Feline dermoid cyst: Retrospective case series and literature review

Abstract

Dermoid cysts are developmental abnormalities usually located at the dorsal body midline. Histologically, these lesions reduplicate the skin, with associated collagen bundles, adnexal structures, and are filled by keratin and hairs. While these cysts have well-recognized breed and anatomical predispositions in dogs, the information in feline patients is restricted to scattered case reports and anecdotal data. Through a multi-institutional retrospective case series, we aim to describe the clinical and demographic features of this condition in cats. We retrieved a total of 220 cases. The average age at the time of diagnosis was 5.5 years, with 59.5% (131/220) being males. Domestic short hairs were the most represented breed, accounting for 56.4% (124/220) of the cases. The average cyst diameter was 1.4 cm, and 99.5% (219/220) of the cases the cysts were cutaneous and subcutaneous with the most common anatomical location being the neck (55.9%; 123/220). One dermoid cyst was in the mesentery. In most cases, no associated inflammatory lesions were reported (66.4%; 146/220). The anatomical location of the dermoid cyst did not differ significantly among sexes (Chi-square test, P = .840), breeds (Chi-square test, P = .999), ages (Chi-square test, P = .627), or other histological findings related to the cyst (Chi-square test, P = .363).

Keywords

cat dermoid cyst dermoid sinus domestic animal feline histology

Dermoid cyst (dermoid sinus) in veterinary pathology is a developmental abnormality identical to its counterpart in humans.⁷ Dermoid cysts are solitary lesions usually located at the dorsal midline and represent an incomplete separation between the ectoderm and neuroectoderm during embryonal development.²¹ These lesions can be cutaneous and extracutaneous.^1,3–20 Dorsal cysts can extend through the subcutis reaching the spinal canal and dura mater.^6,11,21 Histologically, these cysts mimic the haired skin, are filled with keratin and hair, and are lined by squamous epithelium with adnexal structures (sebaceous and apocrine glands, hair follicles) radiating from the cyst wall and surrounded by collagen bundles parallel to the cyst’s wall.^7,6,21 They are considered uncommon lesions, more frequently diagnosed in dogs than cats.^7,21 Although breed predispositions (Rhodesian ridgeback, boxer, and Kerry blue terrier) and common anatomical locations (dorsal midline, neck, and shoulder) have been identified in dogs,^7,6 information in cats is scarce and reported mostly in scattered case reports.^{1,3–5,9,10,12,13,15–20}

Our main purpose here is to elucidate and expand the demographic, anatomic, and histologic features of feline dermoid cysts through a comprehensive retrospective analysis of pathological submissions at 2 veterinary diagnostic institutions and to compare our findings with a literature review of this condition in cats.

Materials and Methods

The cases were collected retrospectively from the computerized diagnostic pathology reports of databases from 2 institutions: Athens Veterinary Diagnostic Laboratory and Antech Diagnostics, Mars Petcare Science & Diagnostics. The database search was done using the words “feline,” “cat,” “dermoid cyst,” and “dermoid sinus” of biopsy and autopsy submissions between 2010 and 2024 at Athens Veterinary Diagnostic Laboratory and from 2021 to 2024 at Antech Diagnostics, Mars Petcare Science & Diagnostics. The inclusion criteria for the case selection included a final diagnosis of a dermoid cyst or dermoid sinus upon the following diagnostic histological criteria: a cystic structure lined by squamous epithelium with keratohyalin granules; filled by keratin and hairs; and surrounded by collagen bundles parallel to the cyst wall, with small well-developed hair follicles (“folliculettes”) attached to and radiating from the cyst wall, sebaceous glands, and apocrine glands.^7,6,21 We included all cases that fulfilled these criteria, regardless of the anatomical location. Relevant demographic information was retrieved from each case, when available, including age, sex, and breed. Clinical findings included the lesion size (diameter), and anatomical location reported in the original submission. Finally, the histological findings in association with the cyst including the presence of inflammation, rupture, or concurrent neoplastic and nonneoplastic lesions were used in the data analysis. The descriptive statistics for continuous data (age and cyst diameter), and frequencies and percentages for categorical data (sex, anatomic location and associated histological findings) were calculated through the IBM SPSS Statistics software package (International Business Machines Corp., Armonk, NY, USA). A McNemar’s chi-square test was performed to evaluate the statistical significance of the correlation between the categorical data. An alpha value of P ≤ .05 was considered statistically significant. The literature review was performed by a comprehensive search of Google, PubMed, CAB Direct, Web of Science, and Scopus, using search terms “cat,” “feline,” “dermoid cyst,” and “dermoid sinus.”

