-mail: [email protected]
42
The lesion was 1.5 × 2 × 1 cm in size with a thick fibrous connective tissue wall (Figure 3). Pathologic examination of the excised specimen showed that the cyst wall consisted of stratified squamous epithelium supported by fibrous connective tissue and keratin formation. Cellular debris and keratin scales were present in the lumen of the cyst. Sebaceous glands, sweat glands, and hair follicles were not present (Figure 4). Histopathological examination confirmed the diagnosis of epidermoid cyst. Postoperatively, uneventful healing was noted and no recurrence of the lesion was observed after 6 months.
Discussion Dermoid and epidermoid cysts are uncommon in the mouth and account for less than 0.01% of all oral cysts.1-3 Most reported cases have involved the floor of the mouth, usually in the midline. 4,5 Rare cases have been reported in the tongue,6-9 lips,10 and intraosseously within the mandible and maxilla.11,12 This case report is a rare example of an epidermoid cyst that appeared submucosally in the cheek.
Figure 1. Intraoral photograph of the right buccal mucosa showing a swelling measuring approximately 1.5 × 2 cm with the overlying mucosa normal in colour and texture. © 2007 AsianAsian Association J Oral Maxillofac of Oral andSurg. Maxillofacial Vol 19, No Surgeons. 1, 2007
Uchida, Miura, Ozeki
a
b
c
d
Figure 2. Magnetic resonance imaging and ultrasound confirmation of cystic lesion. (a) Axial T1-weighted imaging. (b) Axial T2weighted imaging showing the lesion. (c and d) Ultrasound.
Figure 3. Photograph of the enucleated cyst. The cyst was made of a thick fibrous connective tissue. Asian J Oral Maxillofac Surg. Vol 19, No 1, 2007
Figure 4. Photomicrograph of the enucleated cyst (haematoxylin and eosin stain). Cellular debris and keratin plates were adjacent to the inner surface of the cyst wall. No connection could be seen between the sebaceous glands and the cyst cavity. 43
Epidermoid Cyst
Since it was difficult to determine the origin and extensions of this lesion from the results of physical examinations, MRI and US examinations were performed to detect the origin and nature of the lesion, as well as to demonstrate the affected spaces objectively. In this case, MRI demonstrated a mass that showed homogeneous low signal intensity on T1WI and an extremely high signal intensity on T2WI, with well-defined margins in both sequences. Fat-suppressed gadolinium-diethylenetriamine penta-acetic acid-enhanced T1WI showed signal inhibition inside the mass (data not shown). The lesion was found between the buccal mucosa and the buccinator muscle. In the US findings, blood flow signal was not recognised in this cystic lesion, and internal echo findings were consistent with the inner surface of the cyst wall. Both MRI and US findings suggested a cystic lesion including water-like liquid and contents without cytologic examination. After roentgenological examination, the diagnosis was epidermoid cyst of the buccal mucosa. For difficult cases, we consider that diagnostic imaging, such as MRI and US, provides detailed information for surgical planning that would otherwise be difficult to determine from a physical examination alone. In the present study, we report a rare example of a large epidermoid cyst that was localised in the area from the mucosa of the cheek and up to the buccinator muscle. At present, about 6 months after surgery, no recurrence has been observed.
44
References 1.
Brown CA, Barker RD. Dermoid cyst: report of a case. J Oral Surg. 1972;30:55-8.
2.
Rajayogeswaran V, Eveson JW. Epidermoid cyst of the buccal mucosa. Oral Surg Oral Med Oral Pathol. 1989;67:181-4.
3.
Matsuda N, Ohkubo S, Ueda H, Yamada T, Shibuichi I, Nonaka T. Dermoid and epidermoid cysts in the oral cavity: report of seventeen cases. J Jpn Stomatol Soc. 1975;24:109-16.
4.
Meyer I. Dermoid cysts (dermoids) of the floor of the mouth. Oral Surg Oral Med Oral Pathol. 1965;8:1149-64.
5.
Thomas KH, Goldman HM, editors. Oral pathology. 5th ed. St. Louis: CV Mosby Company; 1960:1471-6.
6.
Quinn JH. Congenital epidermoid cyst of anterior half of tongue. Oral
7.
Goldberg AF. Dermoid cyst of the tongue: report of case. J Oral Surg.
Surg Oral Med Oral Pathol. 1960;13:1283-7. 1965;23:649. 8.
Link JF, McKean TW. Dermoid cysts: report of case. J Oral Surg. 1965;23:451-5.
9.
Mathur SK, Menon PR. Dermoid cyst of the tongue: report of a case. Oral Surg Oral Med Oral Pathol. 1980;50:217-8.
10. Rule DC. Dermoid cyst of the lower lip: a case report. Br J Oral Surg. 1976;14:116-9. 11. Issa MA, Davies JD. Dermoid cyst of the jaw. Br Dent J. 1971;131: 543-6. 12. Craig GT, Holland CS, Hindle MO. Dermoid cyst of the mandible. Br J Oral Surg. 1980;18:230-7.
Asian J Oral Maxillofac Surg. Vol 19, No 1, 2007
CASE REPORT
Epidermoid Cyst of Buccal Mucosa Ryuji Uchida, Masayoshi Miura, Satoru Ozeki Department of Oral and Maxillofacial Surgery, Fukuoka Dental College, Fukuoka, Japan
Abstract Dermoid and epidermoid cysts in the mouth are uncommon, and are extremely rare at other sites. An epidermoid cyst of the buccal mucosa in a 28-year-old Japanese woman is reported. Key words: Buccal mucosa, Epidermal cyst, Magnetic resonance imaging, Ultrasonography
Introduction Dermoid and epidermoid cysts in the mouth are uncommon and account for less than 0.01% of all oral cysts.1 When they do occur, they are usually located in the midline of the floor of the mouth, but they are extremely rare at other sites. The following case report is a rare case of an epidermoid cyst that appeared submucosally in the cheek.
Case Report The patient, a 28-year-old healthy Japanese woman, presented with a 1-year history of a slight swelling in the right cheek. On clinical examination, a swelling measuring approximately 1.5 × 2 cm was seen in the right buccal mucosa. It had a dough-like consistency, and was freely mobile between the buccal mucosa and the buccinator muscle. The overlying mucosa was normal in colour and texture (Figure 1). No submental or submandibular lymph nodes were palpable. Magnetic resonance imaging (MRI) and ultrasound (US) demonstrated a mass of homogeneous low signal intensity on T1-weighted images (T1WI) and an extremely high signal intensity on T2-weighted images (T2WI), with well-defined margins in both sequences. A mass was found between the buccal mucosa and the buccinator muscle. US demonstrated a cystic lesion (Figure 2). After clinical and radiological examination, a preliminary diagnosis of dermoid or epidermoid cyst was proposed. The treatment consisted of total surgical removal of the lesion under local anaesthesia. The lesion was encapsuled with fibrous connective tissue and was easily dissected from the surrounding tissue. The cyst was localised between the mucosa of the cheek and the buccinator muscle. Correspondence: Ryuji Uchida, 2-15-1 Tamura, Sawara-ku, Fukuoka 814 0193, Japan. Tel: (81 92) 801 0411; Fax: (81 92) 801 1288; E-mail: [email protected]
42
The lesion was 1.5 × 2 × 1 cm in size with a thick fibrous connective tissue wall (Figure 3). Pathologic examination of the excised specimen showed that the cyst wall consisted of stratified squamous epithelium supported by fibrous connective tissue and keratin formation. Cellular debris and keratin scales were present in the lumen of the cyst. Sebaceous glands, sweat glands, and hair follicles were not present (Figure 4). Histopathological examination confirmed the diagnosis of epidermoid cyst. Postoperatively, uneventful healing was noted and no recurrence of the lesion was observed after 6 months.
Discussion Dermoid and epidermoid cysts are uncommon in the mouth and account for less than 0.01% of all oral cysts.1-3 Most reported cases have involved the floor of the mouth, usually in the midline. 4,5 Rare cases have been reported in the tongue,6-9 lips,10 and intraosseously within the mandible and maxilla.11,12 This case report is a rare example of an epidermoid cyst that appeared submucosally in the cheek.
