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• W3163958621 abstract "Bayne et al reported the clinical presentation of the uncommon entity of a median raphe cyst of the perineum.1Bayne C.E. DeMarco R.T. Wehry M.A. Median raphe cyst of the perineum.J Pediatr. 2020; 216: 236Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar They outlined the embryologic fusion as a major pathogenetic mechanism, the benign course of the abnormality, and proposed complete surgical excision to avoid recurrence.1Bayne C.E. DeMarco R.T. Wehry M.A. Median raphe cyst of the perineum.J Pediatr. 2020; 216: 236Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar We would like to share the outcome of a 4-year-old asymptomatic boy with an analogous 5-cm long lesion that extended from the scrotum to the perineum and consisted of tan-white papules in continuity with a linear tubular formation (Figure 1). Microscopic examination revealed that it was confined to the reticular dermis, and presented both keratinizing and nonkeratinizing squamous epithelium, as well as stratified and pseudostratified columnar epithelium, infiltrated by polymorphonuclear cells (Figure 2). Immunohistochemistry showed expression of cytokeratin-7 and cytokeratin-14 antigens in the squamous epithelium, and cytokeratin-7 and cytokeratin-20 in the columnar epithelium (Figure 3).2Dini M. Baroni G. Colafranceschi M. Median raphe cyst of the penis: a report of two cases with immunohistochemical investigation.Am J Dermatopathol. 2001; 23: 320-324Crossref PubMed Scopus (33) Google Scholar These findings were in favor of a mixed-type lesion, with immature urothelial metaplasia, of the uncommon variant of canal-like type of the abnormality.3Verma S.B. Canal-like median raphe cysts: an unusual presentation of an unusual condition.Clin Exp Dermatol. 2009; 34: e857-e858Crossref PubMed Scopus (17) Google ScholarFigure 2A, Low-power magnification of the cystic lesion lined mostly by squamous epithelium. The area in the square is shown in higher magnification in B. B, The area shown in the square of A, lined by stratified squamous keratinizing epithelium (top, arrow 1), nonkeratinizing squamous epithelium (middle, arrow 2), and stratified columnar epithelium (bottom, arrow 3).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3A, Columnar epithelium (left) in transition to non-keratinizing stratified squamous epithelium (right). B, Immunohistochemical stain for cytokeratin-7 of the area shown in A, displaying diffuse antigen positivity in the columnar epithelium (left), and only residual surface columnar cells in the metaplastic squamous epithelium (right).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Considered benign, median raphe cystic formations may present as complex types of defective embryological evolution, with metaplasia of their epithelial components.4Shao I.H. Chen T.D. Shao H.T. Chen H.W. Male median raphe cysts: serial retrospective analysis and histopathological classification.Diagn Pathol. 2012; 7: 121Crossref PubMed Scopus (36) Google Scholar Furthermore, because they are lesions of the genitoperineal area, they may produce psychological discomfort for years, always with the possibility of trauma or infection. If excision of the lesion is performed properly, in healthy tissue limits, the resulting scar is a normal perineal raphe. For these reasons, we advise timely excision in childhood, instead of decades of expectation and concern. ReplyThe Journal of PediatricsVol. 235PreviewThe authors show histologic images from an excised median raphe cyst in a young boy. To even a humble pediatric urologist, the representative histology shows a cystic space lined with epithelium. This arrangement explains why this embryologic fusion abnormality is unlikely to spontaneous resolve with time. As such, these histology images represent a contribution to the literature. Surgical excision is curative so long as it is complete. Pediatricians should be aware this lesion may span the entire median raphe, from the ventral penile shaft to the anus. Full-Text PDF Median Raphe Cyst of the PerineumThe Journal of PediatricsVol. 216PreviewA 3-month-old boy presented with a scrotal and perineal lesion, persistent since birth (Figure). The lesion was firm to palpation and seemingly nontender. There was no other perinatal, traumatic, or infectious history. A diagnosis of median raphe cyst was made based on physical examination. Full-Text PDF" @default.
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• W3163958621 title "Median raphe cysts: why surgical excision should be performed in childhood" @default.
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• W3163958621 doi "https://doi.org/10.1016/j.jpeds.2021.04.072" @default.
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