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{{short description|Types of cyst}}
{{Infobox_Disease
{{Infobox medical condition (new)
⚫
| Name = {{PAGENAME}}
| Image =
| name = Sebaceous cyst
| Caption =
| image = Inflamed epidermal inclusion cyst.jpg
| DiseasesDB = 29388
| caption =
| ICD10 = {{ICD10|L|72|1|l|60}}
| field = [[Dermatology]], [[general surgery]]
| ICD9 = {{ICD9|706.2}}
| pronounce = {{IPAc-en|s|ɪ|ˈ|b|eɪ|ʃ|ə|s|_|s|ɪ|s|t}}
| ICDO =
| symptoms =
| OMIM =
| complications =
| MedlinePlus = 000842
| onset =
| eMedicineSubj =
| duration =
| eMedicineTopic =
| types =
| MeshID = D004814
| causes =
| risks =
| diagnosis =
| differential =
| prevention =
| treatment =
| medication =
| prognosis =
| frequency =
| deaths =
}}
}}
⚫
[[Image:Sebaceous_cyst.jpg|thumb|right|Close-up of an infected sebaceous cyst that has abscessed, located behind the ear lobe.]]
⚫
[[Image:Sebaceous Cyst on ear.jpg|thumb|right|A small sebaceous cyst, located in the front of the ear lobe.]]


A '''sebaceous cyst''' is a term commonly used to refer to either:<ref>{{cite web |url=http://www.bad.org.uk/for-the-public/patient-information-leaflets/cysts---epidermoid-and-pilar?q=Cysts%20-%20epidermoid%20and%20pilar#.UzwTVPldVJs |title=Epidermoid and pilar cysts (previously known as sebaceous cysts)|publisher=British Association of Dermatologists|access-date=April 2, 2014}}</ref>
A '''sebaceous cyst''' (a form of '''[[trichilemmal]] [[cyst]]''') is a closed sac or [[cyst]] below the surface of the skin that has a lining that resembles the uppermost part ([[infundibulum]]) of a [[hair follicle]] and fills with a fatty white, semi-solid material called [[sebum]]. Sebum is produced by [[sebaceous glands]] of the [[epidermis]].


* [[Epidermoid cyst]]s (also termed epidermal cysts, infundibular cyst)
==Terminology==
* [[Pilar cyst]]s (also termed trichelemmal cysts, isthmus-catagen cysts)
It is sometimes (but not always) considered to be equivalent to [[epidermoid cyst]], or similar enough to be addressed as a single entity.<ref>{{cite web |url=http://www.mayoclinic.com/health/sebaceous-cysts/DS00979/DSECTION=3 |title=Sebaceous cysts: Causes - MayoClinic.com |accessdate=2007-11-14 |format= |work=}}</ref>


Some sources state that a "sebaceous cyst" is defined not by the contents of the cyst (sebum) but by the origin ([[sebaceous glands]]). Because a "epidermoid cyst" originates in the [[epidermis]], and a "pilar cyst" originates from [[hair follicles]], neither type of cyst would be considered a sebaceous cyst by this definition.<ref>{{cite web |url=http://www.patient.co.uk/showdoc/23068818/ |title=Epidermoid and Pilar Cysts Sometimes Called Sebaceous Cysts - Patient UK |accessdate=2007-11-14 |format= |work=}}</ref> However, in practice, the terms are often used interchangeably.
Both of the above types of [[cyst]]s contain [[keratin]], not [[sebum]], and neither originates from [[sebaceous gland]]s. Epidermoid cysts originate in the [[epidermis (skin)|epidermis]] and pilar cysts originate from [[hair follicle]]s. Technically speaking, then, they are not sebaceous cysts.<ref>{{cite web |url=http://www.patient.co.uk/doctor/epidermoid-and-pilar-cysts-sebaceous-cysts |title=Epidermoid and Pilar Cysts (Sebaceous Cysts) - Patient UK |access-date=2013-03-04 }}</ref> "True" sebaceous cysts, which originate from sebaceous glands and which contain sebum, are relatively rare and are known as [[steatocystoma simplex]] or, if multiple, as [[steatocystoma multiplex]].


