A decade of neglecting sublingual mass: A case report of epidermoid cyst

ntroduction: Epidermoid cysts may occur due to anomalies during fetal development, approximately 1–2 % occur
in the oral cavity. A cyst lumen filled with fluid or keratin without skin adnexal structures (such as hair, hair
follicle, sweat gland, sebaceous gland) can be defined as epidermoid cyst. 7 % of these cysts occur in the head and
neck, 1.6 % of which appear in the oral cavity. Gender distribution is balanced but more prevalent in males.
Epidermoid cysts are the most common cutaneous cysts. These cysts are rarely discovered prior to puberty. It has
been reported that 1 % of epidermoid cysts will malignantly develop into squamous cell carcinoma (SCC) or basal
cell carcinoma (BCC).
Case presentation: 18-year-old male patient presented with 57.99 × 55.33 × 41.41 mm-sized epidermoid cyst
treated at the Regional Hospital in Indonesia. The primary complaint was a painless, asymptomatic lump on the
floor of the mouth which was felt 10 years ago. Two years prior, the lump enlarged, and the patient began to feel
difficulty in swallowing, and respiratory distress appeared one year later. Supplementary examinations: ultra
sonography, fine needle aspiration biopsy, plain radiography, multiple slice computed tomography scan was
performed to support epidermoid cyst diagnosis.
Discussion: An intraoral approach-based cystectomy with a horizontal incision was utilized for surgical treatment
to avoid adjacent anatomic structure. Histopathological examination showed a macroscopic image of pouch
tissue with approximately 0.2 cm-thick wall, brownish white in color with yellow mass like cheese pulp, and
microscopic image of tissue covered with monomorphous complex squamous epithelium with eosinophilic
keratinized mass lumen.
Conclusion: Following the procedure, there was no longer respiratory distress nor difficulty in swallowing and the
patient recovered well with no deficiency in aesthetics