Cutaneous ciliated cystCutaneous ciliated cyst(Cutaneous Mullerian cyst)(Cutaneous Mullerian cyst)

Deba P Sarma, MDDeba P Sarma, MD

OmahaOmaha

F 48, right heelF 48, right heel

Cyst in the soft tissue

Note the cilia on the luminal border of the columnar epithelium

Pan-CK (CK AE 1/3): Positive cytoplasmic stain

Cam 5.2 (CK8/18): Positive cytoplasmic stain

CEA: Negative

ER: Positive nuclear stain

PR: Positve nuclear stain

Diagnosis:Diagnosis:

Soft tissue, right heel, excisional biopsy:Soft tissue, right heel, excisional biopsy:- Cutaneous ciliated cystCutaneous ciliated cyst- (Cutaneous Mullerian cyst)(Cutaneous Mullerian cyst)

Cutaneous ciliated cyst (Cutaneous Mullerian cyst)Cutaneous ciliated cyst (Cutaneous Mullerian cyst)

-Solitary cystic lesion of lower limb of woman (10-50 yrs).-Solitary cystic lesion of lower limb of woman (10-50 yrs).

-Thought to be arising from heterotopic Mullerian-Thought to be arising from heterotopic Mullerian

epithelium.epithelium.

-Cyst is unilocular or multilocular with intralocular papillary-Cyst is unilocular or multilocular with intralocular papillary

projections, lined by ciliated cuboidal or columnar epithelium projections, lined by ciliated cuboidal or columnar epithelium similarsimilar

to that of fallopian tube.to that of fallopian tube.

-Lining cells show immmunoprofile similar to that of fallopian tube-Lining cells show immmunoprofile similar to that of fallopian tube

epithelium (Positive cytoplasmic staining with CK, Negative CEA, epithelium (Positive cytoplasmic staining with CK, Negative CEA, andand

Positive nuclear staining with ER and PR).Positive nuclear staining with ER and PR).

-Rare ciliated cutaneous cysts seen in man are thought to be -Rare ciliated cutaneous cysts seen in man are thought to be arisingarising

from eccrine or apocrine gland with cilia metaplasia.from eccrine or apocrine gland with cilia metaplasia.

-Differential diagnosis: Ciliated epithelial cells are also seen in-Differential diagnosis: Ciliated epithelial cells are also seen in

brochogenic, thyroglossal duct, branchial, thymic and mature cysticbrochogenic, thyroglossal duct, branchial, thymic and mature cystic

Teratoma.Teratoma.

REF:REF:

Stevens T, Sarma DP.(2011). Biopsy of a 5 mm cystic Stevens T, Sarma DP.(2011). Biopsy of a 5 mm cystic lesion on the right heel of a 48-year-old woman. lesion on the right heel of a 48-year-old woman. Dermatol Online J. 15(17):6. PMID: 21696686. Dermatol Online J. 15(17):6. PMID: 21696686. [PubMed – indexed for MEDLINE][PubMed – indexed for MEDLINE]