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11 June 2014 - Case of the Week #315

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Thanks to Dr. Nasir Uddin, Aga Khan University Hospital (Pakistan), for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.



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Website news:

(1) There is now an easier way to post images on our Flickr page. Just email the pictures to part85keep@photos.flickr.com and send a CC to CommentsPathout@gmail.com. You can use the subject line to give the image a title and the body to add a description, which should include the diagnosis and the contributor's name.

(2) The links to Webpathology.com do work, but we are in the process of updating the thumbnails, which may take some time since there are so many.

(3) In May 2014, we had record traffic of 623,482 visits, with a daily record of 25,244 visits on May 14.

(4) Our Feature page for June is Diagnostic Testing / Reagents, and highlights Advanced Cell Diagnostics, Inc. (ACD), bioTheranostics, Cell Marque, Leica Biosystems and Ventana Medical. It also contains an original short article, "Diagnostic Reagents: The Potential Role of microRNAs", by Jaleh Mansouri, M.D.

(5) Visit our Updates page to see what topics have been revised based on reviews or new images.

Case of the Week #315

Clinical History:
A 53 year old man presented with a chest wall "sebaceous cyst", which was excised. The gross specimen was 2.5 cm of excised skin with subcutaneous tissue containing a 1.5 cm cyst.

Micro images:

What is your diagnosis?

Squamous cell carcinoma arising in an epidermal inclusion cyst

Epidermoid cysts are the most common cutaneous cysts, typically appearing on the face, scalp, neck, and trunk (see Skin-Nonmelanocytic tumors chapter, eMedicine). Most lesions originate from the follicular infundibulum, so the clinical term "sebaceous cyst" is inaccurate. Histologically, these lesions are lined by keratinized epithelium with a distinct granular layer. The cyst contains lamellated keratin but no calcification.

Although benign, premalignant and malignant lesions have been identified in their walls, often as incidental findings (J Plast Reconstr Aesthet Surg 2012;65:1267), illustrating the importance of routine histology in these lesions (Ann Acad Med Singapore 2000;29:757, N Am J Med Sci 2010;2:46).

Treatment consists of excision, and possibly retinoids for chemoprevention (Dermatol Ther 2014;27:94).

Nat Pernick, M.D., President
and Shivani Thakore, Associate Medical Editor
PathologyOutlines.com, Inc.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
Alternate email: NatPernick@gmail.com