Epidermal inclusion cyst formation from cholesteatoma: Sequelae or proof of recidivism?

Epidermal inclusion cyst formation from cholesteatoma: Sequelae or proof of recidivism?

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A 26-year-old female presented with a right lateral neck mass 21 years after an ipsilateral mastoidectomy.On otoscopy and repeat computed tomography, no evidence of cholesteatoma was documented.Biopsy of the mass revealed findings consistent with keratin flakes.The MRI demonstrated a well-defined lobulated mass in the right retroauricular region extending to the sternocleidomastoid (SCM).It was hypointense on T1-weighted and hyperintense on T2-weighted images with restricted diffusion and signal dropout in the ADC map.

Intraoperatively, an encapsulated, pearly white mass animationbengal.com was embedded in the SCM and had a superior attachment to the mastoid tip only through a fibrous stalk.On examination of the specimen, it was filled with tan, greasy-looking, soft debris.Surgical excision with intact cyst wall was performed.Final histopathologic report poise pads in bulk showed findings consistent with cholesteatoma.Extramastoid (cervical) cholesteatoma is very rare and may arise from inadvertent implantation of the squamous epithelium of a cholesteatoma during the previous surgery.

To our knowledge, this is the 12th case of neck cholesteatoma reported in the English literature.This highlights that otorhinolaryngologists must be careful in performing otologic procedures as this unusual disease entity can still develop and manifest several years post-operatively.