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Cyst under chin. Pathologist has sent the biopsy for a review. Bad sign?

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Oncologist
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My dermatologist thought the bump under my chin was a cyst but the pathologist couldn't make a determination and sent the biopsy to a University for review. Is this a bad sign?
Posted Fri, 27 Apr 2012 in Cancer
 
 
Answered by Dr. Robert Galamaga 4 hours later
Hello and thank you for submitting your question.

Your question is a very good one and I will work on providing you with some information and recommendations regarding your concern.

From what you have submitted it seems that a small biopsy of tissue under your chin has been sent for review by the pathologist. The fact that the tissue was sent to the university pathologist does not necessarily indicate that there is some type of cancer or malignancy to worry about. I would rest assured that right now the pathologists are reviewing the tissue carefully. The likelihood that there is some type of cancer is usually very low. I understand that the pathologist did send this to be very thorough on your behalf.

Generally on the face there are different types of growths which can usually be regarded as the benign. There are sometimes cysts which form under the skin which can be filled with fluid or sebaceous material. Also there can be skin changes due to sun exposure again these are not always a malignant type of thing.

I thank you again for submitting a question . I hope you found my response to be helpful and informative. If you have any additional concerns I would be happy to address them.

Sincerely,

Dr. Robert
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Follow-up: Cyst under chin. Pathologist has sent the biopsy for a review. Bad sign? 42 hours later
Dear Dr. XXXXXXX
I obtained the pathologist's preliminary report. Please let me know what you think. Thank you.
Comment: This is an unusual pilar neoplasm with cystic features.
Clinical data: Cyst
Gross Description: The specimen is received in fixative, labeled "chin" and it consists of a skin pu nch measuring 0.5 cm in diameter and 0.6 cm in depth. The specimen is submitted intact in one cassette marked 1P.
 
 
Answered by Dr. Robert Galamaga 7 hours later
Hi,
Thanks for the followup.

This pilar neoplasm is usually a benign proliferation skin cells. Very rarely these can recur after removal. The pathologist should comment on the grade of the tumor as well which will help determine the followup course which will include observation and serial clinical exams.

This is good news in that this does not appear to be a malignant tumor.

I am glad it has been removed and evaluated by a pathologist to provide more guidance in followup.

Thanks again for the query. Please let me know if there are any additional concerns.

Sincerely,

Dr. Galamaga
Above answer was peer-reviewed by
 
Follow-up: Cyst under chin. Pathologist has sent the biopsy for a review. Bad sign? 16 hours later
Dear Dr. XXXXXXX
I'm confused by the first pathologist's report. She said it's an unusual pilar cystic neoplasm with cystic features. Doesn't neoplasm mean cancerous? Pilar means hair, cystic I guess means cyst, and neoplasm means tumor. Does that mean it's a cyst or a tumor or a tumor on top of a cyst? The clinical data says cyst.
Because she wrote unusual it make me think it's cancerous. I'm still waiting on results. Very worried. Sorry to keep bothering you.

 
 
Answered by Dr. Robert Galamaga 8 hours later
Hello and thank you for the follow up question. Your questions are certainly very good ones and are not bothersome at all to me to address.

I also agreed that some of the terminology in the reports can be confusing and possibly misleading. These types of tumors are unusual because they are simply rare. They are not seen very frequently in clinical practice and that is why she identified it as an unusual growth or tumor.

I am happy to report to you that neoplasm does not always mean cancer. The term neoplasm simply refers to a proliferation of cells. If this were a cancer or malignancy, this would not be termed a simple neoplasm. I am confident that you are not dealing with a cancer or malignant process. I am glad also that it has been removed. Again regular follow up with your doctors will assure that this issue has been completely treated.

I am not concerned that you need to see anybody to discuss any systemic therapy or local therapy at this time. Regular follow-up examinations in 6 to 12 months are adequate for this type of things and your doctor will do a focused examination on the area where the procedure was performed. If there are any skin changes there in the future, a biopsy again can be done.

