Cyst on upper back. Understanding Sebaceous Cysts: Causes, Symptoms, and Treatment Options

22.07.202305.07.2023 by alexxlab

What are sebaceous cysts. How do sebaceous cysts develop. What are the symptoms of sebaceous cysts. How are sebaceous cysts diagnosed. What treatment options are available for sebaceous cysts. Can sebaceous cysts become cancerous. How can sebaceous cysts be prevented.

Содержание

What Are Sebaceous Cysts and How Do They Form?

Sebaceous cysts, more accurately termed epidermoid cysts, are benign, encapsulated nodules that develop beneath the skin’s surface. Despite their common name, these cysts do not actually involve the sebaceous glands. Instead, they originate from the hair follicle’s infundibulum, the upper portion of the hair follicle.

These cysts form when the follicular orifice becomes plugged, leading to an accumulation of keratin â€“ a protein that’s a key component of skin, hair, and nails. The cyst is lined with stratified squamous epithelium, similar to the surface of the skin, which continually produces and sheds keratin into the cyst cavity.

Common Locations for Sebaceous Cysts

While sebaceous cysts can appear anywhere on the body, they are most frequently found on the:

Face
Neck
Trunk (chest and back)
Scalp

Less common locations include the scrotum, genitalia, fingers, and even inside the mouth (buccal mucosa).

Causes and Risk Factors for Sebaceous Cyst Development

The majority of sebaceous cysts occur sporadically, without a clear underlying cause. However, several factors can increase the risk of developing these cysts:

Hormonal changes, particularly during puberty
Skin trauma or injury
Acne, especially severe cases
Genetic predisposition
Certain medications

In some cases, sebaceous cysts may be associated with specific genetic conditions or syndromes:

Gardner syndrome (familial adenomatous polyposis)
Gorlin syndrome (basal cell nevus syndrome)
Favre-Racouchot syndrome (nodular elastosis with cysts and comedones)

Recent research has also implicated ultraviolet (UV) light exposure and human papillomavirus (HPV) infection as potential contributing factors in the development of epidermoid cysts.

Recognizing the Symptoms and Characteristics of Sebaceous Cysts

Sebaceous cysts typically present as slow-growing, painless lumps beneath the skin. Key characteristics include:

Size ranging from 0.5 cm to several centimeters in diameter
Round, dome-shaped appearance
Firm but slightly compressible consistency
Mobility when manipulated
A small, dark “punctum” or opening at the center of the cyst

While most sebaceous cysts remain asymptomatic, they can become problematic if they rupture or become infected. In such cases, patients may experience:

Sudden pain or tenderness
Redness and swelling around the cyst
Drainage of foul-smelling, cheese-like material
Warmth in the affected area

Diagnosis and Evaluation of Sebaceous Cysts

Diagnosing a sebaceous cyst typically involves a thorough physical examination by a healthcare provider. In most cases, the characteristic appearance and location of the cyst are sufficient for an accurate diagnosis. However, additional diagnostic measures may be employed in certain situations:

Physical Examination

During the examination, the healthcare provider will assess:

The size, shape, and consistency of the lump
The presence of a central punctum
Any signs of inflammation or infection
The mobility of the cyst beneath the skin

Imaging Studies

In some cases, imaging studies may be recommended to rule out other conditions or to assess the extent of the cyst:

Ultrasound: Can help differentiate between solid and fluid-filled masses
CT or MRI: May be used for deeper or more complex cysts

Biopsy

While rare, a biopsy may be performed if there are concerns about potential malignancy or if the diagnosis is uncertain. This involves removing a small sample of tissue for microscopic examination.

Treatment Options for Sebaceous Cysts: From Conservative to Surgical Approaches

The management of sebaceous cysts depends on various factors, including the size of the cyst, its location, and whether it’s causing symptoms or complications. Treatment options range from conservative approaches to surgical interventions:

Conservative Management

For asymptomatic cysts that are not bothersome, a wait-and-see approach may be recommended. This involves:

Regular monitoring for changes in size or appearance
Avoiding manipulation or attempts to squeeze the cyst
Protecting the area from trauma or irritation

Intralesional Corticosteroid Injection

For inflamed or symptomatic cysts, a corticosteroid injection may help reduce inflammation and discomfort. This treatment can:

Decrease swelling and redness
Alleviate pain
Potentially shrink the size of the cyst

Incision and Drainage

In cases of infected or ruptured cysts, incision and drainage may be necessary. This procedure involves:

Making a small incision in the cyst
Draining the contents
Cleaning the area with an antiseptic solution

It’s important to note that while this provides temporary relief, the cyst may recur if the entire cyst wall is not removed.

Surgical Excision

Complete surgical removal is the most definitive treatment for sebaceous cysts. This procedure involves:

Making an incision over the cyst
Carefully dissecting the cyst from surrounding tissues
Removing the entire cyst, including its wall
Closing the incision with sutures

Surgical excision offers the lowest risk of recurrence but may result in a small scar.

