Happy Thanksgiving!

 

Today is the time to be thankful, remember good times, and embrace those who enrich our lives. I’m thankful for a lot of things. Happy Thanksgiving to all! from our Scholarly Journal of Otolaryngology (SJO)

Lupine Publishers | The Dermoid Cyst of the Auricle

 Lupine Publishers | Journal of Otolaryngology

 

Abstract

Dermoid cysts of the auricle are extremely rare. A 13-year-old female patient was admitted to our clinic with the complaint of a painful, slowly growing mass that had been present behind her right ear since birth. Ear examination revealed a soft, approximately 2x2 cm cystic mass on the posterior aspect of the right auricle. Histopathological examination of the excised mass was reported as dermoid cyst. The patient, who had no problem after the operation, was called to the controls and discharged. We present this case because dermoid cysts of the auricle are extremely rare and should be considered in the differential diagnosis of congenital masses in children.

Introduction

Dermoid cysts are present at birth and predominantly occur in men. They are asymptomatic, slow growing, single cavity cystic masses. Most are in ovaries [1]. Less than 7% appears in the head and neck region [2].The most common location in the head and neck region is front orbital, in the upper outer part of the orbital. Other settlements are the midline of the nose,the neck, the sublingual region, and the sternal, perineal, scrotal, and sacral regions [3]. Dermoid cysts trapped in the ectoderm sac next to normal folds or surface is a developmental disorder caused by the failure of the ectoderm to leave the neural tube[4].The most valid theory about the dermoid cysts was proposed by New and Erich that was the persistence of the germ layers at birth, along the embryonic fusion line in the deep tissues in the neck. The irregular growth and differentiation of these cells causes the appearance of dermoid cysts. Dermoid cysts are divided into 3 histological types: epidermoid, dermoid and teratoma. Epidermoid cysts contain laminated keratin materials and does not contain a sebaceous gland around. Dermoid cysts are surrounded with a stratified squamous cell epithelium and they are subcutaneous tumors, and they contain various types of skin supplements such as hair follicle, sebaceous gland and sweat glands. Teratomas originate from totipotent cells, contain all three embryonic germ layers and are true neoplasms [4].

Case Report

Thirteen-year-old female patient with a mass complaint in the right auricle admitted to the Otorhinolaryngology outpatient clinic of Kadirli State Hospital. The patient’s mother told that the mass existed since the birth of the child. She stated that the mass was small and painless at the beginning. For the past few years, the mass was growing and became painful. In the otorhinolaryngologic examination of the patient, there was a soft, painless, cystic mass in the posterior part of the upper inner quadrant of the right auricle just lateral to the sulcus. The mass was about 2x2 cm in size. The mass is totally excised under local anesthesia. In the macroscopic examination of specimen, the cyst was surrounded by a stratified squamous cell epithelium and the hair follicles were seen in the lumen. In the 4x10 microscopic examination with hematoxylin-eosinophil stain the cyst was surrounded by the stratified squamous cell epithelium and sebaceous glands were present in the dermis and hair follicle structures were seen in the cyst lumen. Histopathological examination results were reported as dermoid cyst.

Discussion

When we look at the literature, dermoid cysts of the auricle are extremely rare. Ikeda reported 2 cases of the dermoid cyst of the auricle.1 Later, Samper, Bauer, Meagher and DeSouza reported cases of postauricular dermoid cyst[4-7].In 2014, Horikiri et al. reported dermoid cyst of the auricle [8]. Jung et al. reported a case of the congenital dermoid cyst in the right auriculocephalic sulcus[9]. Byeon et al. reported a dermoid cyst on the posterior of the auricle[10]. Also,Wisevarver et al. reported a case of a dermoid cyst on the posterior of the right auricle [11]Nasirmohtaram et al. reported a case of a dermoid cyst located in the concha [12]. Kim et al. reported a case of acquired dermoid cyst and stated that it is not different from the congenital dermoid cyst. Congenital dermoid cyst is surrounded by normal tissues the acquired dermoid cyst is surrounded by fibrous scar tissue[13]. The differential diagnosis of the post auricular cyst includes the epidermal inclusion cyst, the trichilemmal cyst, the lipoma, and the hemangiomas. The trichilemmal or the sebaceous cysts are clinically similar to the epidermoid cysts. The diagnosis was confirmed histologically by the presence of the amorphous keratin material in the cyst cavity. The lipomas are common benign soft tissue adipose tumors and are similar to the dermoid cysts. Hemangiomas are present at birth and are benign tumors of the vascular endothelium and spontaneous involution is possible[8]. The treatment of the dermoid cyst is removal of the cyst wall with complete surgical excision. If it is not removed, it may result in relapse or infection[10].The treatment prevents the conversion to malignancy.
As a result, the dermoid cysts are rare, usually benign, and very rarely malignant. They are congenital masses that can show transformation and can be seen in many parts of the body. They must be considered in the differential diagnosis of congenital ear masses, especially in the children.