Medical professionals have suggested that the term "sebaceous cyst" be avoided since it can be misleading.<ref name=Neville2002>{{cite book|vauthors=Neville BW, Damm DD, Allen CA, Bouquot JE |title=Oral & maxillofacial pathology|year=2002|publisher=W.B. Saunders|location=Philadelphia|isbn=978-0721690032|edition=2nd}}</ref>{{rp|31}} In practice, however, the term is still often used for epidermoid and pilar cysts.
"True" sebaceous cysts are relatively rare.<ref>{{cite web |url=http://www.bad.org.uk/patients/leaflets/cysts.asp |title=cysts - British Association of Dermatologists |accessdate=2007-11-14 |format= |work=}}</ref>


==Signs and symptoms==
==Presentation==
{{Unreferenced section|date=October 2011}}
⚫
The [[scalp]], [[ear]]s, [[back]], [[face]], and [[upper arm]], are common sites for sebaceous cysts, though they may occur anywhere on the body except the palms of the [[hand]]s and [[sole]]s of the feet. In males a common place for them to develop is the [[scrotum]] and [[chest]] .They are more common in hairier areas, where in cases of long duration they could result in [[hair loss]] on the skin surface immediately above the cyst. They are smooth to the touch, vary in size, and are generally round in shape.
⚫
[[Image:Sebaceous cyst.jpg|thumb|Close-up of an infected sebaceous cyst located behind the ear lobe]]
⚫
The [[scalp]], [[ear]]s, [[back]], [[face]], and [[upper arm]], are common sites of sebaceous cysts, though they may occur anywhere on the body except the palms of the [[hand]]s and [[Sole (foot)|soles]] of the feet.<ref>{{Cite web|title=Sebaceous Cysts: Treatment & Cause|url=https://my.clevelandclinic.org/health/diseases/14165-sebaceous-cysts|access-date=2022-02-05|website=Cleveland Clinic}}</ref> They are more common in hairier areas, where in cases of long duration they could result in [[hair loss]] on the skin surface immediately above the cyst. They are smooth to the touch, vary in size, and are generally round in shape.


They are generally mobile masses that can consist of:
They are generally mobile masses that can consist of:
* [[fibrous tissues]] and fluids
* [[Fibrous tissues]] and fluids
* a fatty, ([[keratinous]]), substance that resembles [[cottage cheese]], in which case the cyst may be called "keratin cyst"
* A fatty ([[keratinous]]) substance that resembles [[cottage cheese]], in which case the cyst may be called "keratin cyst" - this material has a characteristic "cheesy" or [[Foot odor#Odor qualities|foot odor]] smell
* a somewhat viscous, serosanguinous fluid (containing [[purulent]] and bloody material)
* A somewhat viscous, serosanguineous fluid (containing [[purulent]] and bloody material)


The nature of the contents of a sebaceous cyst, and of its surrounding capsule, will be determined by whether the cyst has ever been infected.
The nature of the contents of a sebaceous cyst, and of its surrounding capsule, differs depending on whether the cyst has ever been infected.


With surgery, a cyst can usually be excised in its entirety; poor surgical technique or previous infection leading to scarring and tethering of the cyst to the surrounding tissue may lead to rupture during excision and removal. A completely removed cyst will not recur, though if the patient has a predisposition to cyst formation further cysts may develop in the same general area.
With surgery, a cyst can usually be excised in its entirety. Poor surgical technique, or previous infection leading to scarring and tethering of the cyst to the surrounding tissue, may lead to rupture during excision and removal. A completely removed cyst will not recur, though if the patient has a predisposition to cyst formation, further cysts may develop in the same general area.


==Causes==
==Causes==
Cysts may be related to high levels of [[testosterone]], hence may be more frequent in users of [[anabolic steroid]]s.<ref>{{cite journal|last1=Scott|first1=MJ|last2=Scott|first2=AM|date=1992|title=Effects of anabolic-androgenic steroids on the pilosebaceous unit|journal=Cutis|volume=50|issue=2|pages=113–116|pmid=1387354}}</ref>
Blocked [[sebaceous gland]]s, swollen [[hair follicle]]s,<ref>{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000842.htm |title=MedlinePlus Medical Encyclopedia: Sebaceous cyst |accessdate=2007-11-14 |format= |work=}}</ref> excessive [[testosterone]] production, will cause such cysts.<ref>{{cite web |url=http://www.aafp.org/afp/20020401/1409.html |title=Minimal Excision Technique for Epidermoid (Sebaceous) Cysts - April 1, 2002 - American Family Physician |accessdate=2007-10-26 |format= |work=}}</ref>