Minimally Invasive Techniques

Newer, less invasive techniques are being developed for cyst removal, including:

Laser-assisted puncture and drainage
Punch biopsy excision
Minimal excision technique

These methods aim to reduce scarring and recovery time while still effectively removing the cyst.

Potential Complications and Long-Term Outlook for Sebaceous Cysts

While sebaceous cysts are generally benign and harmless, they can occasionally lead to complications or raise concerns about malignancy. Understanding the potential risks and long-term outlook is crucial for patients and healthcare providers alike.

Infection

One of the most common complications of sebaceous cysts is infection. Signs of an infected cyst include:

Increased pain and tenderness
Redness and warmth around the cyst
Swelling
Pus drainage
Fever (in severe cases)

Infected cysts may require antibiotic treatment in addition to drainage or removal.

Rupture

Cyst rupture can occur spontaneously or due to trauma. When a cyst ruptures, it can lead to:

Sudden pain
Inflammation of surrounding tissues
Risk of infection
Scarring

Recurrence

Even after treatment, sebaceous cysts can sometimes recur, particularly if the entire cyst wall is not completely removed during excision. The recurrence rate varies depending on the treatment method used.

Malignant Transformation

While rare, there is a small risk of malignant transformation in sebaceous cysts. Recent studies suggest that approximately 1% of epidermoid cysts may undergo malignant changes, potentially developing into:

Squamous cell carcinoma (SCC)
Basal cell carcinoma (BCC)

This risk underscores the importance of proper evaluation and follow-up for any persistent or changing cysts.

Long-Term Outlook

For most patients, the long-term outlook for sebaceous cysts is excellent. With proper treatment, many individuals experience complete resolution of their cysts without significant complications. However, it’s important to:

Monitor treated areas for signs of recurrence
Seek medical attention for any new or changing skin lesions
Follow up regularly with a healthcare provider, especially if multiple cysts are present or if there’s a family history of related syndromes

Prevention and Self-Care Strategies for Sebaceous Cysts

While it’s not always possible to prevent sebaceous cysts from forming, there are several strategies that may help reduce the risk or manage existing cysts:

Maintain Good Skin Hygiene

Proper skin care can help prevent the blockage of hair follicles, which is often the first step in cyst formation. Tips include:

Washing the face and body regularly with a mild cleanser
Avoiding harsh scrubs or exfoliants that can irritate the skin
Removing makeup thoroughly before bed

Avoid Squeezing or Attempting to Pop Cysts

Manipulating cysts can lead to:

Increased inflammation
Risk of infection
Potential scarring
Spread of cyst contents, potentially leading to new cyst formation

Protect the Skin from Trauma

Since skin trauma can contribute to cyst formation, it’s important to:

Wear protective gear during high-risk activities
Avoid tight clothing or accessories that rub against the skin
Be gentle when shaving or performing other skincare routines

Manage Underlying Skin Conditions

Treating conditions that may contribute to cyst formation, such as acne, can help prevent new cysts from developing. This may involve:

Using topical or oral medications as prescribed by a dermatologist
Following a consistent skincare routine
Avoiding known triggers for skin irritation

Sun Protection

Given the potential link between UV exposure and cyst formation, it’s crucial to practice sun safety:

Use a broad-spectrum sunscreen with an SPF of at least 30
Wear protective clothing, including hats and long sleeves
Seek shade during peak sun hours

Regular Skin Checks

Performing regular self-examinations can help identify new cysts or changes in existing ones early. Be sure to:

Check your skin regularly for new lumps or bumps
Monitor existing cysts for changes in size, color, or texture
Consult a healthcare provider if you notice any concerning changes

The Role of Interprofessional Care in Managing Sebaceous Cysts

Effective management of sebaceous cysts often requires a collaborative approach involving various healthcare professionals. This interprofessional care model ensures comprehensive treatment and optimal outcomes for patients.

Primary Care Physicians

Primary care doctors play a crucial role in:

Initial evaluation and diagnosis of sebaceous cysts
Providing patient education about the condition
Recommending conservative management strategies
Referring patients to specialists when necessary

Dermatologists

Dermatologists are specialists in skin conditions and can offer:

Advanced diagnostic techniques
Specialized treatment options, including minimally invasive procedures
Management of complex or recurrent cases
Evaluation of potential malignancies

Surgeons

In cases requiring surgical intervention, surgeons may be involved to:

Perform complete excision of large or complicated cysts
Address cysts in sensitive or difficult-to-reach areas
Manage any potential complications during or after surgery

Pathologists

Pathologists play a vital role in:

Examining tissue samples to confirm diagnosis
Identifying any signs of malignant transformation
Providing detailed reports to guide further treatment decisions

Nurses and Medical Assistants

These healthcare professionals are essential for:

Assisting with procedures and treatments
Providing patient education and post-procedure care instructions
Monitoring patients for signs of complications or recurrence

Pharmacists

Pharmacists contribute to care by:

Advising on appropriate medications for pain management or infection control
Providing information about potential drug interactions
Offering guidance on proper use of topical treatments

By working together, this interprofessional team can ensure that patients receive comprehensive, individualized care for their sebaceous cysts. This collaborative approach not only improves treatment outcomes but also enhances patient satisfaction and quality of life.

