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Introduction: when faced with a chronic digital injury, the differential diagnosis between osteomyelitis or primary tumor is raised. Coexistence between osteomyelitis and epidermoid bone cyst is not uncommon., Material and Methods: in this article, we describe two cases of epidermoid cysts in distal phalanx of the hand associated with osteomyelitis and a review of the literature is presented., Results: both osteomyelitis and epidermoid bone cyst have been related to the presence of previous trauma at the site of the lesion, nail alterations and chronic phlogotic signs, so it is important to reach a diagnosis of certainty through an anatomopathological study and to perform a good surgical debridement to ensure the healing of both entities., Conclusions: surgical debridement associated with curettage and filling of the bone defect with bone substitute with antibiotic is a good therapeutic option in the treatment of these lesions.

Objectives: In this study, we aimed to define the clinico-radiological data and treatment options for intratesticular epidermoid cysts (IEC). MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients that under went surgery for testicular mass between 1995 and 2017. Data of the patients whose histopathological evaluation revealed IEC were recorded.  RESULTS: A total of 20 patients with IEC were identified.While three of 20 patients were excluded due to incomplete data, the remaining 17 patients with pathologically proven IEC were reviewed and analyzed in the study. The mean patient age was 22.2 years (range, 17-29 years). All patients were presented with painless testicular swelling and/or mass. Serum tumor markers of all patients were within the ranges. Four patients treated with radical orchiectomy (23.5%), while 13 patients under went partial orchiectomy (76.5%). The mean size ofthe IEC was 17.7x15.1 mm (range, 26x10 mm). IEC swere mostly located in the middle pole of the testes (10of 17 patients, 58.8%). CONCLUSIONS: This study is designed in retrospective nature, but the patient population is one the largest reported in the literature. According to our study, we can easily state that partial orchiectomy can be performed safely after FSA in patients that have IECs.

Background: Splenic cysts are rare diseases that are diagnosed incidentally during imaging studies. When cysts are recognized, surgical treatment is recommended adapted to the particular case, depending on the size and location of the cyst and the age of the patient in order to avoid dangerous complications such as spleen rupture or cyst infection with abscess., Clinical Case: We report 2patients with symptomatic splenic epidermoid cyst treated by laparoscopic cleavage., Conclusions: Laparoscopic cleavage is a surgical option for splenic cyst, with the goal of reducing postoperative complications while preserving splenic function., (Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.)

Giant nonparasitic splenic epidermoid cysts are relatively uncommon. These lesions can lead abdominal pain, but most of then are asymptomatic, and they are discovered incidentally. We report a 13-y old female with a giant splenic epidermoid cystic, given the special interest of diagnostic and therapeutic decision-making of this rare entity., Case Report: A 13-y old female with clinical history of abdominal pain since the last two months. On physical examination a firm, tender mass was palpable in left hypochondrium. Diagnosis of a large cystic splenic mass was made based on ultrasound and abdominal computed tomography scan. Splenectomy was performed, and histopathological-immunohistochemistry studies revealed findings suggestive of primary epithelial cyst. The post-operative clinical course was satisfactory and uneventful., Conclusions: Treatment of giant nonparasitic splenic cysts is surgical. Preserve splenic parenchyma must be the aim in an individualized decision-making. The different types of surgical modalities will be according to the diagnosis and clinical situation (cyst size, age, comorbidities).

Background: Retrorectal or presacral space is occupied during embryological stem cell development and therefore may contain a heterogeneous group of tumors., Clinical Case: We report the case of a 22-year-old male with a pilonidal cyst operated due to recurrent pilonidal sinus cyst. Final diagnosis after pelvic computed tomography is large retrorectal cystic tumor and magnetic resonance diagnosis of a presacral cystic compatible wtih germ cell tumor. The tumor was removed surgically through the abdomen and diagnosis of cystic teratoma was established., Conclusion: Retrorectal tumors are rare lesions whose presence must be ruled out in case of recurrent sinus.

We bring two cases of hidradenoma papilliferum, rare injury. We describe the clinical, histopathological and a review of the available literature on the condition.

Introduction: Testicular tumors are usually managed by radical orchiectomy because of the high incidence of malignant lesions. Epidermoid cyst of the testis is a rare benign tumor, and its differential diagnosis from malignant testicular tumors is difficult., Materials and Methods: The clinical records of seven patients who attended our hospital with testicular epidermoid cysts were reviewed. Preoperative evaluation consisted of testicular ultrasonography in 6 patients, and magnetic resonance imaging in 4 patients. A peroperative biopsy was performed in four patients., Results: Ultrasonographic appearance was specific for diagnosis of epidermoid cyst in 80% of patients. Pathological diagnosis was made in all biopsies taken during surgery. Conservative management was (tumorectomy or partial orquidectomy) performed in 6 patients (85%)., Conclusions: Preoperative imaging findings, gross characteristics of the lesion, and peroperative biopsy results provide adequate information to attempt testis-sparing surgery instead of radical orchiectomy.