I thank you again for submitting your question. I hope you found my response to be helpful and informative. If you have any additional concerns I would be happy to address them.

Sincerely,

Dr. Robert
Above answer was peer-reviewed by
 
Follow-up: Cyst under chin. Pathologist has sent the biopsy for a review. Bad sign? 8 days later
Dear Dr. XXXXXXX
The second pathologist's report came back and here it is as summarized by the first pathologist:

Diagnosis: Cystic Follicular Derived Adnexal Tumor with Atypical Pilar Sheath Acanthoma Features, Transected at the specimin base
Comment: Because of focal cytologic atypia and mitotic activity, as well as a positive margin, he would recommend consideration of an additional procedure to be sure this lesion has been completely removed.

Since receiving the second pathology report above, my dermatologist removed "a lot of tissue." This was done on Thursday. He said he took out anything that was "hard or cystlike." He thinks he got it all but if not he will send me to a neck doctor because "I can't go any deeper."

My dermatologist said this is not cancer but it could become cancer. He is not saying that it will only that it might.

When he got these results he said these are "by and large benign" and this "should be considered benign." That's leaves a lot of room in my mind. I asked him about the atypia and mitotic activity. He said it's atypical because it's not normal tissue and he explained mitotic activity. Clearly it was growing but I see the word mitotic related to cancer.

Please give me your thoughts. I'm making a wreck of myself. Do I need to see a cancer specialist?

Thank you.

Lee
 
 
Answered by Dr. Robert Galamaga 35 hours later
Hello and thank you for the follow up question and here are my recommendations.

I agree with the dermatologist for considering such a presentation of the mass to be a benign one and with premalignant potential.

I would suggest you to consult a Oncologist who out of his experience can confirm this fact and also can come out with a definitive figure that how many chances of the mass to get malignant.

Do consult a oncosurgeon, he shall help you better.Get me his opinion I shall discuss with you.

Wish you good health.

Regards,
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Follow-up: Cyst under chin. Pathologist has sent the biopsy for a review. Bad sign? 3 days later
Dear Dr. XXXXXXX

The remainder of the tissue was removed by my dermatologist and the margins are clear. The text from all three biopsies is included below. My dermatologist told me to come back in 3 months to be checked or earlier if I feel a bump. He also felt my lymph nodes and said they feel fine. Do you think I can end my worry here or should I still see another doctor? This all started with the bump under my chin. A small bit of tissue was taken for the first biopsy. That tissue was examined in the second biopsy. The third biopsy report is from the remainder of the tissue that was removed. Thank you for helping me with this. - XXXXXXX

11/9/11 Biopsy: Diagnosis: chin, excision: Dermal Cicatricial Fibrosis with Chronic Inflammation (no evidence of residual neoplasia), margins clear.

10/31/11 Biopsy: Diagnosis: Cystic Follicular Derived Adnexal Tumor, with Atypical Pilar Sheath Acanthoma Features; Comment: Because of focal cytologic atypia and mitotic activity, as well as a positive margin, pathologist recommends consideration of an additional procedure to be sure this lesion is completely removed. (This is the biopsy report from the pathologist at the University of Pennsylvania.)

10/21/11 Biopsy: Diagnosis: chin, punch: unusual pilar cystic neoplasm. This specimen was referred to a pathologist at the University of Pennsylvania.


 
 
Answered by Dr. Robert Galamaga 24 hours later
Hi,

Good that you helped me with the biopsy reports, after reading them I would like to stick to my advice for you to consult a Oncosurgeon once. Focal cytologic atypia and mitotic activity in the microscopy are the findings which require attention of a oncosurgeon and as well as the pathologist.

The integrated approach by both will surely put your trouble to an end by providing you a conclusion and expected future behavior of the lesion.

Wish you good health.

Regards,
Above answer was peer-reviewed by
 
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