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Lupine Publishers | Covid-19 vs. Spanish Flu

 Lupine Publishers | Journal of Otolaryngology

 

Short Communication

CHistory does not repeat itself. Though every single historical moment is distinct, parallels can be drawn between different historical events. Even though history does not teach us what to do, it can inspire us to act. Revising the 1918 influenza pandemic is an opportunity to consider the current coronavirus (COVID-19) crisis from a different perspective. Influenza and coronavirus share basic similarities in the way they are transmitted via respiratory droplets and contact surfaces. Descriptions of H1N1 influenza patients in 1918-19 resemble the respiratory failure of COVID-19 sufferers a century later. Current discussions about holding back social distancing measures and opening the country frequently refer to “waves” of disease that characterized the dramatic mortality of H1N1 influenza in three major peaks in 1918-19. As COVID-19 rates begin to stabilize in some parts of the U.S., people today are nervously eyeing the “second wave” of influenza that came in autumn 1918, that pandemic’s deadliest period.The 1918 influenza pandemic took place during the First World War with three successive waves: the first in the spring of 1918, the second – and most lethal, responsible for 90% of deaths – in the autumn of 1918, and a final one from the winter of 1918 to the spring of 1919. By the end of it, more than half of the world’s population had been infected. Estimations on mortality, showed a broad spectrum ranging from 2.5 to 5% of the world’s population, which translates to between 50 and 100 million deaths. The pandemic was, therefore, five to ten times deadlier than the First World War.
Waves evoke predictability, however, and COVID-19 has been hard to predict. Despite the lessons drawn from past influenza outbreaks, how pandemic influenza struck in 1918 is not an exact template for what can happen with COVID-19 in the upcoming months [1].The 2020 coronavirus and 1918 Spanish influenza pandemics share many similarities, but they also diverge on some points. Here we empathize some of those points. According to Deutsche Bank, a major difference between Spanish flu and COVID-19 is the age distribution of fatalities. For COVID-19, the elderly has been hit the worst. For the Spanish flu of 1918, the younger population were severely affected. The death rate from pneumonia and influenza that year among the middle-aged population in the United States was more than 50% higher than that for the older population. Back to COVID-19, the overall mortality rate measured by weekly new deaths and weekly new cases is around one-third of the level observed in the second half of April which shows a decline in the current wave [2].Over 500 million people, or one-third of the world’s population, became infected with the 1918 Spanish flu. According to the Centers for Disease Control and Prevention, approximately 50 million people died worldwide, with about 675,000 deaths occurring in the US. They added that during the pandemic, mortality was high in three categories of people: younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40-year age group, was a unique feature of this pandemic. With no vaccine to protect against it and no antibiotics to treat secondary bacterial infections that can be associated with it, controlling the disease worldwide were limited to non-pharmaceutical interventions.COVID-19, the disease caused by the virus SARS-CoV-2, has already proved extremely infectious. According to Johns Hopkins University’s Center for Systems Science and Engineering, it had approximately infected 13.1 million people globally and more than 3.4 million in the U.S. The disease had killed at least 573,664 lives worldwide and 135,615 in the U.S.As for Symptomatology, for both COVID-19 and flu, one day or more can pass between a person becoming infected and when he or she starts to experience illness symptoms. However, if a person has COVID-19, it usually takes longer to develop symptoms than if they had flu. For the flu, a person develops symptoms anywhere from 1 to 4 days after infection but for COVID-19, symptoms can appear as early as 2 days after infection or as late as 14 days after infection, and the time range can vary [3].

Being firstly identified in the Chinese city of Wuhan, some have labeled COVID-19 the ‘Chinese virus’. Stigmatizing a group or a nation for its alleged responsibility in a calamity is not a new trend. Take the misnomer of the ‘Spanish Flu’: unlike most of the countries at war at the time, where censorship was extreme and newspapers were initially not allowed to report on the disease, the Spanish press firstly covered the spread of the virus, creating false assumptions that the epidemic originated in Spain.Many other nicknames were given to the pandemic based on nationality or race, for example: ‘Spanish Lady’, ‘French Flu’, ‘Naples Soldier’, ‘War Plague’, ‘Black Man’s Disease’, ‘German Plague’, or even the ‘Turco-Germanic bacterium criminal enterprise’.War censorship and propaganda also had adverse effects on efforts to mitigate the pandemic. By attempting to censor information on the seriousness of the situation, many belligerent countries most certainly hindered public health efforts to stem the pandemic. Many people did not understand how the flu, an ordinarily mild illness, could cause so many deaths. Some believed their government was lying and trying to hide the return of typhus, cholera, or a so-called ‘pneumonic plague’. In Germany, some people accused the government of using a fake pathogen as a pretext to hide the deaths that were caused by malnutrition and exhaustion according to them.The lives lost during that old pandemic teach us that transparent information is essential at all times(Figure 1). To follow public health measures, the population needs to trust the authorities. In 1918, after four years of conflict and propaganda, that trust was broken. This is even more true in 2020. Mistrust of information from health authorities is still a challenge. Modern means of communication and the digital social networks make it even harder. Undocumented claims, false information, conspiracy theories, and dangerous conclusions can spread as quickly as viruses [4,5].

Figure 1: Three waves of death during the pandemic: weekly combined influenza and pneumonia mortality, United Kingdom, 1918–1919. The waves were broadly the same globally[5].

Conflict of Interest

None declared.

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