Epidermoid Cyst – StatPearls – NCBI Bookshelf

Patrick M. Zito; Richard Scharf.

Author Information and Affiliations

Last Update: March 7, 2023.

Continuing Education Activity

Epidermoid cysts, also known as a sebaceous cysts, are encapsulated subepidermal nodules filled with keratin. Although most commonly located on the face, neck, and trunk, epidermoid cysts can form anywhere on the body. Sebaceous cysts are generally considered to be benign, however new evidence indicates that they can develop de novo malignancy. This activity reviews the presentation, evaluation, and management of sebaceous cysts and highlights the role of the interprofessional team caring for patients affected by this condition.

Objectives:

Identify the etiology of sebaceous cysts.
Describe the typical presentation of a patient with a sebaceous cyst.
Review the management options available for sebaceous cysts.
Describe interprofessional team strategies to improve care coordination and management for patients with sebaceous cysts.

Access free multiple choice questions on this topic.

Introduction

Epidermoid cyst, also known as a sebaceous cyst, is a benign encapsulated, subepidermal nodule filled with keratin material. Although most commonly located on the face, neck, and trunk, epidermoid cysts can be found anywhere including the scrotum, genitalia, fingers, and cases within the buccal mucosa. Cysts may progress slowly and remain present for years. The term sebaceous cyst is commonly used; however, the term is a misnomer in that it does not involve the sebaceous gland. Epidermoid cysts develop within the infundibulum. Other common synonyms include infundibular cyst, epidermal cyst, and epidermal inclusion cyst. Although these cysts are recognized as benign lesions, rare malignancy can arise.[1][2][3]

Etiology

The majority of cases are of epidermoid cysts are sporadic. Although epidermoid cysts can be found in autosomal dominant (AD) Gardner syndrome (familial adenomatous polyposis) and Gorlin syndrome (basal cell nevus syndrome). Epidermoid cysts occurring before puberty in unusual locations and numbers raise the suspicion of a syndrome. In Favre-Racouchot syndrome (nodular elastosis with cysts and comedones) in elderly patients, epidermoid cysts may result from chronic sun damage. Patients on BRAF inhibitors can develop epidermoid cysts of the face. Lately, imiquimod and cyclosporine have been noted to cause epidermal inclusion cysts.[4][5][6]

Epidemiology

Epidermoid cysts are the most common cutaneous cysts and typically occur in the third and fourth decades of life. It is rare to find these cysts before puberty. They are predominantly found in males versus females (ratio 2:1). In the neonatal period, small epidermal cysts, referred to as milia, are common. Approximately 1% of epidermoid cysts have been noted to have a malignant transformation to squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).

Pathophysiology

Epidermoid cysts are derived from the follicular infundibulum. Generally, these cysts are the result of plugging of the follicular orifice. The cyst communicates with the surface of the skin through a keratin-filled orifice. Disruption of the follicle is important in the pathogenesis as those with acne vulgaris may have multiple epidermoid cysts originating from comedones. Additionally, they can also occur from traumatic and penetrate injuring leading to the implantation of the epithelium. Epidermoid cysts are lined with stratified squamous epithelium that leads to an accumulation of keratin within the subepidermal layer or dermis. Generally, the cysts are asymptomatic until they rupture. When the cysts rupture, an inflammatory reaction occurs from the displacement of soft and yellow keratin into the dermis and surrounding tissue. Recently ultraviolet (UV) light and infection with the human papillomavirus (HPV) have been implicated as causing epidermoid cysts.

Histopathology

Stratified squamous epithelium lines the cyst. Histological examination reveals an epithelial-lined cyst filled with laminated keratin located within the dermis. The lining of the cyst is similar to the surface epithelium but differs in that it lacks rete ridges. A granular layer is present that is filled with keratohyalin granules.

History and Physical

Physical examination generally reveals a 0.5 cm to several centimeters of non-fluctuant, compressible mass. A central, dark comedone opening (punctum) is often described. Epidermoid cysts are usually asymptomatic; however, if ruptured it may closely resemble a furuncle with tenderness to palpation, erythema, and swelling. A foul-smelling yellowish cheese-like material discharged from the skin may be described. Some patients may describe an event of a fall on their back or someone slapping their back causing painful swelling and the resulting cystic rupture. Epidermoid cysts can be found anywhere but are commonly found on the face, neck, chest, upper back, scrotum, and genitals. They can also be found on the buttocks, palms, and plantar side of feet if due to penetrating trauma. If occurring on the distal portion of the fingers, changes to the nail plate may occur. Taking a good history can aid in determining if the cyst is an isolated case, caused by medications, or if it is part of a genetic syndrome.

