Congenital Epidermal Cyst of the Umbilicus: A Case Report

doi:10.4236/mps.2013.34026

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Modern Plastic Surgery, 2013, 3, 128-129

http://dx.doi.org/10.4236/mps.2013.34026 Published Online October 2013 (http://www.scirp.org/journal/mps)

Congenital Epidermal Cyst of the Umbilicus:

A Case Report*

Noriko Aramaki-Hattori1#, Takara Tanaka2, Kiyoshi Mukai3, Kazuo Kishi1

1Department of Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan; 2Department of Plastic and Reconstruc-

tive Surgery, Saise ikai Central Hospital, Minato-ku, Japan; 3Department of Pathology, Saiseikai Central Hospital, Minato-ku, Japan.

Email: #[email protected]

Received July 29th, 2013; revised August 28th, 2013; accepted September 5th, 2013

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Epidermal cysts are one of the most common benign skin tumors, although they are rarely found in the umbilicus of a

child. Herein we report the case of a 13-year-old girl with a congenital umbilical mass. This mass had been misdiag-

nosed as a lipoma at birth. Awareness of this lesion can avoid its misdiagnosis and inappropriate treatment.

Keywords: Congenital; Epidermal Cyst; Umbilicus

1. Case Report

A 13-year-old girl presented with a red, swollen mass in

her umbilicus (Figure 1). This mass had been present

since birth, and was diagnosed as a lipoma by her pedia-

trician. She was asymptomatic except for occasional

slight pain at the lesion. There was no history of tumor

rupture. Magnetic resonance imaging revealed a subcu-

taneous mass which did not penetrate into the abdominal

cavity or contact any internal organs (Figure 2). The

mass ruptured 1 day prior to surgery, and on the day of

the operation the tumor had developed a large hole and

was crusted over. Total excision was performed under

local anesthesia. Exploration during the operation showed

that the mass did not have any duct connecting it to the

abdominal cavity. The patient’s postoperative course was

uneventful. The sutures were removed after 10 days, and

the patient had a good cosmetic result (Figure 3). Histo-

logical assessment revealed an epidermal cyst; there was

no malignancy (Figure 4).

2. Discussion

Epidermal cysts are common, benign skin tumors usually

involve the scalp, face, neck, back, and trunk [1]. A cyst

may rupture, and extrusion of its keratin into the dermis

may incite a foreign body reaction [2]. Epidermal cysts

are usually asymptomatic unless they get infected or

Figure 1. Pre-operative photograph of the umbilical mass.

Figure 2. Magnetic resonance imaging of the abdomen

showing a subcutaneous mass, not communicating with the

abdominal cavity (see mass adjacent to white arrow).

*Conflict of interest: None declared. Funding: None. Ethical approval:

ot required.

#Corresponding author.

Congenital Epidermal Cyst of the Umbilicus: A Case Report 129

Figure 3. Post-operative photograph of the umbilicus.

Figure 4. Hematoxylin and eosin staining reveals an epi-

dermal cyst (Bar: 100 μm).

enlarge sufficiently to damage adjacent anatomic struc-

tures [3]. In this patient’s case, the tumor was stable for

13 years, rupturing 1 day prior to surgery.

Other types of common, benign skin tumors as a dif-

ferential diagnosis are dermoid cysts, lipomas, and calci-

fying epitheliomas (p ilomatrixomas). Dermoid cysts, one

of the common congenital skin tumors, differ from epi-

dermal cysts in that they have skin structures such as hair

or glands inside the tumor. Although there are a few re-

ports of epidermal inclusion cysts at the umbilicus fol-

lowing abdominoplasty [4,5], we were not able to locate

any report of congenital epidermal cysts in this location.

The differential diagnosis of congenital lesions of the

umbilicus includes umbilical hernia, umbilical cord her-

nia, umbilical polyp, and urachal remnant. By the time of

birth, the umbilical ring has become entirely closed by

the developing abdominal wall except for the space oc-

cupied by the cord, which contains the umbilical vein,

paired umbilical arteries, and the fibrous remnants of the

urachus (allantois), and omphalomesenteric duct (yolk

sac) [6]. Final closure of the umbilical ring does not oc-

cur until separation of the cord at b irth [7]. After ligation

of the cord , the ves sels th rombo se, and the co rd dries and

sloughs, leaving a granulating surface that heals by cica-

trization becomes covered by epithelium [6]. The mecha-

nism of formation for epidermal cysts is still unclear, but

in this case we suspect that the involution of an epider-

mal component into the dermis at birth may have caused

a congenital epidermal cyst.

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