Hu Tao, Wang Dong, Tian Yuan, Yuan Xinyv, Li Yong
Department of General Surgery, The Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang, China.
Transl Cancer Res. 2022 May;11(5):1457-1462. doi: 10.21037/tcr-22-1145.
Epidermoid cysts, which are rarely malignant, are common skin cysts. A giant epidermoid cyst is an epidermoid cyst with a diameter of >5 cm.
The purpose of this study was to describe the clinical presentation, surgery, and postoperative pathological tissue of a 69-year-old man who presented with a giant epidermoid cyst in the abdomen with heterogeneous hyperplasia of squamous epithelium in part of the cyst wall. The only symptom experienced by the patient was local tenderness. The mass was hard and fixed, and its boundary was clear. By performing ultrasound-guided puncture biopsy, the cytopathological results of the abdominal goitre puncture fluid showed that there were heterogeneous proliferating squamous epithelial cells on the right side. The immunohistochemical examination results of the puncture tissue biopsy on the right side showed a squamous cell carcinoma. On 2020-3-23, a tension-free repair of the right abdominal wall goitre was performed under general anaesthesia. The patient was discharged on the fifth postoperative day. The postoperative pathological examination indicated the following: (I) calcified highly differentiated squamous cell carcinoma was observed in part of the cystic wall; (II) the medial fibrous tissue of the striated muscle was covered with well-differentiated squamous epithelium; (III) part of the cyst wall was broken with histiocytosis and foreign body giant cell reaction, with visible scattered keratosis; and (IV) some areas of squamous epithelium were heterogeneously proliferating carcinoma, exhibiting well-differentiated invasive squamous cell carcinoma.
As surgeons, it is crucial to remain vigilant and have a low threshold resection as well as thorough histological examination of specimens for early diagnosis and intervention, which can significantly improve patient outcomes.
表皮样囊肿是常见的皮肤囊肿，很少发生恶变。巨大表皮样囊肿是指直径大于5cm的表皮样囊肿。
本研究旨在描述一名69岁男性患者的临床表现、手术情况及术后病理组织，该患者腹部出现巨大表皮样囊肿，囊肿壁部分鳞状上皮呈异质性增生。患者仅有的症状是局部压痛。肿块质地硬且固定，边界清晰。通过超声引导下穿刺活检，腹部肿物穿刺液的细胞病理学结果显示右侧有异型增生的鳞状上皮细胞。右侧穿刺组织活检的免疫组化检查结果显示为鳞状细胞癌。2020年3月23日，在全身麻醉下对右侧腹壁肿物进行了无张力修补术。患者术后第5天出院。术后病理检查结果如下：（I）囊肿壁部分见钙化的高分化鳞状细胞癌；（II）横纹肌内侧纤维组织被高分化鳞状上皮覆盖；（III）部分囊肿壁破裂，伴有组织细胞增生和异物巨细胞反应，可见散在角化；（IV）部分鳞状上皮区域为异质性增生癌，表现为高分化浸润性鳞状细胞癌。
作为外科医生，保持警惕、降低切除阈值并对标本进行全面的组织学检查以进行早期诊断和干预至关重要，这可显著改善患者预后。
