Modern Plastic Surgery, 2013, 3, 128-129
http://dx.doi.org/10.4236/mps.2013.34026 Published Online October 2013 (http://www.scirp.org/journal/mps)
Congenital Epidermal Cyst of the Umbilicus:
A Case Report*
Noriko Aramaki-Hattori1#, Takara Tanaka2, Kiyoshi Mukai3, Kazuo Kishi1
1Department of Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan; 2Department of Plastic and Reconstruc-
tive Surgery, Saise ikai Central Hospital, Minato-ku, Japan; 3Department of Pathology, Saiseikai Central Hospital, Minato-ku, Japan.
Received July 29th, 2013; revised August 28th, 2013; accepted September 5th, 2013
Copyright © 2013 Noriko Aramaki-Hattori et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Epidermal cysts are one of the most common benign skin tumors, although they are rarely found in the umbilicus of a
child. Herein we report the case of a 13-year-old girl with a congenital umbilical mass. This mass had been misdiag-
nosed as a lipoma at birth. Awareness of this lesion can avoid its misdiagnosis and inappropriate treatment.
Keywords: Congenital; Epidermal Cyst; Umbilicus
1. Case Report
A 13-year-old girl presented with a red, swollen mass in
her umbilicus (Figure 1). This mass had been present
since birth, and was diagnosed as a lipoma by her pedia-
trician. She was asymptomatic except for occasional
slight pain at the lesion. There was no history of tumor
rupture. Magnetic resonance imaging revealed a subcu-
taneous mass which did not penetrate into the abdominal
cavity or contact any internal organs (Figure 2). The
mass ruptured 1 day prior to surgery, and on the day of
the operation the tumor had developed a large hole and
was crusted over. Total excision was performed under
local anesthesia. Exploration during the operation showed
that the mass did not have any duct connecting it to the
abdominal cavity. The patient’s postoperative course was
uneventful. The sutures were removed after 10 days, and
the patient had a good cosmetic result (Figure 3). Histo-
logical assessment revealed an epidermal cyst; there was
no malignancy (Figure 4).
2. Discussion
Epidermal cysts are common, benign skin tumors usually
involve the scalp, face, neck, back, and trunk [1]. A cyst
may rupture, and extrusion of its keratin into the dermis
may incite a foreign body reaction [2]. Epidermal cysts
are usually asymptomatic unless they get infected or
Figure 1. Pre-operative photograph of the umbilical mass.
Figure 2. Magnetic resonance imaging of the abdomen
showing a subcutaneous mass, not communicating with the
abdominal cavity (see mass adjacent to white arrow).
*Conflict of interest: None declared. Funding: None. Ethical approval:
N
ot required.
#Corresponding author.

Congenital Epidermal Cyst of the Umbilicus: A Case Report 129
Figure 3. Post-operative photograph of the umbilicus.
Figure 4. Hematoxylin and eosin staining reveals an epi-
dermal cyst (Bar: 100 μm).
enlarge sufficiently to damage adjacent anatomic struc-
tures [3]. In this patient’s case, the tumor was stable for
13 years, rupturing 1 day prior to surgery.
Other types of common, benign skin tumors as a dif-
ferential diagnosis are dermoid cysts, lipomas, and calci-
fying epitheliomas (p ilomatrixomas). Dermoid cysts, one
of the common congenital skin tumors, differ from epi-
dermal cysts in that they have skin structures such as hair
or glands inside the tumor. Although there are a few re-
ports of epidermal inclusion cysts at the umbilicus fol-
lowing abdominoplasty [4,5], we were not able to locate
any report of congenital epidermal cysts in this location.
The differential diagnosis of congenital lesions of the
umbilicus includes umbilical hernia, umbilical cord her-
nia, umbilical polyp, and urachal remnant. By the time of
birth, the umbilical ring has become entirely closed by
the developing abdominal wall except for the space oc-
cupied by the cord, which contains the umbilical vein,
paired umbilical arteries, and the fibrous remnants of the
urachus (allantois), and omphalomesenteric duct (yolk
sac) [6]. Final closure of the umbilical ring does not oc-
cur until separation of the cord at b irth [7]. After ligation
of the cord , the ves sels th rombo se, and the co rd dries and
sloughs, leaving a granulating surface that heals by cica-
trization becomes covered by epithelium [6]. The mecha-
nism of formation for epidermal cysts is still unclear, but
in this case we suspect that the involution of an epider-
mal component into the dermis at birth may have caused
a congenital epidermal cyst.
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