Evaluation

Evaluation of epidermoid cysts is based largely upon history and physical. The need for histological examination of the excised mass is often debated. Laboratory examination is not necessary. Radiographic tests are not commonly utilized in the evaluation of epidermoid cysts.

Treatment / Management

The most effective treatment involves complete surgical excision of the cyst with the cyst wall intact. The complete excision should be delayed if an active infection is present as the planes of dissection will be difficult. In these cases an initial incision and drainage may be indicated with a potential for reoccurrence in the future A local anesthetic with epinephrine is preferred to minimize bleeding. The anesthetic should be injected around the cyst, with avoidance of direct injection into the cyst. A small diameter elliptical incision with the inclusion of the central core, or punctum can be utilized. For optimal cosmetic results, maintaining the incision in the minimal skin tension lines is important. A multiple-layered subcuticular and epidermal closure will yield an optimal outcome. An alternative surgical approach can also be done with a punch biopsy and expulsion of the intact cyst through the small defect or standard excision. If there is surrounding inflammation, intralesional triamcinolone may be used to help decrease inflammation in addition to a delay in surgical removal. If the cyst has ruptured and the lining destroyed, the cyst will not reoccur. However, removing of the entire cystic lining is important in decreasing recurrence.[7][8][9]

Differential Diagnosis

Depending on location, the differential diagnoses of epidermoid cysts include the following: lipoma, dermoid cyst, pilar cyst (isthmus-catagen cyst, trichilemmal, wen), furuncle, branchial cleft cyst, milia, pilonidal cyst, calcinosis cutis, Pachyonychia Congenita, steatocystoma, and cutaneous findings of Gardner syndrome.

Prognosis

Epidermal inclusion cysts are recognized as benign cysts. However, rare malignancy can occur. Squamous cell carcinoma (SCC) is the most common malignancy followed by basal cell carcinoma (BCC). In developing malignancy, squamous cell carcinoma occurs approximately 70% of the time.

Complications

Complications of rupture include erythema, swelling, and pain. Complications of surgical removal include bleeding, infection, and scaring. Erythema and pain can be managed with intralesional triamcinolone. Infection following surgery can be prevented using proper aseptic techniques. While recognized as a benign cyst, rare malignancy may occur.

Postoperative and Rehabilitation Care

Following surgical excision, it appropriate to avoid contact sports and strenuous activity. Sutures may be removed within 7-10 days. Patients should be instructed on the fact that the surgical scar will generally take 8 weeks to reach a maximum of 80% tensile strength of the original skin strength. Scar revision, if necessary, should take place between 6 months to 1 year following excision as the remodeling phase of wound healing occurs between 3 weeks to 1 year.

Consultations

Consultations are not necessary unless the cyst is large and in an unusual location such as the mouth or face. In those circumstances, specialist consultation may be warranted. Adults with epidermoid cysts in rare locations such as the fingers and toes, history of multiple lipomas, and a family history of colon cancer should raise the suspicion of Gardner syndrome with an appropriate specialist referral.

Pearls and Other Issues

Epidermoid cysts (sebaceous cysts) are common benign encapsulated cysts. Due to the inflammatory reaction from the release of keratin contents, many practitioners will mistake the cyst for an abscess and prescribe antibiotics.

Enhancing Healthcare Team Outcomes

Epidermal cysts are commonly encountered by the primary care provider, dermatologist, nurse practitioner, surgeon and the internist. While the majority of these cysts are benign, it is important to send the excised sample for evaluation to ensure that there is no malignancy.

When completely excised, the outcomes are excellent. However, recurrences are common in patients with genetic syndromes.[10]

Review Questions

Access free multiple choice questions on this topic.
Comment on this article.

Figure

Epidermoid Cysts. Contributed by Dr. Shyam Verma, MBBS, DVD, FRCP, FAAD, Vadodara, India

