Presentation
Right submandibular slow-growing lesion.
Patient Data
There is a well-circumscribed, slight heterogeneous, low attenuating mass in the right submandibular space resulting in mild mass effect on the adjacent structures.
Cystic anechoic mass with posterior acoustic enhancement and mild amount of echogenic debris within it.
Case Discussion
This is a pathology-confirmed dermoid cyst.
The dermoid cysts are lined by epithelium and contain skin appendages (sebaceous glands and hair) and mesodermal elements (bone, cartilage, fat). They manifest in the second and third decade of life as slow-growing mass in the sublingual or submandibular regions. On ultrasound, they usually appear as an-echoic well-defined masses with posterior acoustic enhancement, while on CT scan, they manifest as a well-defined, unilocular, low-attenuating mass lesion. Different degrees of heterogeneity of their appearance on imaging might be present and it is dependent on their contents (bone, cartilage, fat, hair).
Pathology report:
The lining epithelium of the cyst is almost completely denuded. However, there are some residual foci of squamous epithelium with giant cell reaction. Some hair shaft-like structures are also identified. Keratin-like material is also present which is highlighted by cytokeratin stain. The histopathological features are, therefore, most consistent with dermoid cyst with epithelial disruption and denudation.
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