Dermoid Cyst of the Parotid Gland: Report of a Rare Entity with Literature Review

Dermoid cysts (DCs)are benign lesions and histologically composed of tissues originating from ectoderm and mesoderm, but not endoderm. Approximately 7 % of all DCs are seen in head and neck area. However, parotid gland is an extremely rare localization in which DCs develop, and only 17 cases have been reported in the literature to date. Correct preoperative diagnosis is difficult to be established due to the rarity and ambiguous radiological findings. We report a case of a 21-year old man. All previous reports reviewed and the pathogenesis as well as the histopathologic and radiologic features are discussed.

Related papers:

title: Dermoid Cyst of the Lateral Neck: A Case Report and Literature Review
abstract: Dermoid cysts of the lateral neck are rare, with the majority of head and neck dermoids occurring in the midline. The demonstration of a fat-fluid level on MRI or CT is diagnostic for a cervical dermoid cyst. The treatment of choice remains surgical excision.

title: An unusual presentation of neck dermoid cyst
abstract: Congenital masses are the most common non-inflammatory neck lesions in children. Although usually present at birth, they can appear at any age. Dermoid cysts are benign lesions of congenital origin usually presenting as a midline neck mass. They rarely appear in the lateral region of the neck. Lateral cervical dermoid cyst is presented as a rare, unusual case, and differential diagnosis and management are discussed in light of recent literature.

title: Nasal Dermoid Sinus Cysts in Children
abstract: Thirty‐six children with nasal dermoid sinus cysts were treated in the Department Pediatric Otolaryngology, Armand Trousseau's Children's Hospital (Paris, France) between 1974 and 1994. Ten of the patients presented with a midline cyst only, eight had nasal pits only, and 18 had combined cases. In six of the 36 patients, presurgical imagery indicated signs of intracranial extension of the tract, reaching the foramen caecum without intracranial mass. Three surgical techniques were used: an external rhinoplasty approach with medial crura section in 23 cases, a direct median approach in seven cases, and a paracanthal approach in six cases. Only two cases had meningeal adherences. Two superficial recurrences occurred within the 7‐year follow‐up period. Widening of the scar occurred in four children after verticomedian approach or nasal pit excision. The external rhinoplasty procedure with medial crura section results in a wide surgical approach, low recurrence rate, and good aesthetic results.

title: Cysts of the parotid gland. Review and report of two unusual cases.
abstract: Cysts of the major salivary glands are most frequent in the parotid where they form a small percentage of its benign tumours. They can be congenital or acquired and of parotid or extraparotid origin. Two unusual cysts are reported: a cholesteatoma arising from the ipsilateral mastoid, twenty years after successful radical mastoidectomy, and a deeply located cysts of probably congenital origin. The literature is reviewed and the management discussed. Parotidectomy, often with extensive dissection, remains in general the treatment of choice.

title: [Dermoid cyst of the parotid gland].
abstract: Dermoid cyst of the parotid gland is a rare clinical entity. Definitive clinical diagnosis is often difficult to determine preoperatively because of the lack of pathognomonic features. The most frequent location of a parotid dermoid cyst is a triangular area lying above the pinna. Imaging studies do not definitely diagnose a parotid dermoid cyst. Although parotid dermoid cyst is (generally) well-encapsulated, complete removal of the cyst wall is not sufficient to cure it, so it is mandatory to perform careful excision of the cyst by parotidectomy, in terms of preserving facial nerve integrity. Histopathology of the parotid gland tumor removed by parotidectomy makes a diagnosis of certainty, by revealing a cyst wall with keratinization of the squamous epithelium and the presence of skin annexes (hair follicles, sweat glands, sebaceous glands). We present a rare case of parotid dermoid cyst in a 21-year-old male patient with symptoms and imaging rather suggestive of arch I branchial cyst and a brief review of data in the medical literature of the last 20 years.

title: Fine‐needle aspiration cytological features of dermoid cyst of the parotid gland: A report of two cases
abstract: We describe the cytological features of dermoid cyst of the parotid gland and the value of preoperative diagnosis by fine‐needle aspiration (FNA) cytological evaluation. Both patients had painless parotid masses. On physical examination, a freely movable parotid mass was found in each case. CT scan showed a cystic mass in the parotid gland in each patient. FNA in both cases showed anucleated and nucleated squamous epithelium and keratin debris. The clinical features and cytological findings in each case were interpreted as suggestive of a dermoid cyst. Histological examination of surgical specimens confirmed the presence of a dermoid cyst of the parotid gland in each case. FNA is a reliable method for preoperative diagnosis and permits selection of an appropriate form of surgical procedure for dermoid cyst of the parotid gland. Diagn. Cytopathol. 1999;20:387–388.