To better assess the rarity of dermoid cyst in cats, the computerized records of biopsy and autopsy submissions between 2010 and 2024 at Athens Veterinary Diagnostic Laboratory and from 2021 to 2024 at Antech Diagnostics, Mars Petcare Science & Diagnostics were analyzed for reports with diagnosis of “follicular cysts” and “infundibular cysts.”

Results

A total of 220 cases were retrieved after the database search (Supplemental Table S1). Twelve cases were retrieved from Athens Veterinary Diagnostic Laboratory between 2010 and 2024. At the same time frame a total of 46 cases of “infundibular cysts” were issued in this institution (DRR, personal communication). The remaining 208 cases were retrieved from Antech Diagnostics, Mars Petcare Science & Diagnostics between 2021 and 2024. During this time a total of 1811 diagnoses of follicular cysts were issued as follows: 48.2% (873/1811) follicular cysts without specific histological subtype, 51.2% (928/1811) infundibular cysts, 0.5% (9/1811) isthmus cysts (tricholemmal cysts), and 0.1% (1/1811) matrical cyst.

The age was available in 214 cases. The average age of affected cats was 5.5 years, ranging from 6 months to 18 years (±3.9 years standard deviation) (Supplemental Table S1). The sex distribution of the studied population (Table 1) was 59.5% males (131/220) from which 117 (53.1%) were castrated and 14 (6.4%) were intact males. Females were 40.5% (34.1%; 75/220 spayed and 6.4%; 14/220 intact females). Domestic short hair was the most commonly reported breed (56.4%; 124/220), followed by domestic long hair (8.6%; 19/220), domestic medium hair (6.8%; 15/220), Persian (2.3%; 5/220), and Russian blue and Siamese (1.8%; 4/220 each). Maine coon and Scottish fold were represented by 3 individuals each (1.4%). Two individuals were identified as “mixed breed” (0.9%). The remaining breeds (ragdoll, sphynx, Abyssinian, Bengal, Burmese, Manx, Oriental, and Ukrainian Levkoy) were represented by 1 or 2 individuals each. The breed was not specified in 14.1% (32/220) of the cases (Table 2).

Table 1.

Sex and reproductive status distribution in feline cases of dermoid cyst.

Sex	Count	Percentage
Castrated male	117	53.1
Spayed female	75	34.1
Male	14	6.4
Female	14	6.4
Total	220	100.0

Table 2.

Distribution of frequency and percentage of cat breeds with dermoid cyst diagnosis.

Breed	Frequency	Percentage
DSH	124	56.4
NS	31	14.1
DLH	19	8.6
DMH	15	6.8
Persian	5	2.3
Russian blue	4	1.8
Siamese	4	1.8
Maine coon	3	1.4
Scottish fold	3	1.4
Mixed breed	2	0.9
Ragdoll	2	0.9
Sphynx	2	0.9
Abyssinian	1	0.5
Bengal	1	0.5
Burmese	1	0.5
Manx	1	0.5
Oriental	1	0.5
Ukrainian Levkoy	1	0.5
Total	220	100.0

Abbreviations: DLH, domestic long hair; DMH, domestic medium hair; DSH, domestic short hair; NS, not specified.

