Artymowicz, Anna; Homer, Natalie; Bratton, Emily
A 23-month-old female presented with a 6-month history of a nontender inferonasal orbital mass (Fig. 1A). The patient had no medical history and an otherwise normal ophthalmologic examination. MRI showed an 18 mm × 7 mm nonenhancing bilobed cystic lesion in the inferonasal orbit (Fig. 1B, C). Mass resection was performed via a swinging eyelid approach. Isolation of the lesion revealed the inferior oblique muscle to be dividing the cyst (Fig. 2). The lesion was excised in toto. Pathologic evaluation confirmed a dermoid cyst. Two weeks postoperatively, the patient had no diplopia or motility disturbance.
Jeremy Hatcher, Asha Sarma, Rachel Sobel, Dolly Ann Padovani-Claudio
We report the case of a 5-year-old boy who presented with a draining cutaneous pit temporal to the lateral canthus, with recurrent periorbital infections. MRI and CT revealed a sinus tract leading from the pit at the skin surface to a 5 mm lesion located in the sphenoid bone near the left sphenofrontal suture. Intraoperative facial nerve monitoring and a lacrimal probe inside the sinus tract were used to guide dissection to the cyst through a minimally invasive temporal approach, without need for neurosurgical intervention.
Edsel B. Ing,Anastasia Faggioni,Ying Lu
This healthy 35-year-old woman presented with a 2-year history of painless, progressive proptosis in the right eye. There was no lid retraction or dysthyroidism. Her acuity, pupils, confrontation field, motility, and ocular examination findings were normal. Orbital computed tomography showed a large well-circumscribed retrobulbar cyst with intraluminal contents near the ethmoidal-maxillary suture line. The cyst was drained through a transcaruncular incision. Keratin contents and hair were removed, and the inner lining was cauterized with bipolar. The cyst has not recurred at 9-month follow-up. Dermoids are the most common cystic choristomas of the orbit. However, medial intraconal dermoids are rare.
Montolío-Marzo, Santiago; González-Valdivia, Hugo; Casas-Gimeno, Estér; Sebastian-Chapman, Laura; Prat-Bartomeu, Joan
To describe the management of dermoid cysts in a pediatric referral hospital.
Retrospective review of 115 patients with pathological diagnosis of dermoid cyst in a pediatric referral hospital between 2003 and 2019.
One hundred fifteen patients, 51 (44.3%) males, and 64 (55.7%) females were retrospectively reviewed. There were fifty-one (44.3%) right eyes and 64 (55.7%) left eyes. Mean age at surgery was 39.15 months (5.6 months–16.4 years). One hundred four (90.4%) lesions were superficial, and 11 (9.6%) were deep. Quadrant location was 63 (54.8%) superior-temporal, 45 (39.1%) superior-nasal, 4 (3.5%) inferior-temporal, and 2 (1.7%) in the nasal inferior quadrant. Most patients only had aesthetic concerns, but 3 (2.61%) showed lacrimal drainage obstruction symptoms, 2 (1.74%) had proptosis, and 1 case spontaneously drained to the cutaneous surface. Imaging was performed in 51 (44.3%) patients. Regarding to their radiodensity, 71.9% had low density content, 28.1% high density, and only 1 patient showed full liquid content; 10.9% showed heterogeneous content; 53.1% showed bone remodeling. Every patient but 1 underwent surgery for a barely accessible asymptomatic retrobulbar cyst. Nine cysts (7.8%) were breached during surgery. Three recurrences were found (2.6%), but only 1 was related to intraoperative breach.
Dermoid cysts are the most common benign periorbital tumors in the pediatric population. Imaging is required for evaluation of lesions in atypical locations, deep or fixed to underlying tissue. Surgical removal is the gold standard of treatment. Multidisciplinary approach may be required in the most complex cases. After surgery, few complications and recurrences were found in our series.
Jasmina Bajric & Gerald J. Harris
The purpose of this study is to describe a spectrum of surgical approaches to orbital dermoid cysts, influenced by the anatomic location of the expanded cyst wall and other factors.
In this retrospective case series, we reviewed cases of dermoid cysts surgically excised during a 39-year period (1977–2016). Cysts were categorized according to the location of the expanded cyst wall and other considerations. The impact of these factors on surgical management was determined.
We identified six dermoid cyst growth patterns based on the anatomic location of the expanded cyst wall that influence the surgical approach: anterior to the frontozygomatic suture (FZS), superior to the FZS, medial to the FZS and other lateral wall sutures, traversing the FZS and other lateral wall sutures, nasoglabellar, and sinus tract from the orbit to the skin. Two additional factors influencing surgical methodology included satellite inflammatory pseudocysts and recurrence after surgical resection.
