EURORAD ESR

Case 13168

Epidermal cyst of the ischiorectal fossa

Author(s)
Sergio Savastano1, Domenico Vespa2, Daniela Danieli3, Alessandra Costantini1, Davide Dal Borgo1, Stefano Trupiani1, Leonardo Giarraputo1

U.O. Radiologia1, U.O. Chirugia2 and U.O. Anatomia e Istocitopatologia3
Ospedale San Bortolo - V.le F. Rodolfi 37
36100 Vicenza, Italy
 
Patient
female, 61 year(s)
 
 
  • Figure 1
    Contrast-enhanced CT
     

    A well-circumscribed large cyst occupies the right ischiorectal fossa; the rectum and the vagina are contralaterally displaced.

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Coronal reformation.

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Sagittal reformation

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;
     
     
  • Figure 2
    T2-wheighted MRI
     

    Axial image: the cyst is unilocular and delineate by thin hypointense rim.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Axial T2 wheighted fat sat image.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;

    No intra-abdominal extension is evident on sagittal image.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;

    No intra-abdominal extension is evident on coronal plane.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;
     
     
  • Figure 3
    T1-wheighted fat sat MRI
     

    The cystic content is slightly hyperintense on non-enhanced axial image.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;

    No rim enhancement is appreciable on axial post-contrast image.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Post-contrast coronal image (close up) show enhancement of the lower pole rim.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;
     
     
  • Figure 4
    Operative finding.
     

    The lesion appears yellowish at surgery performed in knee-chest position.

     
    Area of Interest: Pelvis; Imaging Technique: Experimental; Procedure: Intraoperative; Special Focus: Cysts;

    Operative specimen.

     
    Area of Interest: Pelvis; Imaging Technique: Experimental; Procedure: Intraoperative; Special Focus: Cysts;
     
     
  • Figure 5
    Histology
     

    The cyst wall is formed by a stratified squamous epithelium resting on a layer of connective tissue. No evidence of dermal adnexal appendages (2.5x EE).

     
    Area of Interest: Paediatric; Imaging Technique: Experimental; Procedure: Diagnostic procedure; Special Focus: Cysts;

    High magnification of stratified keratinizing squamous epithelial wall (20x EE).

     
    Area of Interest: Pelvis; Imaging Technique: Experimental; Procedure: Diagnostic procedure; Special Focus: Cysts;
     
     
A well-circumscribed large cyst occupies the right ischiorectal fossa; the rectum and the vagina are contralaterally displaced.
 
Coronal reformation.
 
Sagittal reformation
 
Axial image: the cyst is unilocular and delineate by thin hypointense rim.
 
Axial T2 wheighted fat sat image.
 
No intra-abdominal extension is evident on sagittal image.
 
No intra-abdominal extension is evident on coronal plane.
 
The cystic content is slightly hyperintense on non-enhanced axial image.
 
No rim enhancement is appreciable on axial post-contrast image.
 
Post-contrast coronal image (close up) show enhancement of the lower pole rim.
 
The lesion appears yellowish at surgery performed in knee-chest position.
 
Operative specimen.
 
The cyst wall is formed by a stratified squamous epithelium resting on a layer of connective tissue. No evidence of dermal adnexal appendages (2.5x EE).
 
High magnification of stratified keratinizing squamous epithelial wall (20x EE).
 
 
 
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