barw Judi Clinical Journal 3105-4102 1 2 2025 11 13 Atypical Presentations of Pilonidal Sinus Disease: A Case Series with Literature Review 76 82 10.70955/JCJ.2025.10 eng Shaban Latif Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah 46001, Kurdistan, Iraq Hemn H. Kaka Ali Gastroenterology and Hepatology Teaching Hospital, Sulaymaniyah, Kurdistan 46001, Iraq Deari A. Ismaeil College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah 46001, Kurdistan, Iraq Karzan M. Salih Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah 46001, Kurdistan, Iraq Ayman M. Mustafa Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah 46001, Kurdistan, Iraq Shko H. Hassan Zad Organization, Saeed Kaban Street, Judi Tower, Sulaymaniyah 46001, Kurdistan, Iraq 0009-0002-6771-6436 Kayhan A. Najar Kscien Organization for Scientific Research (Middle East office), Hamdi Street, Azadi Mall, Sulaymaniyah 46001, Kurdistan, Iraq Harun A. Ahmed Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah 46001, Kurdistan, Iraq Abdullah A. Qadir Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah 46001, Kurdistan, Iraq Bushra O. Hussein Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah 46001, Kurdistan, Iraq 2025 08 20 Introduction: Pilonidal sinus (PNS) typically arises in the sacrococcygeal region but can occasionally present in atypical locations, including the axilla, intermammary region, umbilicus, interdigital web, neck, endoanal, auricular, periauricular, scalp, and submental areas. This study aims to examine clinical features, surgical management, and outcomes of PNS in these uncommon sites. Methods: This retrospective case series was conducted at a single center over eight years and examined patients with extra-sacrococcygeal PNS confirmed by histopathology. Clinical, surgical, and follow-up data were retrieved from patient records.  Data were analyzed using SPSS 25.0 and presented as descriptive statistics (frequencies, percentages, means, and ranges). Results: This study included 4 patients, with an equal sex distribution (2 females, 50%; 2 males, 50%) and a mean age of 24 years (range: 16–31). Presenting symptoms included discharge, itching, pain, redness, and mass formation. None had significant past medical history, and one patient (25%) had prior surgery at the same site. Affected sites were equally distributed: breast (25%), axilla (25%), penile (25%), and scalp (25%). All patients underwent surgical intervention, and histopathology revealed tracts lined with epidermis, surrounded by mixed inflammatory cells, foreign body giant cells, and hair shafts in granulation tissue. During the follow-up period (mean follow-up: 13.5 months), no recurrence was observed. Conclusion: Atypical presentations of PNS, although rare, can occur in diverse anatomical regions. Surgical excision with primary closure might be an effective treatment approach, potentially leading to favorable clinical outcomes and a low recurrence rate.