Dermoid cysts were described in the skin and subcutaneous tissue in 99.5% (219/220) of the cases. There was only an extracutaneous dermoid cyst in the mesentery (case 216). In 11 cases (5%), the anatomic location in the skin was not specified. The most common anatomical region was the neck (55.9%; 123/220) (Fig. 1a, Supplemental Table S1). In the neck, 24.1% (53/220) were described in the ventral region, 15% (33/220) lateral right, 8.6% (19/220) lateral left, 2.3% (5/220) lateral without specification, and 2.3% (5/220) in dorsal neck. Only 8 (3.6%) cases were described as “neck” cysts without further specifications. A total of 12.2% (27/220) of the cases were located at the head ( Fig. 1b ). The distribution of the cysts within the head was 4.5% (10/220) located in the face around the eyes, 2.7% (6/220) in the top of the head, 2.7% (6/220) in the pinna, 1.8% (4/220) in the nose, and 1 case in the chin. The following most commonly reported anatomical locations were the thorax (7.3%; 16/220), abdomen (5.5%; 12/220), and the shoulder and tail (3.2%; 7/220 each) (Fig. 1a, Supplemental Table S1). Less frequent locations included the hip (2.3%; 5/220), lumbar area (1.8%; 4/220), and limbs (2.3%; 5/220). One case was described in the “dorsum” without more specifications (case 202). One case described as a cutaneous scrotal dermoid cyst was in the scrotum over the left testicle at the level of the epididymis (case 186). Only 8.2% (18/220) of the cases were specifically described within the dorsal aspect of the head, neck, thorax, lumbar, hip, or tail.

Figure 1.

Feline dermoid cysts. (a) Topographical distribution and percentage of cases according to the area of the body. (b) Topographical distribution and percentage of cases in the head. (c-e) Percentage of dermoid cysts with associated histologic findings. Absence of inflammation (c), stromal chronic inflammation (d), and severe inflammation associated with the rupture of the cyst (e). Adapted from “species,” “cell types,” and “epithelium” by BioRender.com.² Retrieved from https://app.biorender.com/biorender-templates.

The dermoid cyst size was recorded in 217 cases, with an average diameter of 1.4 cm, ranging from 0.25 to 6 cm (±0.9 cm standard deviation) (Supplemental Table S1). A 6-cm diameter dermoid cyst was removed from the left caudal thorax (case 114). Inflammatory changes were not reported in 66.4% (146/220) of the cases, whereas chronic stromal lymphoplasmacytic or mixed infiltrates were documented in 14.1% (31/220) of the cases; an equal percentage was recorded in cases with rupture of the cyst wall, marked pyogranulomatous inflammation, and proliferation of organizing granulation tissue ( Fig. 1c–e ). In the remaining 12 cases, 3.2% (7/220) of the dermoid cysts were reportedly concurrent with a neoplasm (fibrosarcoma) or a nonneoplastic lesion (fibroadnexal hamartoma, follicular infundibular cyst, or atypical fibroplasia) within the same anatomical location. In 1.8% (4/220) of the cases, a concurrent neoplasia or inflammatory disease was identified in a different anatomical location than the cyst (trichoblastoma, feline eosinophilic granuloma, nerve sheath tumor, or dermatophytic pseudomycetoma), and in 1 case, a concurrent serological diagnosis of feline immunodeficiency virus was made (case 67) (Supplemental Table S1). In 1 case (case 46), there were 2 adjacent dermoid cysts. A pore connecting the cyst’s lumen with the epithelial surface was reported in 1.8% (4/220) of the cases (cases 4, 24, 46, and 132) ( Supplemental Table S1 ). All the cases included fulfilled the histologic criteria ( Fig. 2a–d ).

Figure 2.

Histologic features of feline dermoid cyst. Hematoxylin and eosin. (a) Multilocular dermoid cyst from a 4-year-old, spayed female, domestic short hair cat at the ventral neck. The dermoid cyst expands the subcutis, is filled with keratin and hair shafts, and is surrounded by collagen bundles arranged parallel to the cyst’s wall (arrowheads). Case 10. (b) Higher magnification of dashed square in panel (a). The cyst wall has associated adnexal structures, sebaceous glands, and hair follicles. (c) Subcutaneous dermoid cyst from a 3-year-old, intact female, domestic short hair cat at the left shoulder. The dermoid cyst expands the subcutis and is filled with keratin and hair shafts. Case 3. (d) Higher magnification of dashed square in panel (c). The cyst wall is surrounded by collagen bundles parallel to the cyst’s wall (asterisk) and associated radiating adnexal structures, including small hair follicles (folliculettes) (arrowhead).

The anatomical location of the dermoid cyst did not differ significantly among sexes (Chi-square test, P = .840), breeds (Chi-square test, P = .999), ages (Chi-square test, P = .627), and other histological findings related to the cyst (Chi-square test, P = .363).

A total of 15 cases were retrieved after the literature review (Table 3). The main diagnostic criteria between infundibular cysts and dermoid cysts are summarized in Table 4.

Table 3.

Published cases of dermoid cysts in cats.

Breed	Age	Sex	Location	Follow-up	Reference
Balinese	16 mo	F	Intraparenchymal, spinal, at T3	Euthanized	⁹
DSH	10 y	CM	Subcutaneous, left sublumbar	No recurrence	¹⁸
DSH	7 mo	CM	Right flank connecting to the peritoneum	No recurrence	¹⁸
DSH	4 mo	F	Left ventral forebrain, rostral to optic chiasma	Euthanized, concurrent hydrocephalus and adjacent teratoma	⁴
Burmese	2.5 y	F	Intradural (subarachnoid space), extraparenchymal, spinal canal over cranial portion of C7	A single episode of neurological signs 12 months postsurgery	¹³
Burmese	2 y	M	Intradural (subarachnoid space), extraparenchymal, spinal canal T1-T3	Recovery, 4 years postsurgery	²⁰
DSH	5 y	F	Bilaterally cervical trachea, superficial to sternohyoideus muscles attached to the deep surface of skin	Fully recovery	¹⁹
DSH	6 mo	SF	Subcutaneous, dorsal neck	No recurrence	⁵
Burmese	4.5 mo		Cutaneous between scapulae extending to the dura mater	Euthanized, not treated	¹¹
DSH	5 y	CM	Tail, dorsal, and subcutaneous	No recurrence	²
European shorthair	3 y	CM	Distal jejunum	Full recovered after surgery	¹⁶
Persian	6 y	CM	Subcutaneous abdominal over linea alba extending to the abdominal cavity	Full recovery after surgery	¹⁰
Ragdoll	11 mo	SF	Caudal nasal cavity through the cribriform plate into the calvarium contacting the left olfactory bulb and frontal lobe	Fully recovered after surgical removal, persistence of seizures	³
Siamese	2.5 y	SF	Right dorsolateral perianal region and vaginal wall (perirectal fossa and vaginal infiltration)	No recurrence 1 y after surgery	⁸
Mixed breed	6 y	M	Intracranial, left side of medulla oblongata protruding through the IV ventricle	Euthanized	¹⁵
DSH	2 y	SF	Extending from the temporomandibular joint to the larynx, obliterating the nasopharynx	Full recovery after surgery	¹²
Mixed breed	5 y	SF	Extradural, dorsal aspect of T7 and T8	Full recovery after removal	¹⁷
DSH	6 y	SF	Subcutaneous mass with purulent discharge on dorsal nasal surface with a nasal bone defect	No recurrence 12 mo follow-up	¹⁴

Abbreviations: CM, castrated male; DSH, domestic shorthair; F, female; M, male; mo, months; SF, spayed female; y, years.

Table 4.

Histologic diagnostic criteria between follicular infundibular cysts and dermoid cysts.

