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An unusual case of intraosseous epidermal cyst is reported. The patient, a 45-year-old Japanese female, had suffered from lumbago and dysuria for about 15 years. X-ray examinations and CT scan revealed an expanded osteolytic tumor without marginal sclerotic change within the sacrum, which anteriorly invaded the surrounding soft tissues at the S2/3 level. At this time, chordoma was suspected, but epidermal cyst with foreign body granuloma was finally diagnosed from biopsy and surgical specimens.
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