title: Dermoid cyst of the parotid gland--a case report and brief review of the literature.
abstract: There is controversy over the frequency of dermoid cysts in the head and neck area. Some authors report that they are common, whereas others say that only 7% of such cysts occur in the head and neck area. In either case, they are extremely rare in the parotid gland. When PubMed is searched for 'dermoid cyst of the parotid gland', only 11 articles are listed. Only four of the articles written in English are case reports of dermoid cysts of the parotid gland. Due to the rarity of descriptions and the considerable diversity of swellings of the parotid gland diagnosis is difficult. Visualizing options like computed tomography, magnetic resonance imaging and ultrasound cannot give a conclusive preoperative diagnosis. This case report shows the challenges in diagnosis and gives a short review of the literature.

title: Dermoid Cyst of the Parotid Gland-A Case Report
abstract: Dermoid cysts in the head and neck area account for 7% of all dermoid cysts, with their predominant sites being orbital, oral and nasal regions (80% )rarity of the parotid dermoid cyst and diversity of parotid swellings, corect preoperative diagnosis is dificult. Imaging studies such as computed tomography, ultrasonography and magnetic resonance were inconclusive. Fine needle aspiration biopsy may be helpful. In this article, we report a case of parotid dermoid cyst with literature reviews. (Korean J Otorhinolaryngol-Head ;51 :105-7)

title: Parotid dermoid cyst: a rare entity
abstract: We report a rare case of parotid dermoid cyst.  A case report of parotid dermoid cyst is presented, as well as a brief review of the literature and a summary of the lesion's salient clinicopathological features.  A 69-year-old man presented with a slow-growing, soft tissue mass of the left parotid gland. Pre-operative evaluation included fine needle aspiration cytology and computed tomography. He subsequently underwent a superficial lobectomy; both the macroscopic and histopathological findings were consistent with a dermoid cyst. Although dermoids within the head and neck are not uncommon, such cysts have only rarely been encountered in the parotid gland.  To our knowledge, there are only four previous case reports of parotid dermoid cyst in the English literature. Although the majority of cases of parotid dermoid cyst are diagnosed retrospectively, our case demonstrates the role of fine needle aspiration cytology and highlights the key cytological features suggestive of this entity.

title: A mass at fat density in the parotid gland: dermoid cyst or lipoma.
abstract: A mass at fat density in the parotid gland: dermoid cyst or lipoma. Dermoid cysts (DC) of the head and neck are uncommon and account for only 7% of all dermoid cysts in the body. DCs of the parotid gland are even rarer. In this article, a 42-year-old female patient with DC of the parotid gland is presented and discussed with a brief review of the literature. Radiologic findings suggested that the mass was a lipoma, but observation of a hair in the cyst during surgery changed the clinical diagnosis to DC; this suspicion was confirmed by pathological analysis. Although DCs are rare among the parotid masses, they should be kept in mind during the differential diagnosis.

title: Dermoid cyst of the parotid gland
abstract: A35-year-old man presented with a five-year history of a slowly enlarging soft tissue mass in the right parotid gland. Physical examination showed a soft, non-tender mass, 4 3 cm in diameter, in the superior portion of the parotid gland. Facial nerve function was normal. Fine-needle aspiration cytology revealed anucleated squamous cells and keratin debris . CT scans showed a cystic mass of the superficial lobe extending to the deep lobe of the right parotid gland . A right parotidectomy was performed and the cystic mass was excised completely. Surgical specimen revealed a cystic mass filled with keratinous material. Pathologic examination revealed a cyst lined by stratified squamous epithelium with underlying sebaceous glands, which was diagnostic of dermoid cyst. Postoperative course was uneventful with normal facial nerve function. The patient was followed-up without recurrence for one year. This report was approved by an institutional review board.

title: Dermoid cyst of the parotid gland: first pediatric case.
abstract: A dermoid cyst is the result of inclusion of epithelial cells along the lines of embryonic closure. Dermoid cysts of the head neck are uncommon and account for only 7% of all such cysts. They are most often reported as arising in the floor of the mouth. Dermoid cyst is rarely seen in the parotid gland. To our knowledge, there have been only six previous case reports in the English literature. Dermoid cyst of the parotid gland in pediatric patient has not been previously reported in the literature. This is the first case report concerning a dermoid cyst in a pediatric patient.

