Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obervation Letter
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Quiz
ARTICLE IN PRESS
doi:
10.25259/IJDVL_533_20
CROSSMARK LOGO Buy Reprints
PDF

A cystic nodule on the jaw

Department of Dermatology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
Corresponding author: Prof. Jian-Min Chang, Department of Dermatology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1, Dahua Road, Dong Dan, Beijing 100730, China. changjianmin@medmail.com.cn
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Lv J, Chang J. A cystic nodule on the jaw. Indian J Dermatol Venereol Leprol, doi: 10.25259/IJDVL_533_20

A 59-year-old man presented with an asymptomatic nodule over the right jaw of two years’ duration. On examination, there was a slightly protuberant intracutaneous nodule, 1cm in diameter with a bluish appearance overlying the right jaw [Figure 1]. No similar lesions were noted anywhere on his body. There was no prior history of trauma, no significant past history and no family history of similar lesions. A skin biopsy was done.

Figure 1:: A slightly protuberant subcutaneous nodule, 1cm in diameter, with a bluish appearance over the right jaw

Question

What is the diagnosis?

Answer

Pigmented follicular cyst

Discussion

The nodule was totally resected under local anaesthesia. Histological examination revealed a cyst located in the mid-dermis, surrounded by loose fibrous connective tissue [Figure 2a]. The cyst wall comprised stratified squamous epithelium exhibiting epidermoid keratinization which consisted of stratum granulosum, stratum spinosum, and stratum basale from inside to outside. The cavity was filled with abundant keratinous material and some cross-sections of thick and deeply pigmented hair shafts which were composed of an eosinophilic medulla and numerous melanin granules [Figure 2b]. No sebaceous lobules were noted within the cyst wall.

Figure 2a:: A cyst located in the mid-dermis with wall demonstrating epidermoid keratinization (H and E, ×100)
Figure 2b:: Cyst cavity shows cross-sections of thick and deeply pigmented hair shafts composed of an eosinophilic medulla and melanin granules (H and E, ×200)

Pigmented follicular cyst, first described by Mehregan and Medenica about 40 years ago, is a rare variant of epithelial cysts with characteristic histology.1 The entity is most commonly described in men between 20 and 63 years of age and is mostly located on the upper body, especially the head and neck region.1

Clinically, the entity is typically characterized by a single, 0.4–1.5 cm, deep brown or bluish intracutaneous nodule or dome-shaped papule which often resembles a blue nevus, a melanocytic nevus, a histiocytoma, or a dermatofibroma.1 Multiple pigmented follicular cysts have been also described.2-4 In some rare cases, some patients with multiple lesions have a familial association.2 More infrequently, a pigmented follicular cyst can present as a pigmented ring-shaped lesion as opposed to a papule or nodule.5

Histopathologically, the entity shows a retention cyst within the mid-dermis which is lined by stratified squamous epithelium that resembles the epidermis, occasionally with some dermal papillae and rete ridges present in the cyst wall, usually in the vicinity of a hair follicle.3 Many melanin-pigmented hair shafts are observed in the cyst cavity, characterizing the microscopic appearance, and are responsible for the pigmented clinical appearance of this entity. Sometimes the cyst has a pore-like opening to the epidermis and the cyst wall presents some anagen follicles.1 On occasion, there is a degeneration of hair shafts in a pigmented follicular cyst that can be easily overlooked, leading to a misdiagnosis as an epidermal cyst.6 In some cases, a sebaceous gland can be visualized in the cyst wall, suggesting that the entity should be considered as a continuum of pilosebaceous cysts.3

The differential diagnoses of pigmented follicular cysts include vellus hair cysts, pigmented epidermal cysts and dermoid cysts. Vellus hair cysts are most often multiple 1-4 mm sized, dome-shaped skin colored to pigmented papules located on the anterior chest of young individuals (4-18 years old) without sex predilection.3,7 These cysts may be inherited in an autosomal dominant pattern.7 These can be differentiated from pigmented follicular cysts based on the content of the cysts, and vellus hair cysts contain abundant vellus hairs. Pigmented epidermal cysts are epidermal cysts with a black-brown or bluish appearance, most frequently occurring in dark-skinned races, characterized histopathologically by rich pigment granules in the cyst walls or pigmentophages in the surrounding stroma.8 Dermoid cysts typically manifest at birth, most commonly around the eyes.7 These histologically demonstrate a deep dermal or subcutaneous cyst with an epidermoid wall to which hair follicles and sebaceous glands are connected.1,7

Pigmented follicular cysts are benign cutaneous tumors, and complete excision is recommended for solitary lesions while multiple lesions can be successfully ablated by a continuous-wave CO2 laser or electrosurgery followed by curettage.4

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , . Pigmented follicular cysts. J Cutan Pathol. 1982;9:423-7.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , . Image Gallery: Multiple pigmented follicular cysts, with a familial association. Br J Dermatol. 2016;175:e134-5.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , . Multiple pigmented follicular cysts: A subtype of multiple pilosebaceous cysts. Br J Dermatol. 1996;134:758-62.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , . Multiple pigmented follicular cysts of the vulva successfully treated with CO2 laser: Case report and literature review. Dermatol Surg. 2004;30:1261-4.
    [CrossRef] [PubMed] [Google Scholar]
  5. , , . Pigmented follicular cyst rather than solitary vellus hair cyst. Clin Exp Dermatol. 2010;35:925-6.
    [CrossRef] [PubMed] [Google Scholar]
  6. , , . Pigmented follicular cyst showing degenerating pigmented hair shafts on histology. Br J Dermatol. 1999;140:364-5.
    [CrossRef] [PubMed] [Google Scholar]
  7. . Cysts In: , , , eds. Dermatology (4th ed). Amsterdam: Elsevier-Health Sciences Division; . p. 1917-29.
    [Google Scholar]
  8. , , . Pigmented epidermal cyst. J Dermatol. 1997;24:475-8.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
100

PDF downloads
12
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections