Introduction:

Epidermal inclusion cysts (EICs), also known as epidermoid cysts or sebaceous cysts, are common benign cystic lesions that can occur in various parts of the body, including the vulva. While generally asymptomatic, these cysts can occasionally cause discomfort or become inflamed, necessitating medical attention. This pathology description aims to elucidate the characteristic features of epidermal inclusion cysts of the vulva, encompassing their etiology, histological features, clinical presentation, and differential diagnosis.

Etiology:

Epidermal inclusion cysts of the vulva typically arise from hair follicles or sweat glands that become obstructed, leading to the accumulation of keratinaceous debris within a cystic cavity. Trauma, chronic irritation, or prior surgical procedures in the vulvar region may predispose to the formation of these cysts.

Histological Features:

Histologically, epidermal inclusion cysts of the vulva exhibit characteristic features consistent with their origin from the epidermis. Microscopic examination typically reveals a cystic structure lined by stratified squamous epithelium, resembling normal epidermis. The cyst wall is composed of well-differentiated epithelial cells arranged in layers, with a central lumen containing keratinous material. The presence of a granular layer and occasional sebaceous glands within the cyst wall may also be observed. Inflammatory changes, such as foreign body giant cell reaction or chronic inflammation, may be present in cases of cyst rupture or secondary infection.

Clinical Presentation:

Epidermal inclusion cysts of the vulva usually present as painless, mobile, subcutaneous nodules or swellings in the vulvar region. They may vary in size from a few millimeters to several centimeters and often have a smooth or slightly erythematous surface. While most cysts are asymptomatic, they can occasionally become inflamed, causing pain, tenderness, or drainage of purulent material. Rarely, larger cysts may exert pressure on surrounding structures, leading to discomfort or difficulty with urination or sexual intercourse.

Differential Diagnosis:

The differential diagnosis of vulvar epidermal inclusion cysts includes various benign and malignant lesions that may present with similar clinical features, such as Bartholin gland cysts, sebaceous cysts, lipomas, fibromas, hidradenomas, and vulvar neoplasms (e.g., squamous cell carcinoma, adenocarcinoma). Clinical evaluation, along with histopathological examination of biopsy specimens, is essential to differentiate epidermal inclusion cysts from other vulvar lesions accurately.

Conclusion:

Epidermal inclusion cysts of the vulva are common benign lesions characterized by the accumulation of keratinaceous material within a cystic cavity lined by stratified squamous epithelium. While typically asymptomatic, these cysts can become inflamed or infected, necessitating medical intervention. Awareness of their characteristic histological features and clinical presentation is crucial for accurate diagnosis and appropriate management of vulvar epidermal inclusion cysts.

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