Giant epidermal cyst in the posterior neck developing over 40 years: A case report

Abstract

Conventional epidermal cysts are generally small, slow-growing, non-tender, dome-shaped lesions. An epidermal cyst is usually asymptomatic until it is infected or enlarged to the extent that it causes damage to adjacent anatomical structures. However, few cases of giant epidermal cysts in the neck have been reported. The present case reports a giant epidermal cyst in the posterior neck, which grew to an extremely large size for >40 years without inflammation or rupture, and was misdiagnosed as a large soft tissue neoplasm. The patient exhibited depression and developed social anxiety due to the negative cosmetic consequences of the large mass. The patient underwent excision of the mass. At the follow-up examination two years postoperatively, there were no local recurrence and the psychiatric symptoms of the patient were completely resolved. To the best of our knowledge, a giant epidermal cyst growing for >40 years has not previously been reported.

Keywords: cosmetic problem; giant epidermal cyst; posterior neck; psychiatric symptom.

Figure 1

Three giant subcutaneous masses in the posterior neck (arrowhead), left upper back (arrow), and left scalp (asterisk).

Figure 2

(A) Sagittal T1-weighted MRI revealed a homogenous low intermediate signal intensity mass, surrounded by a low signal intensity well-marginated capsule in the subcutaneous fat of the posterior neck. (B) Axial T2-weighted MRI images showed an oval mass with high signal intensity and debris with low signal intensity at the surrounding capsule.

Figure 3

Mass in the posterior neck was well defined with an elastic texture and contained a cream-colored fluid with a butter-like consistency.

Figure 4

Histopathological examination showed the epidermal cyst wall with a thin layer of benign stratified squamous epithelium and lamellated keratin debris present in the cyst (H&E-stained; original magnification, ×20).

Figure 5

A photograph at the two-year postoperative follow-up showed excellent cosmetic results without recurrence.