Background: Epidermoid tumors represent the third most common lesion of the cerebellopontine angle (CPA). Their evolution and clinical features are distinctively characteristic. We present a comprehensive review of the clinical, imaging and surgical aspects of epidermoid cysts of the CPA., Methods: We conducted a case series of patients diagnosed with epidermoid cyst of the CPA who were operated on between 1998 and 2005. Lesions were classified according to their anatomic extent: grade I(-) within the boundaries of the CPA, grade II(-) extension to the suprasellar and perimesencephalic cisterns, and grade III(-) parasellar and temporomesial region involvement., Results: This study was comprised of 43 patients with a mean follow-up of 85 months. Mean age was 34 years, and 67% of the patients were female. The initial symptom was headache in 58.1% of the cases and trigeminal neuralgia in 41.8%. According to our classification, temporomesial involvement (25.6%) was significantly (p = 0.001) associated with a higher incidence of seizures, and trigeminal neuralgia was present in patients with lesions limited to the CPA (p = 0.006). The lesions were reached essentially through a retrosigmoidal approach (39.5%) and surgical excision was deemed to be complete in 65% of the cases., Conclusions: Our grading classification according to the anatomic extension correlates well with clinical presentation, type of surgical approach and extent of surgical removal. It is desirable to reach a consensus on the classification of tumor extension.

Familial Adenomatous Polyposis (FAP) and its phenotype variant, Gardner's syndrome, constitute a rare autosomal dominant inherited disorder. They are characterised by the development, generally during the second and third decades of life, of multiple adenomatous polyps in the colon and rectum. These polyps have a high risk of subsequently becoming malignant, which normally occurs in the third and fourth decades of life. The phenotypical features of FAP can be very variable. As well as colorectal polyps, these individuals can present with extra-colonic symptoms, among which are particularly: gastro-duodenal polyps, dermoid and epidermoid cysts, desmoid tumours, congenital hypertrophy of the retinal pigment epithelium, disorders of the maxillary and skeletal bones and dental anomalies. In this paper the most important aspects of this syndrome are reviewed, showing an example based on a well documented clinical case. The importance of odonto-stomatological examinations should be pointed out, among others, as a means of reaching a presumptive diagnosis, whose confirmation is vital to the patient.

There are several lesions which can present as a cyst or pseudocyst of the floor of the mouth with submental repercussion. The aim of this paper is to review the diagnosis methods which can help us to differentiate these lesions such as the surgical peculiarities of every tumour. We are reporting two cases of cystic/pseudocystic lesions of the floor of the mouth with submental repercussion. Both of them were epidermoid cysts. Ranulas, lipomas and lymphangiomas should be considered in the differential diagnosis. Imaging diagnosis, fine needle aspiration and adequate treatment in all of the tumours are reviewed. Both cases were operated via intraoral. They are now free of disease after at least one year. Differential diagnosis of cystic lesions of the floor of the mouth is important because the recommended surgery technique is not exactly the same in all of them. The firmness of the wall of dermoid cysts let their exeresis via intraoral even when they are of a big size. Exeresis of sublingual gland is recommended by most authors to treat ranulas, although it is followed by an important percentage of morbidity.

In order to understand the features of splenic epidermoid cysts and their possible associated complications, four cases of splenic epidermoid cyst are presented in this report, two in children, one of them appeared in a child affected by a EBV and BH sepsis complicated with splenic abscesses due to scratch cat disease. The other two cases were adults. According to our histophatological findings, the pathogenesis may be related to a citodiferentation from mesothelium to squamous metaplasia. Our current knowledge about the role of spleen on immunological activity, mainly against capsulated germs, and the increase risk of overwhelming postesplenectomy septicemia have contributed to our conservative attitude about splenic surgery. We believe that management during the neonatal period should be conservative because cysts tend to disappear in most cases. In older children with a small cyst our recommendation is punction-aspiration and sclerotherapy, with ultrasound follow-up control.

Epidermoid cysts of the testis are rare in children (3% of all the testicular tumors). Bilateral appearance has only been described in the pediatric age in 2 cases and none associated to Klinefelter's syndrome. We present, for our knowledge, the first case of bilateral epidermoid testicular cyst associated to klinefelter's syndrome in a boy, highlighting its management and therapeutic approach. We analyze the different kinds of treatment.