A case has been reported of sebaceous cyst being caused by [[Dermatobia hominis]].<ref name="pmid12354816">{{cite journal |author=Harbin LJ, Khan M, Thompson EM, Goldin RD |title=A sebaceous cyst with a difference: Dermatobia hominis |journal=J. Clin. Pathol. |volume=55 |issue=10 |pages=798–9 |year=2002 |pmid=12354816 |doi=}}</ref>
A case has been reported of a sebaceous cyst being caused by the [[Dermatobia hominis|human botfly]].<ref name="pmid12354816">{{cite journal |vauthors=Harbin LJ, Khan M, Thompson EM, Goldin RD |title=A sebaceous cyst with a difference: Dermatobia hominis |journal=J. Clin. Pathol. |volume=55 |issue=10 |pages=798–9 |year=2002 |pmid=12354816 |doi=10.1136/jcp.55.10.798 |pmc=1769786}}</ref>


Hereditary causes of sebaceous cysts include [[Gardner's syndrome]] and [[basal cell nevus syndrome]].
==Treatment==
⚫
{{Refimprovesect|date=September 2007}}
⚫
Sebaceous cysts generally do not require medical treatment. However, if they continue to grow, they may become unsightly, painful, infected, or all of the above.


===Surgical===
==Types==
⚫
[[surgery|Surgical]] [[excision]] of a sebaceous cyst is a simple procedure to completely remove the sac and its contents. <ref name="pmid2349906">{{cite journal |author=Klin B, Ashkenazi H |title=Sebaceous cyst excision with minimal surgery |journal=American family physician |volume=41 |issue=6 |pages=1746–8 |year=1990 |pmid=2349906 |doi=}}</ref>


===Epidermoid cyst===
⚫
There are three general approaches used: traditional wide excision, minimal excision, and punch biopsy excision.<ref name="pmid17403333">{{cite journal |author=Moore RB, Fagan EB, Hulkower S, Skolnik DC, O'Sullivan G |title=Clinical inquiries. What's the best treatment for sebaceous cysts? |journal=The Journal of family practice |volume=56 |issue=4 |pages=315–6 |year=2007 |pmid=17403333 |doi=}}</ref>


{{main|Epidermoid cyst}}


===Pilar cyst===
⚫
The typical outpatient surgical procedure for cyst removal is to numb the DAMN SHAWTY DAMN area around the cyst with a [[local anesthetic]], then to use a [[scalpel]] to open the lesion with either a single cut down the center of the swelling, or an oval cut on both sides of the centerpoint. If the cyst is small, it may be [[lanced]] instead. The person performing the surgery will squeeze out the [[keratin]] (the semi-solid material consisting principally of sebum and dead skin cells) surrounding the cyst, then use blunt-headed scissors or another instrument to hold the incision wide open while using fingers or forceps to try to remove the cyst intact. If the cyst can be removed in one piece, the "cure rate" is 100%.{{Fact|date=November 2007}} If, however, it is fragmented and cannot be entirely recovered, the operator may [[curettage]] (scrape) the remaining exposed fragments, then burn them with an electro-[[cauterization]] tool, in an effort to kill them in place. In such cases the cyst may or may not recur. In either case, the incision is then [[disinfected]] and, if necessary, the skin is stitched back together over it. A [[scar]] will result.


{{main|Pilar cyst}}
An infected cyst may require oral [[antibiotic]]s or other treatment before excision.


About 90% of pilar cysts occur on the scalp, with the remaining sometimes occurring on the face, trunk, and extremities.<ref name=Barnes2008 />{{rp|1477}} Pilar cysts are significantly more common in females, and a tendency to develop these cysts is often inherited in an [[autosomal dominant]] pattern.<ref name=Barnes2008 />{{rp|1477}} In most cases, multiple pilar cysts appear at once.<ref name=Barnes2008>{{cite book|editor=Barnes L|title=Surgical pathology of the head and neck|year=2008|publisher=Informa Healthcare|location=New York|isbn=978-0849390234|edition=3rd}}</ref>{{rp|1477}}
⚫
An approach involving [[incision]], rather than excision, has also been proposed.<ref name="pmid11322399">{{cite journal |author=Nakamura M |title=Treating a sebaceous cyst: an incisional technique |journal=Aesthetic plastic surgery |volume=25 |issue=1 |pages=52–6 |year=2001 |pmid=11322399 |doi=}}</ref>