References

1.: Kasahara R, Tajiri R, Kobayashi K, Yao M, Kitami K. Squamous Cell Carcinoma Developing from a Testicular Epidermal Cyst: A Case Report and Literature Review. Case Rep Urol. 2019;2019:9014301. [PMC free article: PMC6451811] [PubMed: 31019832]
2.: Birge O, Erkan MM, Serin AN. Case report: epidermoid inclusion cyst of the clitoris as a long-term complication of female genital mutilation. J Med Case Rep. 2019 Apr 27;13(1):109. [PMC free article: PMC6486694] [PubMed: 31027516]
3.: Kim SJ, Kim WG. Clinical and Imaging Features of a Ruptured Epidermal Inclusion Cyst in the Subareolar Area: A Case Report. Am J Case Rep. 2019 Apr 24;20:580-586. [PMC free article: PMC6501737] [PubMed: 31015391]
4.: Bashaireh KM, Audat ZA, Jahmani RA, Aleshawi AJ, Al Sbihi AF. Epidermal inclusion cyst of the knee. Eur J Orthop Surg Traumatol. 2019 Aug;29(6):1355-1358. [PubMed: 30968204]
5.: Balasundaram P, Garg A, Prabhakar A, Joseph Devarajan LS, Gaikwad SB, Khanna G. Evolution of epidermoid cyst into dermoid cyst: Embryological explanation and radiological-pathological correlation. Neuroradiol J. 2019 Apr;32(2):92-97. [PMC free article: PMC6410456] [PubMed: 30604653]
6.: Ma J, Jia G, Jia W. Primary intradiploic epidermoid cyst: A case report with literature review. Clin Neuropathol. 2019 Jan/Feb;38(1):28-32. [PubMed: 30526818]
7.: Weir CB, St. Hilaire NJ. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 12, 2023. Epidermal Inclusion Cyst. [PubMed: 30335343]
8.: Prior A, Anania P, Pacetti M, Secci F, Ravegnani M, Pavanello M, Piatelli G, Cama A, Consales A. Dermoid and Epidermoid Cysts of Scalp: Case Series of 234 Consecutive Patients. World Neurosurg. 2018 Dec;120:119-124. [PubMed: 30189303]
9.: Frank E, Macias D, Hondorp B, Kerstetter J, Inman JC. Incidental Squamous Cell Carcinoma in an Epidermal Inclusion Cyst: A Case Report and Review of the Literature. Case Rep Dermatol. 2018 Jan-Apr;10(1):61-68. [PMC free article: PMC5903124] [PubMed: 29681810]
10.: Li J, Qian M, Huang X, Zhao L, Yang X, Xiao J. Repeated recurrent epidermoid cyst with atypical hyperplasia: A case report and literature review. Medicine (Baltimore). 2017 Dec;96(49):e8950. [PMC free article: PMC5728879] [PubMed: 29245264]

: Disclosure: Patrick Zito declares no relevant financial relationships with ineligible companies.
: Disclosure: Richard Scharf declares no relevant financial relationships with ineligible companies.

Epidermoid Cyst – StatPearls – NCBI Bookshelf

Patrick M. Zito; Richard Scharf.

Author Information and Affiliations

Last Update: March 7, 2023.

Continuing Education Activity

Objectives:

Identify the etiology of sebaceous cysts.
Describe the typical presentation of a patient with a sebaceous cyst.
Review the management options available for sebaceous cysts.
Describe interprofessional team strategies to improve care coordination and management for patients with sebaceous cysts.

Access free multiple choice questions on this topic.

Introduction

Etiology

Epidemiology

Pathophysiology

Histopathology

History and Physical

Evaluation

Treatment / Management

Differential Diagnosis

Prognosis

Complications

Postoperative and Rehabilitation Care

Consultations

Pearls and Other Issues

Enhancing Healthcare Team Outcomes

When completely excised, the outcomes are excellent. However, recurrences are common in patients with genetic syndromes.[10]

Review Questions

Access free multiple choice questions on this topic.
Comment on this article.

Figure

Epidermoid Cysts. Contributed by Dr. Shyam Verma, MBBS, DVD, FRCP, FAAD, Vadodara, India

References

1.: Kasahara R, Tajiri R, Kobayashi K, Yao M, Kitami K. Squamous Cell Carcinoma Developing from a Testicular Epidermal Cyst: A Case Report and Literature Review. Case Rep Urol. 2019;2019:9014301. [PMC free article: PMC6451811] [PubMed: 31019832]
2.: Birge O, Erkan MM, Serin AN. Case report: epidermoid inclusion cyst of the clitoris as a long-term complication of female genital mutilation. J Med Case Rep. 2019 Apr 27;13(1):109. [PMC free article: PMC6486694] [PubMed: 31027516]
3.: Kim SJ, Kim WG. Clinical and Imaging Features of a Ruptured Epidermal Inclusion Cyst in the Subareolar Area: A Case Report. Am J Case Rep. 2019 Apr 24;20:580-586. [PMC free article: PMC6501737] [PubMed: 31015391]
4.: Bashaireh KM, Audat ZA, Jahmani RA, Aleshawi AJ, Al Sbihi AF. Epidermal inclusion cyst of the knee. Eur J Orthop Surg Traumatol. 2019 Aug;29(6):1355-1358. [PubMed: 30968204]
5.: Balasundaram P, Garg A, Prabhakar A, Joseph Devarajan LS, Gaikwad SB, Khanna G. Evolution of epidermoid cyst into dermoid cyst: Embryological explanation and radiological-pathological correlation. Neuroradiol J. 2019 Apr;32(2):92-97. [PMC free article: PMC6410456] [PubMed: 30604653]
6.: Ma J, Jia G, Jia W. Primary intradiploic epidermoid cyst: A case report with literature review. Clin Neuropathol. 2019 Jan/Feb;38(1):28-32. [PubMed: 30526818]
7.: Weir CB, St.Hilaire NJ. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 12, 2023. Epidermal Inclusion Cyst. [PubMed: 30335343]
8.: Prior A, Anania P, Pacetti M, Secci F, Ravegnani M, Pavanello M, Piatelli G, Cama A, Consales A. Dermoid and Epidermoid Cysts of Scalp: Case Series of 234 Consecutive Patients. World Neurosurg. 2018 Dec;120:119-124. [PubMed: 30189303]
9.: Frank E, Macias D, Hondorp B, Kerstetter J, Inman JC. Incidental Squamous Cell Carcinoma in an Epidermal Inclusion Cyst: A Case Report and Review of the Literature. Case Rep Dermatol. 2018 Jan-Apr;10(1):61-68. [PMC free article: PMC5903124] [PubMed: 29681810]
10.: Li J, Qian M, Huang X, Zhao L, Yang X, Xiao J. Repeated recurrent epidermoid cyst with atypical hyperplasia: A case report and literature review. Medicine (Baltimore). 2017 Dec;96(49):e8950. [PMC free article: PMC5728879] [PubMed: 29245264]

