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

20.07.202305.07.2023 by alexxlab

What are sebaceous cysts. How do sebaceous cysts form. What are the symptoms of sebaceous cysts. How are sebaceous cysts diagnosed. What treatments are available for sebaceous cysts. Can sebaceous cysts become cancerous. When should you see a doctor for a sebaceous cyst.

Содержание

What Are Sebaceous Cysts and How Do They Form?

Sebaceous cysts, more accurately termed epidermoid cysts, are common benign skin growths that develop beneath the skin’s surface. Despite their name, these cysts do not actually involve the sebaceous glands. Instead, they form within the epidermis, the outermost layer of skin.

How do sebaceous cysts develop? The primary cause is the plugging of a hair follicle or pore. When this occurs, keratin – a protein that makes up skin, hair, and nails – begins to accumulate beneath the skin’s surface. Over time, this buildup creates a dome-shaped, enclosed sac filled with a thick, cheese-like substance.

While most sebaceous cysts occur spontaneously, certain factors can increase the likelihood of their formation:

Hormonal changes, particularly during puberty
Skin trauma or injury
Certain genetic conditions, such as Gardner syndrome
Prolonged sun exposure
Use of specific medications, including BRAF inhibitors and cyclosporine

Identifying Sebaceous Cysts: Key Characteristics and Symptoms

Recognizing a sebaceous cyst is crucial for proper management. These cysts typically present as round, dome-shaped lumps beneath the skin. They can vary in size, ranging from a few millimeters to several centimeters in diameter.

What are the distinguishing features of sebaceous cysts?

Slow-growing and generally painless
Mobile when touched
Firm or slightly soft to the touch
Skin-colored or slightly yellow
Often have a small, dark “punctum” or opening at the center

While sebaceous cysts are usually asymptomatic, they can occasionally cause discomfort or complications. In some cases, the cyst may become infected or rupture, leading to symptoms such as:

Redness and swelling
Pain or tenderness
Discharge of foul-smelling, cheese-like material
Inflammation of surrounding skin

Common Locations: Where Do Sebaceous Cysts Typically Appear?

Sebaceous cysts can develop anywhere on the body where hair follicles or pores are present. However, certain areas are more prone to cyst formation than others. Where are sebaceous cysts most commonly found?

Face and neck
Scalp
Upper back and chest
Genitals and buttocks
Behind the ears

It’s worth noting that while these are the most common locations, sebaceous cysts can appear in less typical areas as well. For instance, they may develop on the fingers, within the mouth (buccal mucosa), or even on the scrotum.

Diagnosing Sebaceous Cysts: Medical Evaluation and Tests

Accurate diagnosis of sebaceous cysts is crucial for appropriate treatment. In most cases, a healthcare provider can diagnose these cysts through a physical examination alone. The characteristic appearance and feel of the cyst, along with its location, often provide sufficient information for a confident diagnosis.

However, in some instances, additional tests may be necessary to confirm the diagnosis or rule out other conditions. These may include:

Ultrasound imaging: To visualize the internal structure of the cyst
Biopsy: A small sample of the cyst is removed and examined under a microscope
CT or MRI scans: In rare cases, to assess the extent of large or deeply situated cysts

During the diagnostic process, your healthcare provider may ask about your medical history, including any previous skin conditions or injuries. They may also inquire about how long you’ve had the cyst and whether it has changed in size or appearance over time.

Treatment Options: Managing and Removing Sebaceous Cysts

The treatment approach for sebaceous cysts depends on various factors, including the size of the cyst, its location, and whether it’s causing symptoms or cosmetic concerns. What are the available treatment options for sebaceous cysts?

Observation: Small, asymptomatic cysts may not require treatment and can be monitored for changes.
Incision and drainage: For infected or inflamed cysts, the doctor may make a small cut to drain the contents. However, this method doesn’t remove the cyst wall, so recurrence is likely.
Intralesional corticosteroid injection: This can help reduce inflammation in irritated cysts.
Surgical excision: Complete removal of the cyst and its wall is the most effective treatment to prevent recurrence.
Minimal excision technique: A smaller incision is made to remove the cyst contents and wall, resulting in less scarring.
Laser therapy: Some studies have shown promise in using CO2 lasers to treat sebaceous cysts.