===Nonsurgical===
==Treatment==
⚫
{{More citations needed section|date=September 2007}}
Another common and effective method of treatment involves placement of a [[heat-pad]] directly on the cyst for about fifteen minutes, twice daily, for about 10 days (depending on size and location of the cyst).<ref>{{cite web |url=http://www.health-disease.org/skin-disorders/sebaceous-cyst.htm |title=health-disease.org |accessdate=2007-11-14 |format= |work=}}</ref><ref>{{cite web |url=http://health.yahoo.com/ency/healthwise/tw6860 |title=Home treatment for a sebaceous cyst - Yahoo! Health |accessdate=2007-11-14 |format= |work=}}</ref>
⚫
Sebaceous cysts generally do not require medical treatment. However, if they continue to grow, they may become unsightly, painful, and/or infected.


===Surgical===
This method works by bringing the temperature of the wax-like material inside of the cyst to a temperature at which it melts and can be reabsorbed and processed by the body as a small amount of oily fluid. This method is preferred over surgery both for reasons of associated costs and risks of surgery. This methodology is not applicable for non-sebaceous cysts, however, as other varieties of cysts do not contain the same hardened sebum deposits, and therefore do not melt to be reabsorbed by the body.
⚫
[[surgery|Surgical]] excision of a sebaceous cyst is a simple procedure to completely remove the sac and its contents,<ref name="pmid2349906">{{cite journal |vauthors=Klin B, Ashkenazi H |title=Sebaceous cyst excision with minimal surgery |journal=American Family Physician |volume=41 |issue=6 |pages=1746–8 |year=1990 |pmid=2349906 }}</ref> although it should be performed when inflammation is minimal.<ref>{{cite journal|author=Zuber TJ|year=2002|title=Minimal excision technique for epidermoid (sebaceous) cysts|url=http://www.aafp.org/afp/20020401/1409.html|journal=Am Fam Physician|volume=65|issue=7|pages=1409–12, 1417–8, 1420|pmid=11996426}}</ref>


⚫
[[File:Sebaceous Cyst.jpg|thumb|A sebaceous cyst that has been surgically removed]]
Under no circumstances must one try to pop the cyst as it can lead to infection of the surrounding tissue. The neck is a vitally dangerous region due to the glands and blood vessels.


⚫
Three general approaches are used - traditional wide excision, minimal excision, and punch biopsy excision.<ref name="pmid17403333">{{cite journal |vauthors=Moore RB, Fagan EB, Hulkower S, Skolnik DC, O'Sullivan G |title=Clinical inquiries. What's the best treatment for sebaceous cysts? |journal=The Journal of Family Practice |volume=56 |issue=4 |pages=315–6 |year=2007 |pmid=17403333 }}</ref>
Some cysts in the genital region are forms of herpes and need to be examined by a physician.

⚫
The typical outpatient surgical procedure for cyst removal is to numb the area around the cyst with a [[local anaesthetic]], then to use a [[scalpel]] to open the lesion with either a single cut down the center of the swelling, or an oval cut on both sides of the center point. If the cyst is small, it may be [[lanced]], instead. The person performing the surgery will squeeze out the contents of the cyst, then use blunt-headed scissors or another instrument to hold the incision wide open while using fingers or forceps to try to remove the cyst wall intact. If the cyst wall can be removed in one piece, the "cure rate" is 100%. If, however, it is fragmented and cannot be entirely recovered, the operator may use [[curettage]] (scraping) to remove the remaining exposed fragments, then burn them with an [[cauterization|electrocauterization]] tool, in an effort to destroy them in place. In such cases, the cyst may recur. In either case, the incision is then [[disinfected]], and if necessary, the skin is stitched back together over it. A [[scar]] will most likely result.

An infected cyst may require oral [[antibiotic]]s or other treatment before or after excision. If pus has already formed, then incision and drainage should be done along with avulsion of the cyst wall with proper antibiotics coverage.