: Disclosure: Patrick Zito declares no relevant financial relationships with ineligible companies.
: Disclosure: Richard Scharf declares no relevant financial relationships with ineligible companies.

Spinal cyst removal (facet joints)

All departments

Surgery to remove a spinal cyst is considered the only effective method of treatment at advanced stages of the disease, when it comes to paraarticular synovial cyst of the intervertebral facet joint. As a rule, this condition is accompanied by pain in the arm or leg, sometimes with numbness. In some medical cases, the pain syndrome is so unbearable that the patient may need emergency spinal surgery.

Cyst of the intervertebral (facet) joints is a benign formation in the cavity of which fluid accumulates. Over time, it increases in size and causes severe pain. Experts classify a spinal cyst as a rare pathology, but recommend not to start the disease and seek help from neurosurgeons in time if symptoms are present.

Spinal cyst symptoms

Depending on the location of the cysts of the spine can be divided into:

Cysts in the cervical spine;
Cysts in the thoracic spine;
Cysts in the lumbar spine;
Cysts in the lumbosacral spine;
Cysts in the sacral spine.

According to the nature of education, specialists distinguish the following types:

Perineural cyst of the spine (usually an incidental finding and does not require treatment)
Para-articular cyst (para-articular synovial cyst of the intervertebral facet joint, requires spinal surgery)
Arachnoid cyst (very rare)

According to experts, there are dozens of varieties of spinal cysts, most of which are considered the norm . Surgical treatment is indicated for a paraarticular synovial cyst of the intervertebral facet joint if radicular compression symptoms are observed. In practice, this means that the patient suffers from regular pain in the localization of the cyst of the spine and in the limbs. Often, the discomfort is accompanied by numbness in the arm or leg. If the pain becomes unbearable, then emergency surgery is recommended.

Spinal cyst treatment

The most modern method for diagnosing spinal cysts is MRI. It is worth noting that in order to obtain an accurate diagnosis, it is necessary to take a picture of 1.5 Tesla. Most cysts do not cause discomfort, so patients live with them for years. Conservative treatment by a neurologist is indicated for back pain with a perineural cyst of the spine. To eliminate the pain syndrome, specialists prescribe a course of injections.

Spinal cyst surgery

As already mentioned, most often surgery is indicated for paraarticular synovial cyst of the intervertebral facet joint. Many patients consider laser removal of a spinal cyst to be the most effective method, but neurosurgeons refute the effectiveness of such an operation. When removing a spinal cyst with a laser, a heat wave adversely affects the vertebral discs, destroying them. Therefore, it has already been experimentally proven that the method of removing a spinal cyst with a laser is noticeably outdated.

Endoscopic removal of a cyst of the spine (facet joint)

Minimally invasive endoscopic spinal surgery is performed in case of paraarticular synovial cyst of the intervertebral facet joint if appropriate symptoms are present. Surgical intervention takes place under general anesthesia for 1-1.5 hours. The neurosurgeon performs all manipulations through small punctures, which has a positive effect on recovery.

Recovery after removal of a spinal cyst

After the operation to remove the cyst of the spine, the patient is discharged from the clinic the next day, and he can return to his normal life. Recovery after endoscopic spinal surgery does not involve bed rest, but it is worth limiting yourself to lifting weights and playing sports.

Why is it worth having an operation to remove a spinal cyst in the Pirogov Clinic?

Neurosurgeons of the highest category, with more than 10 years of experience, with a scientific degree of med. Sciences.
Modern equipment in operating rooms.
Affordable prices for the removal of a cyst of the spine.
Positive feedback about spinal surgery and treatment in our clinic. You can view them on our website, as well as on independent sites, such as Napopravku.ru.
Hospital type wards.
You can get a neurosurgeon’s recommendation on the treatment of your disease absolutely free of charge. You can send MRI images on this page of the site.
The possibility of obtaining an installment plan or a loan for treatment.
Service under VHI policies.