It’s important to note that attempting to drain or remove a sebaceous cyst at home can lead to infection and scarring. Always consult a healthcare professional for proper treatment.

Potential Complications: When Sebaceous Cysts Become Problematic

While sebaceous cysts are generally benign and harmless, they can occasionally lead to complications. Understanding these potential issues can help individuals recognize when medical attention is necessary.

What are the possible complications associated with sebaceous cysts?

Infection: Bacteria can enter the cyst, causing inflammation, pain, and pus formation.
Rupture: If a cyst bursts, it can lead to inflammation and increase the risk of infection.
Scarring: Improper removal or infection can result in permanent scarring.
Discomfort: Large cysts or those in sensitive areas may cause physical discomfort or interfere with daily activities.
Malignant transformation: Although rare, there is a small risk (about 1%) of sebaceous cysts developing into skin cancer, particularly squamous cell carcinoma.

If you notice any signs of infection, such as redness, warmth, or increasing pain around the cyst, it’s crucial to seek medical attention promptly. Additionally, any rapid growth or changes in the appearance of a long-standing cyst should be evaluated by a healthcare provider.

Prevention and Self-Care: Minimizing the Risk of Sebaceous Cysts

While it’s not always possible to prevent sebaceous cysts, certain measures can help reduce the risk of their formation and manage existing cysts effectively. What steps can you take to minimize the occurrence of sebaceous cysts?

Maintain good skin hygiene: Regular cleansing can help prevent pore blockage.
Avoid skin trauma: Protect your skin from injuries that could lead to cyst formation.
Use non-comedogenic products: Choose skincare and cosmetic products that won’t clog pores.
Protect your skin from sun damage: Use sunscreen and protective clothing to minimize UV exposure.
Manage underlying conditions: If you have acne or other skin conditions, proper treatment may help prevent cyst formation.

For existing cysts, gentle self-care measures can help manage minor symptoms:

Apply warm compresses to relieve discomfort and promote drainage
Keep the area clean and dry to prevent infection
Avoid squeezing or attempting to pop the cyst, which can lead to inflammation and scarring
Use over-the-counter pain relievers if needed for discomfort

Remember, while these self-care measures can be helpful, they are not substitutes for professional medical advice and treatment when necessary.

When to Seek Medical Attention: Recognizing Red Flags

While many sebaceous cysts can be managed with observation or minimal intervention, certain situations warrant prompt medical attention. Recognizing these red flags can help prevent complications and ensure timely treatment.

When should you consult a healthcare provider about a sebaceous cyst?

Rapid growth: If the cyst suddenly increases in size, it could indicate infection or rarely, malignancy.
Signs of infection: Redness, warmth, increasing pain, or pus discharge suggest an infected cyst that may require antibiotics or drainage.
Changes in appearance: Any changes in color, texture, or shape of a long-standing cyst should be evaluated.
Interference with daily activities: Large cysts or those in sensitive areas that cause discomfort or hinder movement may need removal.
Cosmetic concerns: If the cyst is in a visible area and causes distress, discuss removal options with your healthcare provider.
Multiple or recurring cysts: This could indicate an underlying condition that requires further investigation.

It’s important to remember that while sebaceous cysts are generally benign, only a healthcare professional can definitively rule out more serious conditions. If you’re unsure about a skin growth, it’s always best to err on the side of caution and seek medical advice.

The Role of Dermatologists in Managing Sebaceous Cysts

Dermatologists play a crucial role in the diagnosis and treatment of sebaceous cysts. These specialists have extensive training in skin conditions and can provide expert care for complex or recurring cysts.

How can a dermatologist help with sebaceous cysts?

