皮样囊肿和畸胎样囊肿

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吃午饭的时候刷了一集Good Doctor (Season 4, episode 5)，看到一个位于中枢神经系统的含有牙齿的皮样囊肿病例。
Tooth within dermoid cyst

于是很疑惑，皮样囊肿？畸胎瘤？

在邱蔚六主编人卫出版的第六版颌面外科学教材中介绍到的相关疾病主要是皮样囊肿和表皮样囊肿，其区别在于囊壁内是否含有皮肤附件。目前关于皮样囊肿的来源有三种观点1：

  1. There is congenital inclusion of dermal and epidermal elements of germ layers in deeper tissues along the embryonic lines of fusion.
  2. Implantation of dermal and epidermal elements of surface epithelium can occur after birth due to trauma, which may proliferate and keratinize.
  3. Growth can occur from the rest of totipotent stem cells displaced from the blastomere.

然而在过去，皮样囊肿(Dermoid cyst)实际上是至少以下六种含角化内容物的新生物的通称：epidermoid, dermoid, teratoid, keratinous, trichilemmal, and teratoma cyst.

所以剧中的这一说法：It's a pocket of tissue with bits of teeth, hair, and fat.可能是沿用了过去的叫法。

另外在Sabin Ranabhat2这篇文章中提到，Warvi和Gates在1943年3最先提出epidermal cysts这一概念，随后，Meyer在1955年在将发生于口底的含角化内容物的囊肿分为epidermoid, dermoid, and teratoid types时，最先使用了teratoid cyst这一概念。其中teratoid cyst与前两者的区别在于还会含有其他胚层来源的成分，比如肌肉或骨等4, 5。

但是在查阅文献的时候看到另外一篇文章：Laparoscopic Management of an Ovarian Dermoid Cyst Containing a Mandibular Structure with Teeth: A Novel Surgical Approach6，是在2020年发表的，所这种概念混用的现象可能至今仍然存在。

而这篇文章Multicentric Dentigerous Dermoid Cyst with an Unusual Location in the Central Nervous System7报道的病例，可能和剧中的病例有类似之处：含有牙齿，位于中枢神经系统。

Multicentric Dentigerous Dermoid Cyst with an Unusual Location in the Central Nervous System(图片来自原作者文章)

  1. Yogesh T. L., Anjani Kumar J., Devatwisha G., Aggi Susan S. Post-auricular dermoid cyst: a case report. IOSR Journal of Dental and Medical Sciences. 2016;15(6):99–102. ↩

  2. Ranabhat S, Tiwari M, Maharjan S. Teratoid Cyst of the Postauricular Region: The First Ever Case Report. Case Rep Pathol. 2017;2017:9235925. doi:10.1155/2017/9235925 ↩

  3. Epidermal cysts – a clinicopathological and biochemical study. Chandrasekaran V, Parkash S, Raghuveer CV Postgrad Med J. 1980 Dec; 56(662):823-7. ↩

  4. Lin HW, Silver AL, Cunnane ME, Sadow PM, Kieff DA. Lateral dermoid cyst of the floor of mouth: unusual radiologic and pathologic findings. Auris Nasus Larynx. 2011 Oct;38(5):650-3. doi: 10.1016/j.anl.2011.01.002. Epub 2011 Feb 21. PMID: 21334151. ↩

  5. DE Araújo Lima, Emeline das Neves et al. “MANAGEMENT AND FOLLOW-UP OF EXTENSIVE TERATOID CYST IN MOUTH FLOOR.” Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery vol. 29,2 (2016): 126-8. doi:10.1590/0102-6720201600020015 ↩

  6. Tardieu S, Appelbaum H. Laparoscopic Management of an Ovarian Dermoid Cyst Containing a Mandibular Structure with Teeth: A Novel Surgical Approach. J Pediatr Adolesc Gynecol. 2020 Oct 9:S1083-3188(20)30344-2. doi: 10.1016/j.jpag.2020.10.001. Epub ahead of print. PMID: 33045371. ↩

  7. Geyik, Abidin Murat et al. “Multicentric Dentigerous Dermoid Cyst with an Unusual Location in the Central Nervous System.” Surgery journal (New York, N.Y.) vol. 2,2 e1-e4. 20 Apr. 2016, doi:10.1055/s-0036-1583205 ↩

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