Large epidermal inclusion cyst presenting as a pelvic mass

Area of Science:

• Gynecologic Surgery
• Pelvic Imaging
• Dermatopathology

Background:

• Epidermal inclusion cysts are common nodules often linked to trauma or surgery.
• Large pelvic epidermal inclusion cysts are exceptionally rare, particularly at the vaginal cuff.

Observation:

• A 49-year-old woman presented with a 7-cm pelvic mass discovered via CT scan 13 years post-vaginal hysterectomy.
• Transvaginal ultrasound revealed classic features of an unruptured EIC: hypoechoic mass with echodensities, thin wall, and no internal flow.
• The cyst was successfully removed laparoscopically from the vaginal cuff.

Findings:

• This case details a large, symptomatic epidermal inclusion cyst originating from the vaginal cuff.
• Imaging characteristics on CT and ultrasound were diagnostic for a benign cystic lesion.
• Surgical removal confirmed the diagnosis and resolved the patient's symptoms.

Implications:

• Increased use of pelvic CT scans may lead to more frequent incidental detection of benign pelvic cysts.
• Surgical trauma, such as hysterectomy, can lead to the formation of EICs from sequestered vaginal epithelium.
• Accurate diagnosis and management are crucial for differentiating these benign cysts from other pelvic masses.