title: Dermoid cyst of the parotid gland.
abstract: A dermoid cyst occurring within the parotid gland of a 37-year-old Chinese man is reported. The diagnostic difficulties, histopathological features and pathogenesis are considered.

title: Dermoid cyst of the parotid gland
abstract: Dermoid cysts of the head and neck are uncommon and account for only 7 % of all such cysts. They are most often reported to arise in the floor of the mouth and orbital and nasal regions; they are rarely seen in the parotid gland. To our knowledge, there have been only nine previous case reports in the literature. The authors report a case of a dermoid cyst with a left parotid location and discuss its nature, diagnosis, and treatment. The previous reports are reviewed and commented upon.

title: Dermoid cysts of the nose.
abstract: Dermoid cysts of the nose may present difficult management problems if inadequately evaluated preoperatively or if incompletely excised. It is most important to differentiate them from nasal gliomas, neurofibromas, encephalocoeles, or meningiocoeles. Confusion with other benign lesions such as sebaceous cysts, mucocoeles, inclusion cysts, hemangiomas, or lipomas is possible but of less consequence. Incompletely excised cysts recur and the final result is usually less acceptable than that following total excision. The use of an operating microscope and microsurgical instruments is strongly advocated.

title: Dermoid cysts of the head and neck
abstract: *국군수도병원 병리과 * Department of Pathology, Capital Armed Forces Ceneral Hospital 이 논문은 1987 년 1 2 월 30 일 접수하여 1988년 2월 8 일에 채택되었음. 하였다. 타액선조영술상 이하선 내에 분엽형 음영결손이 보였 고 이히선관의 분리 및 외측이동이 있었지만 이하선관이 불규 칙하게 좁아지거냐 끊어진 소견은 없었다(Fig.lA) . 초음파 검사상 둥글고 경계가 비교적 뚜렷한 종괴 안에 불균질의 내부에코를 보였으며 변연부 일부에서 저 에코를 관찰할 수 있었다(Fig.lB ) . 전산화단층촬영상 지방밀도의 종 괴가 이하선의 심엽에 있었고 주위 조직과 경계가 뚜렷 했으며 변연부 조영증강은 보이지 않았다 (Fig.1C). 수술소견상 3X4X3 cm 크기의 피냥형성이 잘 된종괴 가 이하선 심엽에 있었고 천엽( superf icia l lobe)을 전 방 및 외측ξ로 밀연서 일부 유착되어 있었다. 병리조직 소견상 단엽성 냥종 ( unilocular cys t) ~로 치즈같은피 지가 차 있었고 낭종의 내벽은 중층상피세포로 이루어 졌으며 그 하부에 많은 모냥과 피지선이 관찰되었다

title: Teratomas, dermoids, and epidermoids of the head and neck.
abstract: Dermoids and epidermoids are ectoderm-lined inclusion cysts that differ in complexity: Epidermoids have only squamous epithelium; dermoids contain hair, sebaceous and sweat glands, and squamous epithelium. Both arise from trapped pouches of ectoderm, near normal folds, or from failure of surface ectoderm to separate from the neural tube. These slowly expanding, unilocular, cystic masses may produce only mild symptoms. They commonly occur in the orbit, calvarial diploic space, and intracranially (the posterior and middle fossae). They may be complicated by rupture leading to chemical meningitis, and dermoids with a fistulous tract can become infected. Craniofacial teratomas are true neoplasms arising from misplaced embryologic germ cells. They contain a medley of heterogeneous tissues, typically reflecting more than one of the three embryonic germ layers. They are usually multiloculated masses, often large, with complex radiologic characteristics. Craniofacial teratomas may manifest prenatally with macrocrania or polyhydramnios, during a difficult delivery, or postnatally as a life-threatening mass causing brain herniation, hydrocephalus, respiratory distress, or feeding difficulty. In infancy, they can be biologically benign, even when their histologic characteristics are immature. Surgery is the treatment of choice for all three masses and may be curative.

title: Midline Dermoid Tumors of the Neck
abstract: Although the midline dermoid tumor of the neck is supposed to be extremely rare in comparison with thyroglossal duct cyst, 13 patients were treated during a period when 45 thyroglossal duct cysts were seen. It is important to check the thyroid gland and to open the cyst for diagnosis before deciding on the matter of hyoid bone resection.

title: Teratomas of the head and neck.
abstract: Teratomas of the head and neck are a particular type of developmental malformation or tumor that are composed of cells with a full range of histogenic potential. They occur almost exclusively in the newborn and infancy periods. Treatment is directed at complete surgical removal with preservation of normal anatomic structures.

title: [Submandibular dermoid cyst extended to the cervical region].
abstract: Dermoid cysts of the submandibular region are rare. We report an exceptional case with extension to the neck.



