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Spot Diagnosis - Congenital Nodule

Discussion in 'Spot Diagnosis' started by neo_star, Feb 4, 2013.

  1. neo_star

    neo_star Moderator

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    Healthy 12 month boy had an asymptomatic congenital nodule on his nose. The nodule was mobile, nontender, and had changed little since birth.

    [​IMG]


    What is the most likely diagnosis ?
     

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    Karel from Olomouc likes this.

  2. kangourou

    kangourou Famous Member

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    By the looks of it I would say it's a dermoid cyst
     

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  3. Emergency medicine Mike

    Emergency medicine Mike Bronze Member

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    Yes, its dermoid cyst.
     

  4. neo_star

    neo_star Moderator

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    Ans : Sequestration Dermoid Cyst

    Discussion - a dermoid cyst lies deep to the skin and is lined by skin and all types contains desqumated putaceous material which are derived form the desqumated cells.

    4 types of dermod cyst

    a) Sequestration dermoid - formed congenitally due to inclusion of epithelium, buried at the line of fusion between 2 embryonic segments. May contain hair, sweat glands, sebaceous glands or just plain squamous epithelium

    common sites
    - at the midline of the body ex. neck, root of nose
    - external angular - just above the outer canthus of the eye ( at the line of fusion of fronto-nasal and maxillary process )
    - post auricular - at the site of fusion of mesodermal hillocks
    - at the site of fusion of skull bones

    b) Implantation dermoid - it's an acquired dermoid and arises from indriven epithelium beneath the skin due to a puncture injury eg. needle prick or thorn prick. common in gardeners and tailors and in surgical practice - if we fail to evert the skin edges along suture lines.

    implantation.jpeg

    Note - an implantation dermoid may have an overlying scar as opposed to no scar in sequestration dermoid and a punctum in sebaceous cyst.

    c) Tubulo dermoid - develops from an unobliterated portion of a congenital epidermal duct.
    ex - thyroglossal cyst ( commonest example )

    thyroglossal cyst.jpg


    d) teratomatous dermoid - develops from totipotent cells with ectodermal predominance and contains mesodermal elements like bone, cartilage etc.
    ex - ovarian teratoma


    teratoma-ovarian-14817_3.jpg


    Credit to everybody for recognising the very subtle dermoid (Y)
     

    Last edited: Feb 5, 2013

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