⚫
An approach involving [[Surgical incision|incision]], rather than [[Surgery#Types of surgery|excision]], has also been proposed.<ref name="pmid11322399">{{cite journal |author=Nakamura M |title=Treating a sebaceous cyst: an incisional technique |journal=Aesthetic Plastic Surgery |volume=25 |issue=1 |pages=52–6 |year=2001 |pmid=11322399 |doi=10.1007/s002660010095|s2cid=8354318 }}</ref>


==References==
==References==
{{reflist|2}}
{{reflist|30em}}


==External links==
== External links ==
{{Medical resources
* [http://www.aafp.org/afp/20020401/1409.html Minimal Excision Technique for Epidermoid (Sebaceous) Cysts] at [[American Family Physician]]
| DiseasesDB = 29388
* [http://www.umm.edu/dermatology-info/cysts.htm Overview] at [[University of Maryland]]
| ICD10 = Epidermoid cyst {{ICD10|L|72|0|0|60}},<br />Pilar cyst {{ICD10|L|72|1|l|60}}
* [http://www.emedicine.com/derm/topic860.htm (article "Epidermal Inclusion Cyst")] at [[eMedicine]]
⚫
| ICD9 = {{ICD9|706.2}}
| ICDO =
| OMIM =
| MedlinePlus = 000842
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D004814
| ICD10CM = {{ICD10CM|L72.3}}
}}
{{commons category|Sebaceous cysts}}
* [https://web.archive.org/web/20100408042923/www.umm.edu/ency/article/000842all.htm Overview] at University of Maryland Medical Center
* {{EMedicine|derm|860|Epidermal Inclusion Cyst}}


{{Diseases of the skin and subcutaneous tissue}}
{{Disorders of skin appendages}}
{{Authority control}}
[[Category:Dermatology]]


{{DEFAULTSORT:Sebaceous Cyst}}
[[de:Atherom]]
[[Category:Epidermal nevi, neoplasms, and cysts]]
[[it:Cisti sebacea]]
[[pt:Cisto sebáceo]]

Latest revision as of 19:47, 30 December 2023

Sebaceous cyst
Pronunciation
SpecialtyDermatology, general surgery

A sebaceous cyst is a term commonly used to refer to either:[1]

Both of the above types of cysts contain keratin, not sebum, and neither originates from sebaceous glands. Epidermoid cysts originate in the epidermis and pilar cysts originate from hair follicles. Technically speaking, then, they are not sebaceous cysts.[2] "True" sebaceous cysts, which originate from sebaceous glands and which contain sebum, are relatively rare and are known as steatocystoma simplex or, if multiple, as steatocystoma multiplex.

Medical professionals have suggested that the term "sebaceous cyst" be avoided since it can be misleading.[3]: 31  In practice, however, the term is still often used for epidermoid and pilar cysts.

Signs and symptoms[edit]

Close-up of an infected sebaceous cyst located behind the ear lobe

The scalp, ears, back, face, and upper arm, are common sites of sebaceous cysts, though they may occur anywhere on the body except the palms of the hands and soles of the feet.[4] They are more common in hairier areas, where in cases of long duration they could result in hair loss on the skin surface immediately above the cyst. They are smooth to the touch, vary in size, and are generally round in shape.

They are generally mobile masses that can consist of:

  • Fibrous tissues and fluids
  • A fatty (keratinous) substance that resembles cottage cheese, in which case the cyst may be called "keratin cyst" - this material has a characteristic "cheesy" or foot odor smell
  • A somewhat viscous, serosanguineous fluid (containing purulent and bloody material)

The nature of the contents of a sebaceous cyst, and of its surrounding capsule, differs depending on whether the cyst has ever been infected.

With surgery, a cyst can usually be excised in its entirety. Poor surgical technique, or previous infection leading to scarring and tethering of the cyst to the surrounding tissue, may lead to rupture during excision and removal. A completely removed cyst will not recur, though if the patient has a predisposition to cyst formation, further cysts may develop in the same general area.

Causes[edit]

Cysts may be related to high levels of testosterone, hence may be more frequent in users of anabolic steroids.[5]

A case has been reported of a sebaceous cyst being caused by the human botfly.[6]

Hereditary causes of sebaceous cysts include Gardner's syndrome and basal cell nevus syndrome.