The patient presented with a voluminous left submandibular cystic tumor with extension to the neck and to floor of the mouth. Ultrasonography and CT scan contributed to the diagnosis and to chose the best surgical approach in case of large cyst. In our case, the tumor was removed using a double cervical and intraoral approach. Histopathological examination confirmed a dermoid cyst.



We report an exceptional case of dermoid cyst originating from submandibular region. A double surgical approach was necessary for tumor resection. Tumor removal must be complete; the submandibular gland may be removed if necessary.

title: An alternative surgical approach for sublingual dermoid cysts: a case report.
abstract: A 52-year-old woman presented with a painless swelling in the floor of the mouth. She stated that it had existed there for 40 years and had undergone a gradual enlargement within the past year. Examination showed a mass, 5x4 cm in size. An aspiration from the lesion revealed a cyst. The lesion was removed by a U-shaped superior based flap. Histopathological examination showed stratified squamous epithelium lining the cystic lumen. This technique can be an alternative approach in such lesions because it protects the oral mucosa by providing good exposure, and prevents injury to the lingual nerve and submandibular duct.

title: Parotid masses in patients with previous ear surgery.
abstract: This paper describes three cases of patients presenting with lumps in their parotid gland, the origin of which was difficult to define. In each case the past medical history revealed that the patients had undergone previous ipsilateral middle ear surgery. We highlight the fact that where there has been previous incisions in the skin about the ear, there is a risk of epidermal inclusion cysts in the parotid gland. These cysts can occur many years after the initial surgery and therefore may not be identified as an obvious origin to lumps in the parotid gland. Rarely as this series highlights there may also be extension of a cholesteatoma (a collection of keratin which arises from the eardrum and extends into the middle ear space) from the mastoid bone to the parotid gland. We recommend formal ear examination where there is a history of previous ear surgery and an ipsilateral parotid gland lump is present.

title: An epidermal cyst in the parotid gland following ear surgery: a case report.
abstract: Iatrogenic epidermal cysts have been reported in various locations following otological surgical procedures. Especially after endaural incisions, surgeons may implant squamous epithelium into underlying tissue. An epidermal cyst of the parotid region may appear years after ipsilateral ear surgery.



A cystic lesion in the superficial lobe of the parotid gland was identified by computed tomography and ultrasonography in a 30-year-old man with a history of myringoplasty and endaural surgery. A superficial parotidectomy was performed to remove the mass.



The mass was histopathologically diagnosed as an epidermal cyst.



If a cystic lesion is present in the parotid gland in a patient with a history of otologic surgery, it must be considered that the mass is of epidermal origin.

title: [Epidermal cyst of the parotid gland].
abstract: Epidermoid cysts of the parotid gland are rare. We report the case of a 60-year-old man with a cystic tumor of the right parotid gland. The patient had undergone ipsilateral middle ear surgery twice four years previously. The tumor was identified by computed tomography and ultrasonography and removed by total parotidectomy under suspicion of a parotid tumor. Histopathology revealed the diagnosis of an epidermal cyst. The differential diagnosis of a parotid tumor should include (iatrogenic) epidermoid cyst, in particular if there is a history of prior ear surgery via an endaural approach.

title: Ultrasonographic appearance of dermoid and epidermoid cysts in the head and neck
abstract: The ultrasonographic features of 6 histologically proven dermoid and epidermoid cysts in the head and neck are reported. All 6 cysts had internal echoes, with a solid appearance. Five of the 6 were echogenic, with only slight or no posterior echo enhancement. Amorphous keratinous debris from keratinizing stratified squamous epithelium filled the lumen of each cyst, producing the internal echoes. Most of the true solid tumors examined were generally of lower echogenicity, and could be differentiated from dermoid and epidermoid cysts ultrasonographically, although lipomas were indistinguishable from these cysts.