Epidermal cysts of parapharyngeal location are very unusual tumors, with a benign character, though when they reach a great size, adjacent zones and vascular and nervous structures of great importance can be affected. We are going to describe the clinical aspects of this case, the instructions and the surgical approach used: the Fabre inferior and internal jaw approach of the lateropharingeal space and infrasphenotemporal fossa, which avoids the aesthetics and functional aftereffects of other more common approaches.

Objective: To report two cases of epidermoid cyst of the testis, with special reference to the diagnostic and therapeutic aspects, and to review the literature., Methods: Two cases of epidermoid cyst of the testis are presented: one patient consulted for testicular swelling and the other for supraclavicular lymphadenopathy., Results: In both cases the pathological diagnosis was testicular epidermoid cyst., Conclusions: Testicular epidermoid cysts are uncommon. High frequency ultrasonography is a reliable diagnostic imaging method. Treatment by tumor enucleation with preservation of the testis is advocated, when possible.

We present the case of a 42-year-old male patient with a large hepatic cyst, simulating a hydatid cyst. Subtotal cystectomy was performed. Thirteen months after this procedure the patient relapsed and a second laparotomy and total cystectomy were performed. A histopathological diagnosis of epidermoid cyst of the liver was made. The differential diagnosis of epidermoid cysts of the liver is broad and definitive diagnosis is usually only obtained after pathological examination of the surgical specimen. For this reason, and because of the potential for neoplasia, complete resection of the hepatic lesion should be attempted.

Epidermal cysts of the cerebello-pontine angle (CPA) are lesions arising from epidermal remainders having an expansive and slow growth sitting on the PCA space or on the temporal bone. Are diagnosed approximately in the fourth life's decade by its deficient or irritant symptoms related to VIIth and VIIIth cranial nerves. It is important the nuclear magnetic resonance exam because the specific radiologic characteristics that distinguish these cysts from other conditions of CPA as neuromata or meningiomata.

We report a case of simple epidermoid cyst of the scrotum. Complete excision was performed transcrotally and the presence of epidermoid cyst confirmed by histopathological examination. Epidermoid cyst of the scrotum is a rare disease and only 10 cases have been reported. Simple excision was sufficient for treatment of this very rare lesion. The patient is now in the follow-up period.

Epidermoid cysts os the testes have an incidence between 1-2% of total tumours in that organ. The embryonary origin of this benign neoplasia is unknown, although the most widely accepted theory is they are monodermal teratomas. Differential diagnosis with germinal cells is established through the characteristic dartboard-like ultrasound image, which allows testicular conservant surgery though only in the case of certainty about the lesion. Since that was not the case and given the ultrasound variability recorded in the literature, radical orchiectomy was performed to overcome the persistent doubt at staging the tumour's benignancy.

Objective: To describe a case of scrotal epidermal cyst with special reference to the differential diagnosis between cystic and tumoral lesions., Methods/results: The clinical history of a patient with an epidermal cyst localized to the scrotum is presented and the literature is briefly reviewed. Scrotal epidermal cysts and pilonidal cysts are distinct. Their etiology (embryonic vs acquired) is discussed from an academic perspective., Conclusions: Pilonidal and epidermal cysts are benign lesions. Excisional biopsy using local anesthesia will generally suffice for the classification and treatment of these lesions.

Introduction: Dermoid and epidermoid cysts are dysembryogenic tumors representing 1% of all intracranial tumors. They are characterized by slow growth, localization to the middle in relation to the basal cisterns and their benign course., Objectives: To analyze the clinical and radiological characteristics, and the results of surgical treatment of intracranial dermoid and epidermoid cysts., Patients and Methods: We reviewed 18 cases of epidermoid and 3 dermoid intracranial cysts which had been diagnosed and treated during a period of 18 years. All patients were diagnosed by computerized tomography (CT) and the last 15 cases by magnetic resonance (MR)., Results: The commonest site was the temporal lobe with 7 cases, followed by the suprasellar region with 4 cases. All patients had peculiar imaging characteristics both on CT (hypodense and with no contrast silhouetted) and on MR (hypointensity in T1 and in T2). They were completely resected in 16 cases. There were 3 episodes of aseptic meningitis and 2 deaths., Conclusions: Dermoid and epidermoid cysts are characterized by long term clinical symptoms. The commonest site is supratentorial in the midline or in the temporosylvian region. The diagnostic investigation of choice is MR. Treatment is surgical, preferably complete resection. However, after sub-total resection there is a prolonged period of remission.

Testicular epidermoid cysts are benign tumours which account for less than 1% of all testicular tumours. Their uncertain histogenesis, difficult pre-operative diagnosis and controversial therapeutic approach are at the base of this paper. Report on two patients, 20- and 21-year old, with testicular epidermoid cysts treated by inguinal radical orchiectomy and tumorectomy, respectively. Literature review focused on the diagnostic and therapeutic aspects. Emphasis on the relevance of ultrasound for pre-operative diagnosis. We also advocate for a conservative management if their presence is suspected or in the presence of negative tumoral markers.