Orbital dermoid cysts are not monolithic lesions. Functional and aesthetic outcomes can benefit from considering the anatomic pattern of cyst wall expansion and other factors in their surgical management.
Neelam Pushker, Rachna Meel, Anand Kumar, Seema Kashyap, Seema Sen, Mandeep S. Bajaj
To report one of the largest case series on periorbital and orbital dermoid/epidermoid cyst and to highlight some important and unusual findings.
Retrospective analysis of 280 cases with orbital or periorbital dermoid/epidermoid cyst that presented over a period of 14 years.
Periorbital cyst was more than twice as common as orbital cyst. Majority of patients had bony changes with some unusual findings seen in cases with orbital cysts, that is, presence of fluid-fluid level, calcification in the wall, and coexistent double cysts in 19 (6.8%), 5 (1.8%), and 4 (1.5%) cases, respectively. Dumbbell dermoid cyst with connection in temporal fossa was seen in 16 (5.7%) cases. Subperiosteal location of orbital dermoid cyst was most destructive because of extensive bony invasion. Most of the periorbital cysts were removed in toto, whereas orbital cysts required decompression before removal. The histopathological diagnosis was dermoid cyst in 250 (89%) cases and epidermoid cyst in 30 (11%) cases. In 69 (25%) cases, there was a chronic inflammatory response.
We recommend imaging in all patients with orbital dermoid to rule out dumbbell or subperiosteal extension. Also, we advocate early removal of all dermoid cysts in view of bone changes seen in majority of our cases and presence of inflammatory cells in 25% of cases.
Nathaniel L. Simmons, Richard M. Robb, David J. Tybor, Aubrey L. Gilbert
We analyzed clinical and histopathologic data of 97 pediatric patients who underwent excision of dermoid cysts. On review, 16.5% of the sample population demonstrated localized chronic inflammatory changes, including the presence of giant cells and epithelial disruption. These features were considered indicative of prior cyst rupture. Age at time of initial presentation was significantly older and cyst size was significantly larger in patients with histopathologic signs of previous rupture. Longer time to presentation and time to excision were associated with increased odds of spontaneous rupture.
Michelle M. Maeng, Kyle J. Godfrey & Michael Kazim
Dermoid cysts are histologically defined as surface epithelium encapsulating an inner lumen. They are well described in the literature as discrete, single masses, either circumscribed or dumbbell-shaped, with or without a longstanding fistula. Chronic granulomatous inflammation is often a feature of dermoid cysts, contributing to local soft tissue and bony destruction. Isolated multicystic dermoids are not well described. We present a case of a multilobular dermoid characterized both radiographically and histopathologically. These findings may be attributed to repeated rupture and reformation of the dermoid cyst. When possible, our experience favours early excision of orbital dermoid cysts to minimize morbidity.
Amir Tengku-Fatishah, Baharudin Abdullah, Nadarajah Sanjeevan, Abdul Hamid Nurul-Shuhada, Tuan Sharif Sharifah-Emilia, Juhara Haron, Ismail Shatriah
A dermoid cyst is a choristoma that originates from the ectoderm and mesoderm that usually entraps at suture lines.1, 2 An orbital dermoid cyst typically presents as an egg-shaped mass under the skin adjacent to the bones of the eye socket. The most common site for a dermoid cyst is at the frontozygomatic suture, which is situated close to the eyebrow.
Dermoid cysts that are situated close to the lacrimal drainage passage are extremely uncommon. We report a toddler who presented with recurrent episodes of acute dacryocystitis as a consequence of an infraorbital dermoid cyst and discuss the options for managing this challenging case.
Raksha Rao, Santosh G Honavar, Kaustubh Mulay
A 20-year-old male presented with a gradually growing mass in the left lateral brow region for 2 years. On imaging, the mass appeared to arise from the lacrimal gland, was cystic, without any bony abnormality. With a diagnosis of dermoid cyst, an excision biopsy was performed. The histopathology revealed an epithelium-lined cyst, with the wall of the cyst comprising dermal adnexa and inflammatory cells. The wall also contained fragments of skeletal muscle, nerve bundles, adipose tissue, exocrine and secretory acini, few blood vessels with occasional hair shafts, with the lacrimal gland in the periphery of the tumor. There were no immature elements, atypia, and malignant cells, thus confirming the diagnosis of a mature cystic teratoma. Primary lacrimal gland teratoma is a rare diagnosis and its presentation in adults is extremely uncommon.