Congenital peristernal dermal sinuses: a new entity?

Suprasternal dermoid sinus: A case report

INTRODUCTION

Congenital anomalies in the neck region, such as dermoid sinuses, pose diagnostic challenges in pediatrics. Surgical excisions are vital to prevent complications.

PRESENTATION OF CASE

A 7-month-old male infant had presented with a congenital suprasternal dermoid sinus, which had been evident since birth. Imaging confirmed the diagnosis, prompting surgical intervention under general anesthesia. A delicate excision was performed, guided by a methylene blue dye injection, followed by histopathological confirmation.

DISCUSSION

Dermoid sinuses typically manifest as cutaneous pits or sinus tracts, with a left-sided predominance and a female predilection. An accurate diagnosis relies on clinical examination and imaging studies to delineate the anomaly. Surgical excision remains crucial to prevent recurrence and complications.

CONCLUSION

This case reaffirms the necessity of prompt and accurate diagnosis followed by surgical intervention for managing congenital dermoid sinuses. Ongoing research and collaborative studies are needed to further refine management strategies and improve outcomes for patients with these anomalies, particularly when presenting in atypical locations.

Congenital dermoid sinus of anterior chest: Case report and review of literature

INTRODUCTION

Congenital dermoid sinus which is a rare congenital anomaly of the anterior chest wall (CDACR) is frequently misdiagnosed or mistreated. This report aims to raise awareness about this condition and share experience based on a demarcation technique for anomalous tissue.

PRESENTATION OF CASE

A case of surgically treated CDACR in our clinic and subsequently confirmed through histopathology was chosen. Health records such as, demographics, visits, imaging modalities, management, outcome, and histopathology were reviewed of the patient.

DISCUSSION

Our patient aged 4 years underwent ultrasonography, which revealed a dermoid sinus on her right anterior chest. This diagnosis was later confirmed via histopathology after the excision of the sinus, which was facilitated by a mix of methylene blue and fibrin glue. The incision healed well without any complications.

CONCLUSION

Thus, it was found that CDACRs are those rare congenital anomalies requiring immediate excision to prevent recurrent infections or complications. Knowing how to identify and deal with them is essential.

The congenital sternoclavicular sinus: a single-institution retrospective study of 88 patients

BACKGROUND

Sinus near the sternoclavicular joint was considered as a rare congenital neck abnormality. Though it was reported as a dermoid sinus in some literatures, the embryological origin of the sinus was unclear. This study aimed at reviewing the clinical and histological characteristics and analyzing the possible embryological origin of this malformation in children.

METHODS

The medical records of all patients with congenital sternoclavicular sinus who underwent surgical resection between March 2018 through June 2020 were reviewed retrospectively. The clinical presentations, complications, histological examination, and treatment were analyzed.

RESULTS

Of the 88 patients with congenital sternoclavicular sinus included, the mean age of surgery was 2.73 ± 1.71 years old. The sinuses occurred on the left side in 73 (83.0%) cases. Sixty-three patients experienced sinus infection and 44 patients underwent incision and drainage before excision. All patients received surgical resection with one patient who recurred after surgery. Histopathological examination showed that the sinuses were lined by squamous epithelium in most patients. However, ciliated epithelium was observed in one patient and salivary glands were detected in two patients.

CONCLUSIONS

The congenital sternoclavicular sinus should be excised promptly to prevent recurrent infection. According to the ciliated epithelium and salivary gland were found in the wall of sinus, it should be viewed as the skin side remnant of the fourth branchial cleft rather than a dermoid cyst/sinus.

Congenital dermoid sinus of the anterior chest region

BACKGROUND

Congenital dermoid sinus of the anterior chest region (CDACR) is a rare developmental anomaly. Therefore, the aim of our study was to draw attention to this underrecognized lesion.

METHODS

From 2011 to 2019, our study group included 11 patients who presented to our hospital with pits and masses of their anterior chest walls. All lesions were surgically excised with histologic confirmation of the diagnosis of CDACR. The medical records of these patients were reviewed for the following data: patient age, gender, clinical characteristics of the lesion and site of involvement, department first visited, diagnostic evaluation, management, postoperative complications, and histopathological findings.

RESULTS

There was a clear left-sided predominance, with 10/11 cases occurring on the left and a female predominance of eight cases out of 11. Although the pits were present at birth, the mean age at presentation was 19.7 months. All patients showed clinical signs of infection at the time of presentation and were treated with antibiotics. Seven patients had a history of abscess formation treated with incision and drainage. Ultrasound was performed in eight patients. In all cases, the lesions, including pit and sinus, were completely excised.

CONCLUSIONS

Congenital dermoid sinus of the anterior chest region is likely underrecognized. We encountered a high frequency of complications such as infections or abscesses prior to surgical excision. Complete excision of CDACR is not technically difficult. Therefore, surgical removal should be considered, even for asymptomatic lesions, to avoid future complications and for cosmesis.

Cutaneous ultrasound and its utility in Pediatric Dermatology: Part II-Developmental anomalies and vascular lesions

High-frequency ultrasonography represents a promising tool for pediatric dermatologists. It is a noninvasive and harmless diagnostic technique that is especially appealing when working with children. It can be easily performed at the patient's bedside, avoiding diagnostic delays, sedation, or multiple visits. It represents a useful adjunct to clinical examination and aids our understanding of cutaneous pathology. In this second part, we describe the ultrasonographic findings of developmental anomalies and vascular lesions.

Sternoclavicular sinus: Case series and literature review of a rare head and neck lesion

OBJECTIVE

The objective of this study is to describe the clinical and pathologic features of a rare congenital neck anomaly, a sternoclavicular sinus, and review the literature on this topic.

STUDY DESIGN

This study is a retrospective case series of four subjects diagnosed with a sternoclavicular sinus.

METHODS

Patients with a congenital neck anomaly, distinct from common branchial cleft anomalies, were identified through a 10-year retrospective chart review of a tertiary care pediatric otolaryngology practice.

RESULTS

We describe four patients with a congenital neck anomaly with common features of a sternoclavicular anomaly. All patients presented with a superficial neck anomaly adjacent to the sternoclavicular joint. Surgical excision through an external approach was successfully performed in three out of the four patients with subsequent resolution of symptoms. The literature review compiles all the cases presented. Theories on embryologic origin include incomplete fusion of sternum and clavicle or unusual remnant of a fourth branchial cleft. Commonalities include left sided predominance, squamous epithelium lined sinus tract ending at the sternoclavicular junction, and successful surgical excision in almost all cases.

CONCLUSION

A sternoclavicular sinus is a rarely described congenital neck abnormality. Presentation and management is similar to branchial cleft anomaly but with a distinct anatomical pathway that is important for surgeons to recognize.

LEVEL OF EVIDENCE

This manuscript presents a case series. The level of evidence proposed is Level 4.

Lateral buttock and postanal congenital dermal sinus tract

We present 2 rare cases of lateral buttock and postanal congenital dermal sinus tract. These 2 children were noted to have a pit in the left upper lateral buttock and a postanal orifice after birth. Magnetic resonance imaging, computed tomography, and ultrasonography showed an inflammatory mass lesion in the buttock and a funicular structure adjacent to the rectum. Fistulography showed no connection between the pit and orifice. Surgical exploration revealed firm tracts from both the lateral buttock and postanus running deep to the tip of the coccyx. Histopathologic findings showed squamous cells in the walls of the sinus tracts. Our report broadens the clinical literature regarding congenital dermal sinus tract. We postulate that this disease may not always have a connection with the central nervous system, and our cases may provide examples of anal fistulas of congenital etiology in infants.