Follicular Infundibular Cyst	Dermoid Cyst
Lined by epithelial stratified squamous epithelium with a prominent granular cell layer	Lined by epithelial stratified squamous epithelium with a prominent granular cell layer
Filled with concentric keratin, loose keratin flakes or hair fragments	Filled with hair, keratin lamellae, and sebaceous secretions
Surrounding collagen has a normal dermal pattern, not parallel to the cyst wall	Surrounded by collagen bundles arranged parallel to the cyst wall
Normal follicles adjacent to the wall perpendicularly arranged toward the epidermis, not the cyst wall, random clusters of sebaceous glands present	“Folliculettes” radiating toward the cyst lumen, sebaceous glands, and/or apocrine glands
A pore connecting the cyst lumen with the epithelial surface can be present	A pore connecting the cyst lumen with the epithelial surface can be present

Discussion

Our results highlight important contrasts between the collected cases and the information available in the literature. Dermoid cysts are believed to affect younger dogs and cats since they represent a developmental abnormality.²¹ Thus, these cysts are conventionally reported in young feline and canine patients (<2 years),^6,21 with cases documented in cats as young as 4 months old.⁴ The average age of the affected cats in our study was 5.5 years, suggesting that this lesion is either not noticeable or subclinical in most of the cases until the patients reached an older age. Sex predilection is not reported in cats, with almost 50% of the retrieved cases in the literature review as females.^{3–5,8,9,12–14,17,19} In our study, males were slightly more commonly affected than females (59.5% vs 40.5%), although this was not statistically significant. Breed predispositions are not determined in cats,²⁰ but the vast majority of our cases were domestic short hair cats (56.4%). Nevertheless, rather than a true breed predisposition, we suspect that domestic short hair cats are overrepresented in our studied population due to their abundance as pets. Dermoid cysts have been documented in several breeds besides domestic short hair cats, including Balinese,⁸ Burmese,^11,13,20 ragdoll,³ European shorthair,¹⁶ and Persian.¹⁰ Our findings add to this list domestic longhair, domestic medium hair, Russian blue, Siamese, Maine coon, Scottish fold, Sphynx, Abyssinian, Bengal, Manx, Oriental, and Ukrainian Levkoy, suggesting that dermoid cysts can occur in a wide variety of breeds.

The skin and subcutis were the most common locations reported for our dermoid cysts, with 99.5% identified in these locations. The dorsal midline is the predilected site for the development of these lesions in dogs due to its pathogenesis.⁶ However, in our study, only a few cases (8.2%) were specifically presented in the dorsal body midline, suggesting that cats do not have similar trends as dogs. They are reported to occur particularly in the lateral neck and shoulder of cats.^7,20 Other cutaneous locations include the left sublumbar area,¹⁸ bilateral cervical,¹⁹ dorsal neck,⁵ tail,¹ perirectal fossa,⁸ and ventral abdomen.¹⁰ The neck is the most common location for dermoid cysts in cats according to our results, with 55.9% reported in this region (24.1% in the ventral neck and 25.9% in the lateral neck). The shoulder was less frequently involved (3.2%) than the head (12.2%), thorax (7.3%), and abdomen (5.5%). Although more infrequent, in our study, these lesions were identified in other anatomical sites, including nose, chin, face, limbs, and pinna.

Extracutaneous locations reported for dermoid cysts in cats include the spinal cord (intradural and intraparenchymal,⁹ intradural and extraparenchymal,^11,13,20 and within the spinal canal¹⁷), intracranial,^4,15 pharyngeal,¹² nasal,^3,14 and intestinal.¹⁶ Rare case reports describe the extension of the cysts from subcutaneous tissues into the abdominal cavity and peritoneum.^10,18 None of our cutaneous dermoid cysts extended to the internal anatomical structures. Only 1 case was noncutaneous and was in the mesentery. No associations between the location of the cysts and other factors like the age, sex, and breed of the cats were found in our study.