The epidermoid cyst of the penis is an uncommon benign intratesticular tumour. This paper presents two cases that were diagnosed and operated in our centre. It also describes the most significant clinical, radiological and histological aspects.

INTRODUCTION. Epidermoid tumors in the spinal canal are rare. Whether congenitally or iatrogenically caused, they form as the result of epidermal cells implanted within the spinal channel. Such implantation can occur during a variety of procedures and events such as bullet wounds, surgery, myelography or punctures for diagnosis, anesthesia or treatment. Although this complication is not discussed in books or journals on anesthesiology, we have found it mentioned in over 100 published cases reporting iatrogenically caused spinal epidermoid tumors. ETIOPATHOGENESIS. Iatrogenic epidermoid tumors of the spine derive from the implantation of epidermal tissue transported inside the spinal canal during lumbar punctures without guidance or with inadequate guidance. There is ample evidence that such tumors are iatrogenic. All cases occur in patients with a history of lumbar puncture. They are rarely associated with congenital anomalies. They are extramedullary. They tend to develop near sites of earlier lumbar puncture, usually near the conus medullaris and the cauda equina. Iatrogenic epidermoid tumors of the spine have been reproduced experimentally in two studies in which autologous skin fragments were implanted in the spinal canal. CLINICAL SIGNS. These tumors are well tolerated by patients for extended periods of time, ranging from 2 to 10 years. At the cauda equinus, tumors can grow slowly for long periods without signs of nerve compression. Symptoms are directly related to tumor size and site. All patients with tumors at the cauda equinus report severe pain radiating toward the roots of compressed nerves. Nuclear magnetic resonance makes it possible to detect the tumor without administration of intrathecal contrast. At present gadolinium-DTPA improves the image so that these tumors can be distinguished from other types. The prognosis for epidermoid tumors of the spine is good, as they are histologically benign. Treatment is always surgical. CONCLUSION. Although the causal relation between epidermoid spinal tumors and lumbar puncture is well documented, anesthesiologists are not sufficiently aware of this possible complication. Between 1977 and 1995, 28 new cases were published. We believe that a deeper understanding of such rare complications will show us how to prevent them while providing appropriate use of epidural and subarachnoid anesthesia.

We report two cases of epidermoid cyst of the spermatic cord in infants 14 months and 2 1/2 years old, respectively. The initial diagnosis in one patient was funicular hydrocele and paratesticular mass no transilluminable in the other case. The treatment was the local excision of tumor and the diagnostic was histological in both patients. Postoperative course was excellent in both, the first after fistullization and surgical treatment. Must be explored the transillumination of the mass which would have led us to think other of the diagnoses different from that of the cord hydrocele before the operation, since it would have given negative. During the operation, must be assured that the cystic anomaly is limited to spermatic cord, to evite fistulization in the postoperative course.

Objective: To further knowledge of syringoma and its importance within the overall condition of the patient, with a view to making it relevant in the differential diagnosis of other conditions such as xanthomata or milium cysts., Design: A descriptive study of a crossover type., Setting: Primary care and the dermatology clinic of a health centre in the metropolitan area of Madrid., Patients and Other Participants: The records of patients with syringomas confirmed by histological tests during 1990-1993 were examined. Patients with only a clinical diagnosis were discarded. The different diagnoses on referral by the primary care doctor were also studied., Measurements and Main Results: Seven patients (5 women, two men) were confirmed by histological tests as suffering Syringomas. They were between 16 and 52 years old. Four had lesions only on the eyelids; in the other three they were widespread. All of them were asymptomatic, had been over three years without lesions and had no special previous history. None of them wanted to undergo treatment. The referral diagnoses cited xanthomata in five cases and milium cysts in the others., Conclusions: The primary care doctor must become better informed about syringoma, given its frequent confusion with other conditions (xanthomata and milium cysts). This confusion gives rise to unnecessary additional examinations and discomfort for the patients. These lesions should be verified histologically, as it is an nonaggressive method.

In 1928, P. Masson described in hemorrhoids a peculiar lesions which he called "intravascular vegetating hemangioendothelioma". The possibility of cutaneous location of this lesion was demonstrated only in 1967. Rare if isolated, the intravascular vegetating hemangioendothelioma is often associated with other vascular lesions such as polyps, hemorrhoids, etc. Always benign, this tumor may be misdiagnosed as an angiosarcoma by inexperienced pathologists. In this article, three additional cases are described, the histological differences with an angiosarcoma are stressed and the pathogenesis of this lesion is discussed.

The vellus eruptive cyst is characterized by the development of multiple papules that are dermal cysts with vellus hair inside them. We present a case and a literature review.