title: Ovarian teratomas: tumor types and imaging characteristics.
abstract: Ovarian teratomas include mature cystic teratomas (dermoid cysts), immature teratomas, and monodermal teratomas (eg, struma ovarii, carcinoid tumors, neural tumors). Most mature cystic teratomas can be diagnosed at ultrasonography (US) but may have a variety of appearances, characterized by echogenic sebaceous material and calcification. At computed tomography (CT), fat attenuation within a cyst is diagnostic. At magnetic resonance (MR) imaging, the sebaceous component is specifically identified with fat-saturation techniques. The US appearances of immature teratoma are nonspecific, although the tumors are typically heterogeneous, partially solid lesions, usually with scattered calcifications. At CT and MR imaging, immature teratomas characteristically have a large, irregular solid component containing coarse calcifications. Small foci of fat help identify these tumors. The US features of struma ovarii are also nonspecific, but a heterogeneous, predominantly solid mass may be seen. On T1- and T2-weighted images, the cystic spaces demonstrate both high and low signal intensity. Familiarity with the US, CT, and MR imaging features of ovarian teratomas can aid in differentiation and diagnosis.

title: Diagnosis of dermoid cyst of the floor of the mouth by fine‐needle aspiration cytology: A case report
abstract: A case of a dermoid cyst in the floor of the mouth in a 17‐yr‐old male is described. The diagnosis was made by fine‐needle aspiration cytology and supported by histologic examination of the subsequently excised tissue. Dermoid cysts are benign lesions that can occur in the floor of the mouth. This case is presented to increase awareness of this entity and its occurrence in this location, and to demonstrate the feasibility of diagnosis by fine‐needle aspiration. The cytologic and histologic features of dermoid cysts are described and discussed. Diagn. Cytopathol. 1999;

title: The place of fine‐needle aspiration in the preoperative diagnosis of the congenital sublingual teratoid cyst
abstract: The term “teratoid cyst” was first used by Meyer in his classification of dysontogenetic cysts of the cervicofacial region, which was based on the type of germinative layers included in the cyst wall. Sublingual location of a dermoid cyst is not common, with an incidence of 1.6%. The teratoid cyst is the least common, accounting for 1.8% of sublingual dermoid cysts, and such lesions are extremely rare in infancy. In our case, a 7‐mo‐old male infant was referred with a sublingual mass. Ultrasonography yielded a cystic mass with internal echoes but no specific diagnosis. The smears obtained from fine‐needle aspiration (FNA) displayed sheets of large, benign‐appearing, anucleated and nucleated squamous cells. There were a number of neutrophils, which had no significant importance. No atypical cells were observed. According to the clinical picture and FNA findings, it appeared to be a cystic structure of keratogenous origin and could have been any type of dermoid cyst. The cyst was excised completely by the oral approach. On histopathological examination, the presence of skin appendages along with mature cartilage and respiratory epithelium confirmed the final diagnosis of a teratoid cyst. In conclusion, although FNA is not comparable with computed tomography (CT) and magnetic resonance imaging (MRI), it might be valuable for the diagnosis of lesions occurring in this anatomical location. It is safe, cost‐effective, and reliable. FNA is not only able to help selecting the most appropriate surgical method, but also be used as a therapeutic modality in some emergencies or during surgery. Diagn. Cytopathol. 2003;29:33–37.

title: Dermoid cyst of the floor of the mouth diagnosed by fine needle aspiration cytology: a case report.
abstract: Dermoid cyst of the floor of the mouth is a rare, benign lesion requiring surgical intervention. To our knowledge, the preoperative diagnosis of this entity by fine needle aspiration (FNA) cytology has not been previously reported in the cytologic literature.



The patient presented with a massive swelling of the floor of the mouth that displaced the tongue superiorly. A computed tomographic (CT) scan demonstrated a cystic lesion thought to be consistent with a lymphangioma. FNA was performed without complications and demonstrated numerous anucleated and some nucleated squames consistent with a diagnosis of dermoid cyst. Establishment of the correct diagnosis by FNA enabled the surgeon to proceed with the appropriate operation; that outcome might not have been possible had the erroneous CT diagnosis of lymphangioma been trusted.



A preoperative diagnosis of dermoid cyst of the floor of the mouth was established by FNA. In contrast to reports in the older literature, the FNA procedure caused no complications. In patients presenting with lesions of the floor of the mouth, FNA should be the diagnostic procedure of first choice.