Pedunculated dermolipoma with overlying upper lid coloboma and absent lateral canthus: cause and effect

Epibulbar osseous choristoma with dermolipoma: A case report and review of literature

BACKGROUND

A choristoma is defined as a growth of histologically normal tissue in an abnormal location. Epibulbar osseous choristoma is the rarest type among all ocular choristoma with less than 100 cases reported. Here, we report a case of epibulbar osseous choristoma combined with dermolipoma and a literature review.

METHODS

A 15-year-old female patient presented with an accidentally found subconjunctival mass in her left eye. Slit lamp examination revealed a 10 × 10 mm elevated, sigmoid-shaped mass in the supratemporal quadrant of the bulbar conjunctiva. We performed a debulking excisional biopsy of the mass.

RESULTS

The pathology confirmed osseous tissue surrounded by mature adipose tissue. At 1 week after the operation, the wound was clear and the patient was satisfied with the treatment. A systematic literature review of 14 previously published cases taken from PubMed dating back to 1987 along with ours was undertaken. The average age at presentation was 11.6 years and there was a female preponderance with 10 cases being female and the other 5 cases being male. Supratemporal conjunctiva was the most common site of presentation. There was no systemic disease associated with any of the cases. Since it is a benign tumor, it can be managed by observation, but if necessary, it can be treated by surgical removal.

CONCLUSION

In pediatric subconjunctival mass, particularly located in supratemporal quadrant of bulbar conjunctiva, osseous choristoma should be considered in the differential diagnosis. Pre-operative CT scans will helpful to not also reduce complication with surgical excision but also helpful in prediction of diagnosis and prognosis.

The Presentation and Surgical Treatment of Peribulbar Dermolipomas

PURPOSE

To evaluate the presentation, treatment, and outcome for patients with peribulbar dermolipomas and describe a reliable technique for excision of large lesions.

PATIENTS AND METHODS

Retrospective chart review for patients seen at Moorfields Eye Hospital between 1976 and 2019. Patient demographics, clinical features, imaging (CT or MRI, where available), histopathology, and surgical outcomes were reviewed.

RESULTS

One hundred and ninety-six eyes of 187 patients (117 females; 63%) were identified as having dermolipoma, the patients presenting at an average age of 21.5 years and-where recorded in 163 patients-had first symptoms at an average age of 12.9 years. Although 8/187 (4%) patients were asymptomatic, the commonest symptom was increasing size of a longstanding peribulbar lump (136 patients; 73%); other symptoms included ocular irritation (24%), episodic localized conjunctival injection (12%), and mucoid discharge (12%). One-third of dermolipomas had visible hairs (some with localized giant papillary conjunctivitis), lateral canthal widening was present in 44 patients, aberrant lacrimal gland ductules opening onto skin in 8, and a complex lateral canthal anomaly-with both an external dermoid and an internal dermolipoma-was present in 9 patients. Complete management details were available for 120 patients (those treated after 1990) and 40 (33%) electing for observation, 71 (59%) had excision for long-term irritation and discharge and 9 (8%) for cosmesis: together with the integral subdermal fat lobule, in all cases the abnormal, nonwetting squamous epithelium was delineated and excised under microscopic control, and the conjunctival defect closed directly (59/80 eyes) or with a "V-to-Y" closure (21 eyes; 26%). The presenting symptoms were cured in all except 1 patient, who required excision of residual abnormal epithelium causing persistent symptoms. Two patients developed symblepharon to the lateral canthus after direct conjunctival closure, this having no functional effect, and 2 other patients had slight restriction of extreme horizontal gaze.

CONCLUSION

Dermolipomas may require surgery when they become more prominent with age, or start causing ocular irritation and discharge. Complications are few with meticulous removal of the nonwetting squamous epithelium and direct conjunctival closure, or when using a "V-to-Y" conjunctivoplasty for larger defects.

Epibulbar osseous choristoma within a dermolipoma: case report and literature review

A healthy 18-year-old girl presented with a superotemporal epibulbar mass that was present since birth. Computed tomography revealed a cystic mass with fat-like low-density and a central oval-shaped mass that was isodense to the bone in the superotemporal region of the globe. Histopathology of the excised tumour revealed osseous choristoma and dermolipoma. Our review of literature yielded nine reported cases of epibulbar osseous choristoma within a dermolipoma and we reviewed these cases.

Surgical approach in a rare case of coloboma–choristoma

Embryogenic eyelid defects can be isolated or associated with malformative diseases, such as Tessier craniofacial clefts. We describe the exceptional coexistence of upper eyelid coloboma and lower eyelid dermolipoma in a 45-day-old infant with a Tessier no. 0-1 cleft. The surgical intervention carried out on this patient, which used a flap of subconjunctival choristoma and grafting of reshaped cutaneous and tarsal portions of a preauricular anlage, is presented as a technique for correcting congenital palpebral coloboma. Adoption of this technique allowed virtually complete repair of the defect and gave an acceptable functional and cosmetic result.