Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2013  |  Volume : 56  |  Issue : 4  |  Page : 477--478

Epibulbar dermolipoma


Neeraj Garg, Nirupma Panikar 
 Department of Pathology, UCMS & GTB Hospital, New Delhi, India

Correspondence Address:
Neeraj Garg
Department of Pathology,UCMS & GTB Hospital, New Delhi - 110 095
India




How to cite this article:
Garg N, Panikar N. Epibulbar dermolipoma.Indian J Pathol Microbiol 2013;56:477-478


How to cite this URL:
Garg N, Panikar N. Epibulbar dermolipoma. Indian J Pathol Microbiol [serial online] 2013 [cited 2020 Oct 25 ];56:477-478
Available from: https://www.ijpmonline.org/text.asp?2013/56/4/477/125393


Full Text

Sir,

This was a case report of a 14-year-old female patient attended ophthalmology department with a white mass extending from upper fornix to lower fornix laterally in bulbar conjunctiva of left eye. Mass was measuring 9 mm × 6 mm, non-tender, no redness, mobile and no discharge. Non-contrast computed tomography scan of orbit was normal. Patient was examined to look for coloboma, Goldenhar syndrome or epidermal nevus syndromes, but none was associated.

Gross: Single, yellow, soft-tissue mass measuring 8 mm × 5 mm × 5 mm was received.

Microscopic Examination showed stratified columnar epithelium containing goblet cells characteristic of conjunctival epithelium underneath, which is dense collagen, few sebaceous glands and abundant adipose tissue [Figure 1], [Figure 2], [Figure 3].{Figure 1}{Figure 2}{Figure 3}

Dermolipoma is an uncommon benign tumor. It constitutes 4.2% of all conjunctival lesion. [1] It is a type of choristoma. Choristomas are congenital proliferations and occasionally familial. Choristomas are defined as mature tissue elements not normally present at the site of occurrence. Types of choristomas are limbal dermoid, dermolipoma, ectopic lacrimal gland, and episcleral osseous choristoma. Choristomas are the most common epibulbar and orbital tumors in children. Site of occurrence is bulbar conjunctiva, orbit. [2] Choristomas may be associated with coloboma, Goldenhar syndrome or epidermal nevus syndromes. Epibulbar choristomas may arise from the cornea, limbus or subconjunctival space. They range in appearance from a small, flat lesion to a large mass filling most of the epibulbar region. Astigmatism is often present. Clinically, dermolipoma closely resembles orbital fat prolapse and limbal dermoid. [3]

The dermolipoma features dense collagen bundles, similar to what is seen in the dermis of skin, and abundant adipose tissue. Few adnexal structures can be seen. [4] A limbal dermoid generally shows a keratinized stratified squamous epithelium covering the surface of the lesion with hair shafts and adnexal structures in the substantia propria. In addition the loose collagen of the substantia propria is replaced with dense collagen in thick bundles. Complex choristomas, in addition to having the features of a dermoid or dermolipoma, include other tissues such as cartilage, bone and lacrimal gland. Rotational conjunctival flap is a useful technique of conjunctival reconstruction following removal of large dermolipomas and the overlying epithelium. [5] Post-operative complications such as blepharoptosis, diplopia, or keratoconjunctivitis sicca can develop.

The appearance of dermolipoma closely resembles orbital fat prolapse and limbal dermoid and therefore it is necessary to take this into account in diagnosis.

References

1Elshazly LH. A clinicopathologic study of excised conjunctival lesions. Middle East Afr J Ophthalmol 2011;18:48-54.
2Mansour AM, Barber JC, Reinecke RD, Wang FM. Ocular choristomas. Surv Ophthalmol 1989;33:339-58.
3Kinoshita S, Kakizaki H, Iwaki M, Hara K. Two cases of dermolipoma. Nihon Ganka Gakkai Zasshi 2007;111:965-9.
4Rosai J. Eye and ocular adnexa. In: Rosai and Ackerman's Surgical Pathology. New York, USA: Mosby; 2004. p. 2730.
5Sa HS, Kim HK, Shin JH, Woo KI, Kim YD. Dermolipoma surgery with rotational conjunctival flaps. Acta Ophthalmol 2012;90:86-90.