WANT TO ASK A QUESTION ABOUT YOUR OCCASION? SEND YOUR MRI IMAGES

How to describe your complaints correctly:

Describe in detail: the nature and localization of pain; the presence and localization of numbness and weakness in the limbs; conditions for the onset or intensification of pain; the presence of morning stiffness in the back; whether there is relief after “pacing”; whether the pain gets worse after prolonged sitting or standing; what worries more pain in the back / neck or leg / arm, it is desirable to evaluate both on a 10-point scale; whether the pain increases after flexion-extension; Is there relief after rest? whether there is an increase / increase in weakness / numbness in the legs after walking a certain distance with relief after stopping and bending or sitting down; is there a temperature; Is there an increase in pain at night and so on.
Medical history: duration of the disease, provoking factors, what you attribute the onset of the disease to, the treatment being carried out, the dynamics of the condition.
Presence of other diseases.
What hinders you the most? what would you like to get rid of? What are your expectations from the operation, if it is necessary?

How to send MRI images correctly

MRI images (not a doctor’s report, but images) must be on a disk, made on a device with a magnetic field voltage of at least 1.5 Tesla.

Insert disc into CD-ROM.
Copy folder with pictures in one file ENTIRELY to computer (right mouse button).
Name the copied file with your last name.
Add file to archive (right mouse button).
To upload MRI images (DICOM files), use an external cloud storage, such as Yandex Disk, Dropbox or Google Drive. Paste in the field above the link to the file or archive from the cloud storage.

Your images will be sent to our neurosurgeon Mereji Amir Mratovich.

Make an appointment

Licenses

Pirogov Clinic

Treatment of cysts of the spine in Moscow at the Dikul clinic: prices, appointments

A cyst of the spine is a cavity filled with fluid (hemorrhagic, cerebrospinal fluid, etc. ). Cystic formations in the spine are a fairly rare pathology, and the cyst can be located in any of its departments (from the cervical to the lumbosacral). A spinal cyst may be asymptomatic and can often be diagnosed incidentally or present with only chronic dull pain. Treatment of a spinal cyst depends on the location of the cyst, its size, and the degree of impact on nearby structures.

Varieties of spinal cysts

By origin, spinal cysts are divided into:

congenital,
purchased.

Depending on the morphological features (wall structure), the cyst can be:

true (there is an epithelial lining inside the cystic formation)
false (no epithelial lining)

The size, location and shape of a spinal cyst varies depending on the genesis of the formation.

Cysts of the spine are divided into morphological types:

Ganglionic. Such a formation does not have a synovial membrane inside the cavity layer of endothelial cells. As the tumor grows, it gradually separates from the bone.
Periarticular cyst.

Periarticular cyst of the spine is formed in the area of the intervertebral (facet) joints. Often formed due to trauma or degenerative disorders (in older people). Most often, it is formed in the facet joints of the lumbar and thoracic spine. Once formed, the periarticular cyst extends beyond the facet joint cavity. Periarticular cyst of the spine is the cause of radicular syndrome in almost 1% of cases. Depending on the presence of synovial epithelium, the periarticular cyst is divided into: ganglionic and synovial.

Perineural cyst of the spine.

Perineural cyst of the spine is found in almost 7% of all cystic formations. Often this cyst has a congenital origin, due to a violation of the development of the spine in the embryonic period – in the lumen of the spinal canal, there is some protrusion of the spinal cord. If this is a small protrusion, then it does not manifest itself clinically. If the protrusion is large, then compression of the spinal nerves occurs with the corresponding symptoms, which can appear already in childhood.

Aneurysmal cyst.

An aneurysmal cyst of the spine is a cavity formation inside the bone tissue of the vertebra, which gradually increases and is filled with venous blood. This serious pathology is quite rare, associated with tumor-like diseases and often leads to severe vertebral fractures. The cyst develops more often in childhood, mainly in girls. An aneurysmal cyst is usually caused by trauma.

Arachnoid cyst. Arachnoid cyst of the spine (Tarlov’s cyst) is a cavity formation, the walls of which are lined with the arachnoid membrane of the spinal cord. With dimensions of more than 15 mm, it can have a compressive effect on the nerve roots and spinal cord, which will manifest itself with characteristic symptoms.

Spinal liquor cyst

Spinal cerebrospinal fluid cyst is a cavity inside which there is cerebrospinal fluid, this fluid that circulates in the space of the spinal cord. Clinically, a CSF cyst will manifest itself depending on the level of its location in the spine, and neurological deficit below the level of cyst localization.

Cysts in the lumbar and sacral region. With small sizes, they do not manifest themselves clinically. With an increase in size, symptoms and a functional neurological deficit occur, depending on which root is compressed.