Types[edit]

Epidermoid cyst[edit]

Main article: Epidermoid cyst

Pilar cyst[edit]

Main article: Pilar cyst

About 90% of pilar cysts occur on the scalp, with the remaining sometimes occurring on the face, trunk, and extremities.[7]: 1477  Pilar cysts are significantly more common in females, and a tendency to develop these cysts is often inherited in an autosomal dominant pattern.[7]: 1477  In most cases, multiple pilar cysts appear at once.[7]: 1477 

Treatment[edit]

Sebaceous cysts generally do not require medical treatment. However, if they continue to grow, they may become unsightly, painful, and/or infected.

Surgical[edit]

Surgical excision of a sebaceous cyst is a simple procedure to completely remove the sac and its contents,[8] although it should be performed when inflammation is minimal.[9]

A sebaceous cyst that has been surgically removed

Three general approaches are used - traditional wide excision, minimal excision, and punch biopsy excision.[10]

The typical outpatient surgical procedure for cyst removal is to numb the area around the cyst with a local anaesthetic, then to use a scalpel to open the lesion with either a single cut down the center of the swelling, or an oval cut on both sides of the center point. If the cyst is small, it may be lanced, instead. The person performing the surgery will squeeze out the contents of the cyst, then use blunt-headed scissors or another instrument to hold the incision wide open while using fingers or forceps to try to remove the cyst wall intact. If the cyst wall can be removed in one piece, the "cure rate" is 100%. If, however, it is fragmented and cannot be entirely recovered, the operator may use curettage (scraping) to remove the remaining exposed fragments, then burn them with an electrocauterization tool, in an effort to destroy them in place. In such cases, the cyst may recur. In either case, the incision is then disinfected, and if necessary, the skin is stitched back together over it. A scar will most likely result.

An infected cyst may require oral antibiotics or other treatment before or after excision. If pus has already formed, then incision and drainage should be done along with avulsion of the cyst wall with proper antibiotics coverage.

An approach involving incision, rather than excision, has also been proposed.[11]

References[edit]

  1. ^ "Epidermoid and pilar cysts (previously known as sebaceous cysts)". British Association of Dermatologists. Retrieved April 2, 2014.
  2. ^ "Epidermoid and Pilar Cysts (Sebaceous Cysts) - Patient UK". Retrieved 2013-03-04.
  3. ^ Neville BW, Damm DD, Allen CA, Bouquot JE (2002). Oral & maxillofacial pathology (2nd ed.). Philadelphia: W.B. Saunders. ISBN 978-0721690032.
  4. ^ "Sebaceous Cysts: Treatment & Cause". Cleveland Clinic. Retrieved 2022-02-05.
  5. ^ Scott, MJ; Scott, AM (1992). "Effects of anabolic-androgenic steroids on the pilosebaceous unit". Cutis. 50 (2): 113–116. PMID 1387354.
  6. ^ Harbin LJ, Khan M, Thompson EM, Goldin RD (2002). "A sebaceous cyst with a difference: Dermatobia hominis". J. Clin. Pathol. 55 (10): 798–9. doi:10.1136/jcp.55.10.798. PMC 1769786. PMID 12354816.
  7. ^ a b c Barnes L, ed. (2008). Surgical pathology of the head and neck (3rd ed.). New York: Informa Healthcare. ISBN 978-0849390234.
  8. ^ Klin B, Ashkenazi H (1990). "Sebaceous cyst excision with minimal surgery". American Family Physician. 41 (6): 1746–8. PMID 2349906.
  9. ^ Zuber TJ (2002). "Minimal excision technique for epidermoid (sebaceous) cysts". Am Fam Physician. 65 (7): 1409–12, 1417–8, 1420. PMID 11996426.
  10. ^ Moore RB, Fagan EB, Hulkower S, Skolnik DC, O'Sullivan G (2007). "Clinical inquiries. What's the best treatment for sebaceous cysts?". The Journal of Family Practice. 56 (4): 315–6. PMID 17403333.
  11. ^ Nakamura M (2001). "Treating a sebaceous cyst: an incisional technique". Aesthetic Plastic Surgery. 25 (1): 52–6. doi:10.1007/s002660010095. PMID 11322399. S2CID 8354318.

External links[edit]

source: https://en.wikipedia.org/w/index.php?title=Sebaceous_cyst&diff=1192685676&oldid=194331872

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