Accurate diagnosis, differentiating cysts from other skin growths
Advanced treatment options, including surgical excision and laser therapy
Management of complications, such as infected cysts
Cosmetic considerations, minimizing scarring during removal procedures
Ongoing monitoring for recurrence or development of new cysts

If you have concerns about a sebaceous cyst or have experienced recurring cysts, consider consulting a dermatologist for specialized care and treatment options.

Myths and Misconceptions: Clarifying Common Beliefs About Sebaceous Cysts

There are several misconceptions surrounding sebaceous cysts that can lead to confusion and inappropriate management. Let’s address some of these myths to provide clarity:

Myth 1: Sebaceous cysts are caused by poor hygiene

While good hygiene is important for overall skin health, sebaceous cysts are not caused by poor hygiene. They result from blocked hair follicles or pores, which can occur even with regular cleansing.

Myth 2: Squeezing a sebaceous cyst will make it go away

Attempting to squeeze or pop a sebaceous cyst can lead to infection, inflammation, and scarring. It may also cause the cyst to recur. Professional treatment is the safest and most effective approach.

Myth 3: Sebaceous cysts always require immediate removal

Many sebaceous cysts are harmless and can be left alone if they’re not causing symptoms or cosmetic concerns. However, monitoring for changes is important.

Myth 4: All bumps under the skin are sebaceous cysts

While sebaceous cysts are common, not all subcutaneous lumps are cysts. Other possibilities include lipomas, abscesses, or in rare cases, tumors. Professional diagnosis is crucial for proper identification and treatment.

Myth 5: Sebaceous cysts are contagious

Sebaceous cysts are not contagious and cannot be spread from person to person or from one part of the body to another through contact.

Understanding these facts can help individuals make informed decisions about seeking treatment and managing their skin health effectively.

Living with Sebaceous Cysts: Coping Strategies and Quality of Life

For individuals living with sebaceous cysts, particularly those that are visible or recurrent, the condition can have both physical and emotional impacts. Developing effective coping strategies can significantly improve quality of life.

How can you manage the physical and emotional aspects of living with sebaceous cysts?

Education: Learn about your condition to feel more in control and make informed decisions about treatment.
Open communication: Discuss your concerns with healthcare providers to ensure your needs are addressed.
Skincare routine: Develop a gentle, consistent skincare regimen to maintain overall skin health.
Clothing choices: If cysts are in visible areas, choose clothing that provides comfort and coverage as needed.
Stress management: Practice stress-reduction techniques, as stress can exacerbate skin conditions.
Support groups: Connect with others who have similar experiences for emotional support and practical tips.

Remember, while sebaceous cysts can be frustrating, they are generally harmless and treatable. With proper care and support, most individuals can effectively manage this condition and maintain a high quality of life.

Future Perspectives: Advancements in Sebaceous Cyst Treatment

As medical research continues to progress, new and improved treatments for sebaceous cysts are being explored. These advancements aim to provide more effective, less invasive options for managing and removing cysts.

What are some of the promising developments in sebaceous cyst treatment?

Improved minimal excision techniques: Refinements in surgical methods may lead to even less scarring and faster recovery times.
Advanced laser therapies: Ongoing research into laser treatments may provide non-invasive options for cyst removal.
Targeted medications: Development of topical or systemic drugs that could prevent cyst formation or promote resolution without surgery.
Genetic therapies: For individuals with genetic predispositions to cyst formation, gene therapy could potentially offer long-term prevention.
Immunotherapies: Research into the immune system’s role in cyst formation could lead to new treatment approaches.

While these potential advancements are exciting, it’s important to note that many are still in the research phase. Current best practices, as recommended by healthcare professionals, remain the most reliable approach to managing sebaceous cysts.

As our understanding of sebaceous cysts continues to evolve, patients can look forward to potentially more effective and less invasive treatment options in the future. Staying informed about these developments can help individuals make the best decisions for their skin health in consultation with their healthcare providers.

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.
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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.
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Name the copied file with your last name.
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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.