Figure 1. Intraoral photograph of the right buccal mucosa showing a swelling measuring approximately 1.5 × 2 cm with the overlying mucosa normal in colour and texture. © 2007 AsianAsian Association J Oral Maxillofac of Oral andSurg. Maxillofacial Vol 19, No Surgeons. 1, 2007
Uchida, Miura, Ozeki
a
b
c
d
Figure 2. Magnetic resonance imaging and ultrasound confirmation of cystic lesion. (a) Axial T1-weighted imaging. (b) Axial T2weighted imaging showing the lesion. (c and d) Ultrasound.
Figure 3. Photograph of the enucleated cyst. The cyst was made of a thick fibrous connective tissue. Asian J Oral Maxillofac Surg. Vol 19, No 1, 2007
Figure 4. Photomicrograph of the enucleated cyst (haematoxylin and eosin stain). Cellular debris and keratin plates were adjacent to the inner surface of the cyst wall. No connection could be seen between the sebaceous glands and the cyst cavity. 43
Epidermoid Cyst
Since it was difficult to determine the origin and extensions of this lesion from the results of physical examinations, MRI and US examinations were performed to detect the origin and nature of the lesion, as well as to demonstrate the affected spaces objectively. In this case, MRI demonstrated a mass that showed homogeneous low signal intensity on T1WI and an extremely high signal intensity on T2WI, with well-defined margins in both sequences. Fat-suppressed gadolinium-diethylenetriamine penta-acetic acid-enhanced T1WI showed signal inhibition inside the mass (data not shown). The lesion was found between the buccal mucosa and the buccinator muscle. In the US findings, blood flow signal was not recognised in this cystic lesion, and internal echo findings were consistent with the inner surface of the cyst wall. Both MRI and US findings suggested a cystic lesion including water-like liquid and contents without cytologic examination. After roentgenological examination, the diagnosis was epidermoid cyst of the buccal mucosa. For difficult cases, we consider that diagnostic imaging, such as MRI and US, provides detailed information for surgical planning that would otherwise be difficult to determine from a physical examination alone. In the present study, we report a rare example of a large epidermoid cyst that was localised in the area from the mucosa of the cheek and up to the buccinator muscle. At present, about 6 months after surgery, no recurrence has been observed.
44
References 1.
Brown CA, Barker RD. Dermoid cyst: report of a case. J Oral Surg. 1972;30:55-8.
2.
Rajayogeswaran V, Eveson JW. Epidermoid cyst of the buccal mucosa. Oral Surg Oral Med Oral Pathol. 1989;67:181-4.
3.
Matsuda N, Ohkubo S, Ueda H, Yamada T, Shibuichi I, Nonaka T. Dermoid and epidermoid cysts in the oral cavity: report of seventeen cases. J Jpn Stomatol Soc. 1975;24:109-16.
4.
Meyer I. Dermoid cysts (dermoids) of the floor of the mouth. Oral Surg Oral Med Oral Pathol. 1965;8:1149-64.
5.
Thomas KH, Goldman HM, editors. Oral pathology. 5th ed. St. Louis: CV Mosby Company; 1960:1471-6.
6.
Quinn JH. Congenital epidermoid cyst of anterior half of tongue. Oral
7.
Goldberg AF. Dermoid cyst of the tongue: report of case. J Oral Surg.
Surg Oral Med Oral Pathol. 1960;13:1283-7. 1965;23:649. 8.
Link JF, McKean TW. Dermoid cysts: report of case. J Oral Surg. 1965;23:451-5.
9.
Mathur SK, Menon PR. Dermoid cyst of the tongue: report of a case. Oral Surg Oral Med Oral Pathol. 1980;50:217-8.
10. Rule DC. Dermoid cyst of the lower lip: a case report. Br J Oral Surg. 1976;14:116-9. 11. Issa MA, Davies JD. Dermoid cyst of the jaw. Br Dent J. 1971;131: 543-6. 12. Craig GT, Holland CS, Hindle MO. Dermoid cyst of the mandible. Br J Oral Surg. 1980;18:230-7.
Asian J Oral Maxillofac Surg. Vol 19, No 1, 2007