Successful Excision and Enucleation of a Chest Wall Epidermoid Cyst

Chief Complaints

A 34-year-old female patient with a body mass index of 20 presented to the Oncology Department at PACE Hospitals, Hitech City, Hyderabad, with a complaint of a swelling over the central chest wall.

The patient had no known comorbidities, including diabetes mellitus, hypertension, cardiovascular disease, or tuberculosis. There was no significant past surgical history, and no prior chest wall swelling or trauma was reported.

On examination, the patient was conscious, coherent, and well oriented, with stable vital signs. Local examination revealed a small cystic swelling with a punctum over the intermammary region of the chest wall, slightly to the left of the midline. Per abdominal examination was soft and non-tender, with no other significant systemic abnormalities detected.

Upon admission to PACE Hospitals, following the clinical assessment, the Oncology team conducted a comprehensive evaluation based on the patient’s complaint of swelling over the central chest wall. A detailed medical history, physical examination, and preoperative assessment were performed to evaluate overall fitness for surgery and to identify associated comorbid conditions.

Baseline investigations, including routine hematological and biochemical parameters, were carried out as part of the preoperative workup, which were within acceptable limits for surgical intervention. Clinical examination revealed a small cystic swelling with a punctum over the intermammary region of the chest wall, slightly to the left of the midline.

Based on the confirmed diagnosis, the patient was advised to undergo Epidermoid Cyst Treatment in Hyderabad, India, under the expert care of the Oncology Department.

After a detailed evaluation by Dr. Ramesh Parimi, Consultant Surgical Oncologist, Dr. M Sudhir, Senior Gastroenterologist and Hepatologist, along with the multidisciplinary team including Dr. Govind Verma, Gastroenterologist, Hepatologist & Therapeutic Endoscopist, Dr. Padma Priya Medical Gastroenterologist, a comprehensive assessment was performed to determine the most appropriate diagnostic and therapeutic approach.

Considering the patient’s history of swelling over the central chest wall and clinical examination findings suggestive of a benign cystic lesion, the case was carefully reviewed. Clinical evaluation and operative assessment were consistent with a diagnosis of epidermoid cyst of the chest wall.

Based on clinical assessment, examination findings, and surgical evaluation, it was determined that Excision Enucleation of the epidermoid cyst was the most appropriate and effective management strategy. This approach was chosen to completely excise the lesion along with its capsule, prevent recurrence, and achieve optimal cosmetic and functional outcomes.

The patient and her family members were counselled regarding the diagnosis, clinical findings, planned surgical procedure, possible risks, postoperative care, and the importance of regular follow-up.

Following the decision, the patient was scheduled for an Excision Enucleation Procedure in Hyderabad at PACE Hospitals, under the expert care and supervision of the Oncology team.

The following steps were carried out during the procedure:

• Patient Preparation and Positioning: The patient was taken to the operating room and placed in a supine position on the operating table. Standard aseptic precautions were followed, and the operative field over the intermammary region of the chest wall was cleaned and draped in a sterile manner.

• Anaesthesia Administration: The procedure was performed under intravenous sedation, followed by local infiltration using 0.5% local anesthetic to achieve adequate anaesthesia over the lesion site. Adequate analgesia was confirmed before proceeding.

• Incision and Exposure: A small elliptical skin incision was made over the lesion in the intermammary region, slightly to the left of the midline, encompassing the punctum. The skin and subcutaneous tissue were carefully dissected to expose the underlying cyst.

• Enucleation of the Cyst: A well-defined cyst measuring approximately 1.5 × 1 cm was identified. Careful blunt and sharp dissection was performed to enucleate the cyst in toto along with its capsule, ensuring complete removal without rupture.

• Hemostasis and Wound Closure: Meticulous hemostasis was achieved. The surgical cavity was irrigated, and the wound was closed in layers using appropriate sutures. A sterile dressing was applied. The procedure was completed uneventfully, and the specimen was sent for histopathological examination.
  

The procedure was uneventful, and the patient tolerated it well. Postoperatively, she showed symptomatic improvement and remained hemodynamically stable following excision and enucleation of the epidermoid cyst. The histopathology report showed an epidermal inclusion (epidermoid) cyst with chronic inflammation and a giant cell reaction, which is benign and non-cancerous. She was managed with appropriate postoperative care and medications and was subsequently discharged in stable condition with the following medical advice.

Upon discharge, the patient was advised a short course of medication to prevent postoperative wound infection and to provide relief from postoperative pain, to be taken for a few days and thereafter as needed.

The patient was advised to return for follow-up review with the Oncologist in Hyderabad at PACE Hospitals after 7 days. A follow-up visit with the Surgical Gastroenterologist was also advised after 7 days for further postoperative evaluation and assessment.

This case highlights successful management of an epidermoid cyst of the chest wall through excision enucleation. The procedure was uneventful with complete removal of the lesion, leading to symptomatic relief and an uncomplicated postoperative recovery. The patient was discharged in stable condition with appropriate follow-up advised for further evaluation and wound assessment.