PMC6216085_01
Cavitating perineal inclusion cyst, pre excision.
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This lesion measured about 5 cm in diameter, with associated underlying soft tissue induration, extending from scrotum anteriorly to about one centimeter from anal verge posteriorly. (Fig. 1) The cavitating portion was moist and irritated, and patient complained of discomfort to touch.
Pre op CT scan.
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CT scan and biopsy. CT scan showed a cavitating cutaneous lesion, without any involvement of anorectal or urological structures (Fig. 2).
Post excision histology.
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A repeat biopsy yielded in situ, and possible invasive squamous cell cancer, arising in the background of an epidermal inclusion cyst, probably related to HPV infection (Fig. 3a-c).
A: post wide excision, B: s/p closure by flap advancement, C: perineum 6 months post excision during takedown of colostomy.
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Following laparoscopic end colostomy and Hartmann pouch as the first step in surgery, wide excision of the perineal lesion was performed by a urology and general surgery team (Fig. 4a). Reconstruction was performed by advancement flaps; elasticity of the scrotum facilitated closure (Fig. 4b). Once healing was complete at approximately 6 months post-surgery (Fig. 4c) patient was taken back to operating room to undergo robotic assisted laparoscopic closure of colostomy.