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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 10.5144/0256-4947.2007.129aasm-2-129aLettersRe: Epidermoid cyst of the cecum in an elderly man Reyes Cesar V. Staff Physician, Morris Hospital, 150 West High Street, Morris, IL 60450, USA, creyes@morrishospital.orgMar-Apr 2007 27 2 129 130 Copyright © 2007, Annals of Saudi Medicine2007This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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To the Editor: Let me offer an addendum to the article entitled “Epidermoid cyst of the cecum in an elderly man” by Ali Uzunlar and Yasar Burke, Ann Saudi Med 2006;26(6):477–479.

There has been another paper on this topic published in 2003 that was not mentioned by the authors in their review, namely: Reyes CV et al Epithelial inclusion cyst of the cecum, Practical Gastroenterology 2003;27(9):52–58.

Briefly, a 66-year old man who presented with acute right lower quadrant abdominal pain, which was interpreted atypical for acute appendicitis. A subserosal/muscular cystic mass in the cecum without luminal communication but accompanied by tiny pockets of free air and acute inflammatory changes in the right colonic gutter was noted on computed tomographic scan with contrast. On exploration, no obvious perforation of any viscus but a tracking of purulent material along the right pericecal gutter was found. With a palpation finding of a soft mass in the cecal wall and low suspicion for malignancy, only a short segment ileocecectomy was performed. The patient had uneventful postoperative follow up.

The lesion microscopically was lined by stratified squamous epithelium, contained ample keratinous material, and associated with a granular cell tumor wall in the sub-epithelial soft tissue and surrounding smooth muscle. Special studies (periodic acid-Schiff and immunostaining with neuron specific enolase, S-100, lyzosymes, desmin and vimentin) affirmed a reactive histiocytic nature of the granular cells.

The paper was also well illustrated with four figures, including a CT scan with contrast, gross photograph of the surgical specimen, microscopic findings of the keratinized squamous epithelial lining, and an incidental granular cell tumor was found in the wall of the cyst.

A literature review was also presented.