Causes

Causes of formation of spinal cysts are diverse:

For congenital cysts of the spine – disturbances in the development of tissues in the fetus.

For acquired tumors:

degenerative-dystrophic processes in the tissues of the spine,
spinal injury (bruises, fractures),
excessive, disproportionate loads on motor segments (including those caused by the type of activity),
sedentary lifestyle, which leads to the development of dystrophic changes in the tissues of the spine,
bleeding in the tissues of the spine,
parasitic injury (eg echinococcosis).

Symptoms

The symptoms of spinal cysts depend on the cause, size and location. Small tumors usually do not show up at all and are found incidentally during examination for other diseases. As the disease progresses, the size of the cyst increases and it begins to put pressure on the spinal roots. And as a result:

Neurological disorders of varying severity are detected.
There is pain located in the area of the tumor projection. Perhaps the spread of pain in the buttocks, lower limbs and other parts of the body.
Pain in the spine is felt both at rest and during movement.
Possible headache and dizziness, tinnitus (such symptoms are most often associated with arachnoid cysts).
Sensory disturbances (pins and needles, tingling, numbness of hands and/or feet, fingers).
Intestinal and bladder dysfunction may occur when the corresponding spinal roots are compressed.
As the cyst progresses, there may be muscle weakness in the lower extremities, which can lead to lameness. It becomes difficult for the patient to remain in a sitting position for a long time.
Paresis of the arms or legs.
Vestibular disorders

Pain that appears during movement, after prolonged sitting and is localized at the site of projection of the cyst in the spine. According to the degree of intensity, the pain can be severe or weak.

Diagnosis of a cyst of the spine

Diagnosis of a cyst of the spine is based on a comprehensive examination.

Patient complaints
Anamnesis (medical history).
General examination assessment of neurological deficit, severity and localization of pain, sensory and motor activity disorders, etc.

Research methods:

Radiography
MRI
CT (MSCT)
Spinal ultrasound
CT myelography
ENMG – used to evaluate nerve conduction disorders
General clinical methods

Treatment of a spinal cyst

Treatment of a spinal cyst is complex and is aimed at alleviating the condition and preventing the risk of serious complications. Treatment of spinal cysts can be either conservative or surgical. Conservative treatment is possible with small cysts, in the absence of severe pain and without impaired function of internal organs.

Non-surgical treatment of a spinal cyst includes:

Bed rest.
Balanced diet with enough vitamins, proteins, micro and macro elements.

Drug treatment

Prescription of analgesics and anti-inflammatory drugs.
Appointment of B vitamins (improvement of metabolic processes in the cell) and vitamin C (strengthens blood vessels and improves immunity).
Use of preparations to improve microcirculation
The use of drugs that reduce degenerative-dystrophic processes in bone and cartilage tissue (chondroprotectors).

Blockades . Perhaps the appointment of a therapeutic blockade is the introduction of anesthetics (novocaine, lidocaine) to the place where the pain is most pronounced, the so-called trigger points, or the introduction of an anesthetic into the epidural space (epidural blockade). Possible blockade with the combined use of an anesthetic and a corticosteroid drug (Cortizone, Diprospan).

Physiotherapy

Exercise therapy. Therapeutic exercises begin with a minimum load and under the strict supervision of a doctor. Exercise therapy is carried out after the elimination of acute pain syndrome and allows you to strengthen the muscles of the back and stabilize the spine.

Acupuncture (acupuncture, electroacupuncture, laser therapy).

Corsetting. In certain cases, short-term wearing of various corsets is indicated. They limit the range of motion, reduce pain and muscle spasm.

Surgical removal of a cyst of the spine

Surgical treatment of a cyst of the spine is performed to eliminate compression of the roots and spinal cord, improve blood circulation, restore impaired sensitivity and motor activity, as well as disorders of the functions of internal organs. And, as a result, surgical treatment of spinal cysts helps to prevent disability and restore working capacity as much as possible.

Large tumors are usually removed. The volume and type of surgical intervention is determined by the neurosurgeon after the diagnosis is made. Usually the tumor is removed by puncture or completely cut out with all its walls.

Surgery to remove a spinal cyst can be performed using endoscopic methods or under X-ray or CT guidance, which significantly reduces the risk of postoperative complications.

Prevention

Prevention of spinal cysts is non-specific and consists of the following.

Balanced diet with a sufficient content of micro and macro elements, protein, vitamins.
Minimize the risk of injury and bruising (injury sports are not recommended).
Avoid strenuous physical activity, including heavy lifting. Evenly distribute the load throughout the body.
Engage in physical activities such as swimming, walking, therapeutic exercises.
Monitor weight.
Eliminate bad habits .
Regularly monitor the presence of parasites in the body
Periodically conduct preventive examinations

Forecast

The prognosis of a cyst of the spine, with a small size and clinically not manifesting itself, is favorable both for life and for work.