Beyond the Norm: Unveiling a Dermoid Cyst in an Inguinal Hernia Case

Abstract

This case report focuses on a rare presentation of a dermoid cyst within an inguinal hernia in a 15-year-old male patient. The patient presented with a four-day history of a persistent, non-reducible, physical exertion-related bulge in the left groin area, which improved upon lying supine. Ultrasound investigations revealed a complex cystic structure resembling a dermoid cyst within a left direct inguinal hernia. Post-operative histopathology confirmed the dermoid cyst with no signs of malignancy. This case emphasizes the need for a high degree of suspicion when dealing with inguinal swellings, as rare entities like epidermal cysts may mimic more common conditions like inguinal hernias.

Keywords: benign skin lesions; dermoid cyst; epidermoid cyst; germ layers; inguinal hernia; inguinal swelling.

Figure 1. Ultrasound examination of the left groin

Demonstrating a structure containing bowel and fluid medial to the inferior epigastric artery and a well-defined complex cystic structure exhibiting mixed echogenicity, measuring approximately 4.2 x 2.2 cm.

Figure 2. Intraoperative view

A: The suspected dermoid cyst. B: A cut section of the cyst shows the presence of greasy material with hair content.

Figure 3. Histopathological examination of the excised tissue

A: A cystic space is lined by keratinizing stratified squamous epithelium, and the lumen is filled with loose keratin flakes. H&E stain, 10X magnification. B: The wall of the cyst harbors variable skin appendages, including pilosebaceous units and apocrine ducts, consistent with a dermoid cyst. H&E stain, 10X magnification.