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Fig. 1.98 Sinonasal mature teratoma. A Benign teratoma showing cysts lined by squamous epithelium and cartilage in stroma. B Cartilage and respiratory mucosa in mature teratoma. C Teratoma containing mature glial tissue.

ally diagnostic, heterotopic CNS tissue and meningocele should be considered in the differential diagnosis. The presence of immature elements or any other germ cell tumour excludes mature ter-atoma.

Histogenesis

The most popular theories are derivation from primordial germ cells or primitive somatic cells that escaped the influence of organizers and inducers {2558}.

Prognosis and predictive factors

Complete surgical excision is curative.

Dermoid cyst

Definition

A dermoid cyst is a developmental lesion histogenetically and histologically composed of ectoderm and mesoderm, but no endoderm.

ICD-O code 9084/0

Synonyms

Nasal dermoid sinus cyst, cystic der-moid.

Epidemiology

Dermoid cysts of the nose comprise 3% of all dermoids and about 10% of those of the head and neck region {2891}. There is a male predominance. More than half are detected in children 6 years old or less, and approximately a third are present at birth {582}.

Localization

Dermoid cysts of the head and neck are located more often in the subcutaneous tissue of the lateral supraorbital ridge and nose. In the nose, they occur most commonly in the bridge and always in the midline. The glabella, nasal tip, and columella are less common sites {582,2891}. A few cases have been described as originating in the paranasal sinuses {2622}.

Clinical features

Nasal dermoid cysts manifest as a mid-line nasal pit, fistula, or subcutaneous infected mass. They may cause broadening of the nasal bridge and occasionally cellulitis or purulent discharge. On palpation, the cysts are soft to fluctuant with a pale yellowish-pink colour noted beneath the thinned but intact epithelium; when keratin debris and sebum fill the lumen, they may have a doughy consistency {99,582,822,2891}. Most patients do not have other congenital malformations, but some do {2058}. Imaging studies are valuable in detecting a potential intracranial component and excluding an encephalocele {582, 2622,2891}.

Macroscopy

The cysts range up to 12 cm. The lumen contains cheesy, yellow-white material.

Histopathology

Dermoid cysts are lined with mature ker-atinizing squamous epithelium and frequently contain cutaneous appendages in the cyst wall. This lesion is differentiated from a teratoma by the limited variety of tissue types and the absence of endodermal components. Epidermal inclusion cysts may resemble dermoid cysts but do not contain adnexa and occur predominantly in adults {99,582,2622}.

Histogenesis

The most likely explanation for the ontogeny of dermoid cysts is the retention of ectodermal tissue along the lines of closure at junctions of bones, soft tissues, and embryonic membranes

Prognosis and predictive factors

Dermoid cysts are treated by complete surgical excision. Recurrence is uncommon (<7%) {582,2891}.

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