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Pilar Cyst Pigmented Epithelial Remnants: A Potential Diagnostic Pitfall
11 Rashid Hospital, Dubai, United Arab Emirates.
International Journal of Surgical Pathology
|May 2, 2019
Summary
Pilar cysts, common skin growths, can be misdiagnosed due to epithelial changes. Recognizing these histologic variations, like epithelial remnants, is crucial for accurate diagnosis in surgical pathology.
Area of Science:
- Dermatopathology
- Surgical Pathology
- Histology
Background:
- Pilar cysts are common, typically easy-to-diagnose cutaneous cysts originating from hair follicles.
- Diagnostic challenges can arise from inflammatory processes, cyst wall destruction, or unusual epithelial lining.
- Epithelial remnants and separation within pilar cysts are underreported phenomena that can lead to misdiagnosis.
Observation:
- A case of a scalp cyst presented with a single layer of pigmented cuboidal lining epithelium.
- The differential diagnosis included hidrocystoma, solid-cystic hidradenoma, arteriovenous malformation, and lymphangioma.
- Histologic examination revealed intraepithelial melanin pigment and specific immunoprofile of the lining epithelium.
Findings:
- The cyst lining epithelium showed positivity for cytokeratin cocktail, CK5/6, CK8, CK19, p63, and D2-40.
- Scattered S-100 protein and melan-A positive melanocytes were observed.
- The case was initially misdiagnosed as melanin-pigmented eccrine hidrocystoma due to unawareness of epithelial splitting in pilar cysts.
Implications:
- Awareness of epithelial remnants and splitting in pilar cysts is essential for surgical pathologists to avoid diagnostic errors.
- Attention to specific histologic clues and understanding the immunoprofile of the basal layer aids in correct identification.
- Accurate diagnosis of pilar cysts prevents misclassification and ensures appropriate patient management.
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