intra - abdominal organs and small or large bowel as content of inguinal hernia is common but epidermoid cyst as content of inguinal hernia is very rare . they are usually located at the intradermal or subcutaneous region and formed by invagination of keratinized squamous epithelium . epidermal cysts can be located in any part of the body , commonly on the face , torso , extremities and scalp . other rare contents of the inguinal canal are teratoma , lipoma , lymphangiomas , leiomyoma and endometriosis . a 29-year - old female presented with a lump in the left inguinal region for the last 4 years . she experienced mild , occasional pain on standing for a long time . on examination , the lump was found to be non - tender and partially reducible , and cough impulse was present , getting above the swelling was negative . the patient was planned for an elective totally extra - peritoneal ( tep ) mesh repair after routine preoperative investigations . during surgery a large mass of about 11 cm 5 cm was found in the left inguinal region , extending from the deep inguinal ring to beyond the superficial inguinal ring . intraoperatively , the mass seemed to be a cystic lesion and was attached to the left round ligament within the inguinal canal [ figure 1 ] . the operative approach was changed to trans - abdominal preperitoneal ( tapp ) repair due to the large size of the mass and to view the intra - abdominal organs to trace the site of origin . intra - abdominal organs such as the uterus , ovaries and its ligaments were normal and the cystic mass was only attached to the round ligament in the left inguinal canal . polypropylene mesh ( prolene , ethicon ) of 15 cm  13 cm size was placed for hernia repair at the left myopectineal orifice . the excised mass [ figure 2 ] was sent for histopathological examination and was reported to be epidermal inclusion cyst [ figure 3 ] . cystic mass attached to the round ligament in the left inguinal region cut section of excised cystic mass 200 , he stain , stratified squamous lined cyst filled with acellular lamellated keratin material without any calcification no case has been reported so far on epidermal inclusion cyst ( epidermoid cyst ) as content of inguinal hernia . in this patient , epidermoids have only squamous epithelium while dermoids contain hair , sebaceous glands , sweat glands and squamous epithelium . both arise from trapped pouches of the ectoderm , near - normal folds or from failure of the surface ectoderm to separate from the neural tube . presence of the skin , along with its appendages and sebaceous gland , differentiates dermoids from epidermoid cysts that have stratified squamous epithelium surrounded by fibrous tissue forming their wall . epidermoid cyst may result from the sequestration of epidermal nests during the embryonic life , occlusion of the pilosebaceous unit , or traumatic or surgical implantation of epithelial elements . they contain a medley of heterogeneous tissues , typically reflecting more than one of the three embryonic germ layers . other rare swellings reported in the literature include preperitoneal lipoma , inguinal lymphangioma , round ligament leiomyoma and inguinal endometriosis .
epidermoid cysts can occur in a variety of locations including the face , trunk , neck , extremities , and scalp . 
 no case of epidermoid cyst as content of inguinal hernia has been reported so far ; however , cases with dermoid , teratoma , lipoma , lymphangioma and leiomyoma as content of inguinal canal have been reported . a 29-year - old female presented with a lump in the left inguinal region that was clinically diagnosed as left inguinal hernia . 
 the patient was planned for laparoscopic inguinal hernia repair after routine investigation . 
 intraoperatively , a cystic mass was found to be attached to the left round ligament that was excised completely . 
 histopathological report was consistent with epidermal inclusion cyst . 
 inguinal epidermoid cyst mimicking inguinal hernia is a rare entity . 
 if such a cyst is encountered during operation , it should be completely excised .