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Year : 2020  |  Volume : 63  |  Issue : 2  |  Page : 330-331
Intraconal dermoid cyst – A common condition at uncommon location and age


Department of Histopathology, SRL and Dr. Avinash Phadke Labs, Mumbai, Maharashtra, India

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Date of Web Publication18-Apr-2020
 

How to cite this article:
Rijhsinghani AN, Majethia NK. Intraconal dermoid cyst – A common condition at uncommon location and age. Indian J Pathol Microbiol 2020;63:330-1

How to cite this URL:
Rijhsinghani AN, Majethia NK. Intraconal dermoid cyst – A common condition at uncommon location and age. Indian J Pathol Microbiol [serial online] 2020 [cited 2020 Aug 15];63:330-1. Available from: http://www.ijpmonline.org/text.asp?2020/63/2/330/282704




Dear Editor,

A 25-year-old girl presented with swelling in the right eye, forward protrusion, and pain since 3–4 months. There was history of trauma to the right eye 1 year back. On examination, the right eye was opthalmoplegic; however, the eye movements were full and free in all quadrants; the vision in the right eye was <6/60 and in the left eye was 6/9. On computed tomography scan [Figure 1]a-c], the orbit showed a small, oval hypoattenuated lesion in the outer cantus of the right eye. This also extended superiolaterally, measuring 28 × 22 × 26 mm in size. It was seen to cause focal scalloping of the underlying bone. A non-neoplastic lesion with intra- and extraconal component with no intracranial extension was noted. A right lateral orbitotomy was carried out under general anesthesia. The postoperative period was uneventful and recovery was complete with return of vision to 6/6. As per literature, dermoids form one-third of all childhood orbital tumors. Limbal was associated with anomalies, with a mean patient age of 18.64 years. Among patients, 48.83% were male. Preseptal location was most common (41 cases). It was surgically classified as juxtasutural, sutural (causes bone erosion), and soft-tissue types by Shields and Shields.[1] Our case was not attached to the bone, so en block removal was possible. Surgical challenge is for lesions which have intraconal components [Figure 1]d, as sometimes en block removal of the orbital dumbbell-shaped dermoid cysts as they are tightly adhered to the bones at the frontozygomatic suture. Decompression by needle aspiration facilitates the exposure of the cyst. Methylene blue injection helps delineate the extent of the cyst.[2] Dermoid and epidermoid cysts' diagnosis is made after a histopathological evaluation only. Review of literature[3],[4] suggests choristomatous elements like epidermal appendages, fat, smooth/striated muscle, cartilage, and even lacrimal tissue. About 84% of the cysts' lining was keratinizing, stratified squamous epithelium, and 5% was non-keratinizing epithelium resembling conjunctiva. Hair shafts were present in the wall or lumen of the cyst in 99% of specimens, sebaceous glands in 75%, and sweat glands in 20%; inflammation was present in 38% of the cases. Our cyst on microscopy showed similar findings [Figure 1]e and [Figure 1]f. Goldenhar syndrome is a bilateral condition characterized by limbal dermoids, accessory auricular appendages, aural fistulas, and other bony and soft tissue anomalies. Bonavolonta and associates found that dermoids are benign mostly and destruction of adjacent bony structures occurs in 14% cases. Occasionally, the lesions can extend into the frontal sinus and rupture spontaneously inciting intense orbital inflammatory response or drain intermittently through a secondary fistula to the skin. Intraorbital location, though rare, should not be overlooked. Before the decision to treat such lesions, a detailed diagnostic procedure is necessary to be done to locate the cyst precisely and determine its size and possible propagation into the surrounding periorbital structures. Apart from cosmetic indications, operative procedures are recommended in case of cysts with constant progressions, which cause the pressure to the eye lobe, lead to motility disturbances, and indirectly compress the optical nerve and branches of the cranial nerves.[5]
Figure 1: (a-c) Computed tomography image of the lesion. (d) Anatomical relations to surrounding structures. (e and f) Photomicrograph of the excised lesion

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Acknowledgement

The author thank SRL and Dr Avinash Phadke Labs, Mumbai.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Shields JA, Kaden IH, Eagle RC Jr, Shields CL. Orbital dermoid cyst: Clinicopathologic correlations, classification, and management the 1997 Josephine E. Schueler lecture. Ophthalmic Plast Reconstr Surg 1997;13:265-76.  Back to cited text no. 1
    
2.
Knani L, Gatfaoui F, Krifa F, Mahjoub H, Daldoul N, Ben Hadj Hamida F. Orbital dermoid clinical spectrum and outcome. J Fr Opthal 2015;38:950-4.  Back to cited text no. 2
    
3.
Purohit BS, Vargas MI, Ailianou A, Merlini L, Poletti PA, Platon A, et al. Orbital tumors and tumor like lesions exploring the armamentarium of multiparametric imaging. Insights Imaging 2016;7:43-68.  Back to cited text no. 3
    
4.
Odashiro AN, Cummings TJ, Burnier MN Jr. Eye and ocular adnexa. In: Mills SE, editor. Sternberg Diagnostic Surgical Pathology. 6th ed. Chapter 24. p. 1592-4.  Back to cited text no. 4
    
5.
Veselinovic D, Krasic D, Stefanovic I, Veselinlinovic A, Randovanovic Z, Kostic A, et al. Orbital dermoid and epidermoid cyst case study. Srp Arch Celok 2010;138:755-9.  Back to cited text no. 5
    

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Correspondence Address:
Nikhil K Majethia
Ashirwad, Plot 71, Sector 28, Vashi, Navi Mumbai - 400 703, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_590_18

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