The main differential diagnoses for dermoid cysts are trichofolliculomas, infundibular cysts, and fibroadnexal hamartomas.^6,21 The trichofolliculomas have more hair follicles radiating from the main cysts, and the epithelium is not exclusively a squamous epithelium with infundibular differentiation containing keratohyalin granules.^7,20 Trichofolliculomas can be lined by epithelium similar to the isthmic and inferior segment of the hair follicle.^7,20

The differentiation between dermoid cysts and infundibular cysts can be challenging.⁷ Dermoid cysts have folliculettes and folliculosebaceous units radiating and perpendicularly oriented toward the cyst’s wall; infundibular cysts can have clusters of sebaceous glands adjacent to the wall, but the hair follicles are normally oriented toward the epidermal surface and not the cyst’s wall.⁷ The concentric arranged collagen fibers at the periphery of the dermoid cysts is lacking in infundibular cysts.⁷ Infundibular cysts were more common lesions than dermoid cysts. When comparing the diagnoses from the 2 different institutions within the same timeframe, the infundibular cyst to dermoid cysts ratio was 4:1 (46 infundibular cysts vs 12 dermoid cysts) in Athens Veterinary Diagnostic Laboratory and 4:1 (928 infundibular cysts vs 208 dermoid cysts) at Antech Diagnostics, Mars Petcare Science & Diagnostics. Fibroadnexal hamartomas might represent another differential diagnosis, particularly in older animals; however, the folliculosebaceous units in hamartomas are not oriented around a central cyst filled with keratin and hairs and are disorganized.⁶

In cats, dermoid cysts are described clinically as small lesions, less than 2 cm in diameter, with a small pore connecting it with the surface.^7,21 The presence of a pore connecting the lumen with the epithelial surface was evidenced in only 1.8% (4/220) of the cases in our study; thus, we consider this feature not common in this lesion. The average size of the cysts in our study was 1.4 cm; however, we documented a case that was 6 cm in diameter. The cysts are amenable to surgical excision, which is considered curative in most cases, and do not represent a life-threatening condition, unless lesions occur in the intracranial or spinal location, which typically leads to euthanasia of the patient.^9,4,15 If the dermoid cyst is incompletely excised it might recur.⁶ The rupture of the cyst will release keratin and hairs into the cutaneous or subcutaneous stroma, leading to a foreign-body inflammatory response with large infiltrates of macrophages and neutrophils.^7,6 Inflammatory changes in association with the cysts were observed in 38.2% of our cases, with severe pyogranulomatous inflammation in association with the wall rupture in 14.1% of cases. In most cases (66.4%), secondary inflammatory changes were not reported.

In summary, in a cohort of 220 cats, dermoid cysts most commonly occurred in the ventral and lateral neck regions, with the domestic shorthair cat being the most represented breed. Affected animals were, on average, 5.5-years-old at the time of diagnosis. Most lesions lacked an inflammatory response and were less than 2 cm in diameter, often remaining unnoticed. A connecting pore with the epithelial surface was found to be an uncommon histological feature of dermoid cysts in cats. For diagnosis, the pathologist should evaluate specific features, such as hair folliculosebaceous units oriented perpendicularly to the cyst wall and surrounding collagen bundles aligned parallel to the cyst wall.

Supplemental Material

sj-pdf-1-vet-10.1177_03009858251317457 – Supplemental material for Feline dermoid cyst: Retrospective case series and literature review

Supplemental material, sj-pdf-1-vet-10.1177_03009858251317457 for Feline dermoid cyst: Retrospective case series and literature review by Daniel Felipe Barrantes Murillo, Daniel R. Rissi, Dominique J. Wiener and Tatiane Terumi Negrão Watanabe in Veterinary Pathology

Footnotes

Author Contributions

DFBM and TTNW designed and supervised the study. DFBM, DRR, and TTNW collected the data and performed the histopathological evaluations. DFBM performed the data analysis. DFBM, DRR, DJW, and TTNW wrote the manuscript. All the authors reviewed and critically edited the manuscript. All authors read and approved the final manuscript.

Declaration of Conflicting Interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: TTNW is employed at Antech Diagnostics, Mars Petcare Science & Diagnostics. The remaining authors declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Daniel Felipe Barrantes Murillo

Daniel R. Rissi

Supplemental material for this article is available online.

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