Phakomatous choristoma: a case report and review of the literature

Immature Chondroid Choristoma: Clinicopathologic, Immunohistochemical, and Molecular Study of an Unusual Benign Skin Tumor

ABSTRACT

An unusual benign skin tumor is reported occurring in a 68-year-old woman with no significant medical history. The lesion presented as a small skin nodule in the neck. Histologic examination showed a well-circumscribed superficial dermal nodule composed of a solid proliferation of large, round cells with abundant eosinophilic cytoplasm and small centrally placed nuclei displaying a vaguely chondroid appearance. Immunohistochemical studies showed strong positivity of the tumor cells for S100 protein and vimentin and negative staining for SOX10, melanoma cocktail, HMB45, Melan-A, cytokeratin AE1/AE3, inhibin, desmin, smooth muscle actin, CD68, CD164, and neuron specific enolase. Next-generation sequencing using a panel of 50 actionable genes commonly encountered in human neoplasia did not reveal the presence of any mutations. Owing to the remarkable similarity of the lesion to immature cartilage, we consider this to be a benign tumor, most likely resulting from an embryologic defect. We propose the term immature chondroid choristoma to designate this lesion.

Phakomatous Choristomas: A Case Report and Review of Literature

PURPOSE

To document a case of phakomatous choristoma (PC), a rare benign periocular tumor, and to review the literature on previously reported cases.

METHODS

The authors describe a case of PC and its clinical, histopathological, immunohistochemical, and radiological features, and present findings from a comprehensive review of all previously reported cases of this rare pediatric tumor.

RESULTS

This case report and review highlights the benign clinical nature of PC. It typically presents at birth as a lower eyelid mass involving the orbit. Definitive diagnosis is made with hematoxylin and eosin stain showing the tumor's histological similarities to lenticular tissue.

CONCLUSION

PC remains a rare entity that should be included in the differential of pediatric eyelid lesions. Surgical excision is curative, and the postoperative clinical course is unremarkable as there have been no reports of recurrence. Prompt recognition and surgical intervention may be warranted due to astigmatism and anisometropia induced by mass effect.

Phakomatous Choristoma of the Eyelid and Orbit: A Case Report

Phakomatous choristoma was first described as a distinct pathologic entity by Zimmerman in 1971. Report of only 26 cases of this tumor so far is an indicator of the rarity of phakomatous choristoma. We present a 4-month-old infant with an orbital mass beneath the right lower eyelid. Surgical excision was undertaken and the histopathologic findings of a dense fibrocollagenous stroma containing small to medium size islands and glandular-like structures surrounded by thick basement membrane and filled by amorphous eosinophilic material confirmed the diagnosis. Immunohistochemical study showed positive staining for S-100 and vimentin and negative staining for cytokeratins, glial fibrillary acidic protein, smooth muscle actin, synaptophysin, CD34, melan-A, and epithelial membrane antigen markers. This is the first patient with phakomatous choristoma presented from our country and the 27th reported case worldwide. Phakomatous choristoma is a rare, benign congenital tumor of lenticular anlage, almost always presenting in the medial lower eyelid and anterior orbit. Surgical excision is curative and allows precise diagnosis due to the unique histopathologic and immunostaining characteristics of this choristoma.

Phakomatous Choristoma of the Orbit With Involvement of the Inferior Oblique Muscle

The authors report a case of phakomatous choristoma presenting as an orbital tumor with involvement of the inferior oblique muscle. This is the only known case of this rare tumor directly invading and incorporating the inferior oblique. This tumor should be included in the differential of eyelid tumors and orbital tumors in infants. Finally, the authors review the histopathological and embryological characteristics of this lenticular tumor.

Phakomatous choristoma in a 10-week-old boy: a case report and review of the literature

Phakomatous choristoma (PC) is a rare benign congenital lesion of lenticular anlage. It presents in young patients as a firm subcutaneous mass in the medial eyelid or orbit and may raise clinical concern for neoplasms such as rhabdomyosarcoma, but its histopathology is distinct, consisting of dense collagenous stroma and eosinophilic cuboidal epithelial cells forming nests, tubules, cords, or pseudoglands. We present a case of PC in a 10-week-old boy to illustrate the unique clinical, histopathologic, and immunophenotypic features of this condition and to reaffirm that familiarity with this rare entity aids accurate diagnosis.

Phakomatous choristoma of the lower eyelid: a case study with a review of the literature

We report a case of phakomatous choristoma of the lower eyelid. A 2-week-old girl was referred with a tumor of the right lower eyelid near the inner canthus, present since birth. No other abnormalities were noted. The tumor was excised, and histopathologic examination of the tumor showed phakomatous choristoma of the eyelid. This is the first report of phakomatous choristoma of the eyelid in Turkey.

Phakomatous choristoma of the eyelid: a report of a case

Phakomatous choristoma is a rare congenital hamartoma of lens tissue. It presents in newborns or young infants as a subcutaneous mass in the medial lower eyelid. We present a case of phakomatous choristoma recently identified among old consultation files at Children's Hospital in Boston. Our case illustrates unique histological features of this entity which has to be included in differential diagnosis of skin lesions of the inferonasal eyelid.

Phakomatous choristoma of the eyelid

BACKGROUND

We report a case of a phakomatous choristoma of the lower eyelid.

METHODS

A subcutaneous tumor was excised from the eyelid.

RESULTS

A 12-month-old girl was referred because of a tumor in her right lower eyelid, which had been present since birth. The subcutaneous tumor had remained unchanged and was considered a dermoid cyst. No other abnormalities were present. The tumor was excised. Histologically, the tumor consisted of abnormal lens tissue. The immunohistochemical profile included strong immunoreactivity for vimentin and S-100.

CONCLUSION

Phakomatous choristoma is an extraordinary rare tumor that probably develops from an abnormal separation or migration of cells from the lens placode into the mesodermal structures of the lid. Only 18 cases have been described so far, less than 5 in the European literature. This benign tumor may be confused with cutaneous adnexal neoplasms.

Eyelid phakomatous choristoma

PURPOSE

To report a case of congenital phakomatous choristoma (PC) of the eyelid, a rare tumor of lenticular anlage in the subcutaneous tissue and dermis.

CASE

A boy had a mass in the right lower eyelid near the inner canthus at birth. At age 10 months, the tumor was excised.

RESULTS

The tumor cells showed intense immunoreactivity positive for S-100 protein, vimentin, and periodic acid-Schiff. Keratin markers, epithelial membrane antigen, glial fibrillary acidic protein, muscle specific actin, and epithelial membrane antigen were negative. The histopathologic features were consistent with those of a PC.

CONCLUSIONS

This histopathologic and immunoreactivity study supports the proposal that PC is a rare entity of lenticular anlage origin. Only 18 such cases have been described previously.

Case report of bilateral cervical chondrocutaneous branchial remnants

Cervical chondrocutaneous branchial remnants are rare and not well known lesions. Histologically the lesion per definition presents as a Choristoma. Choristoma is the pathohistological term for a developmental tumor-like anomaly consisting of tissues foreign to the site at which it is located. Treatment is complete surgical removal as promptly as possible in order to get an exact histopathological diagnosis. A case of a 4-month-old boy with cervical chondrocutaneous branchial remnants anterior to the sternocleidomastoid muscles on both sides is presented. According to literature search this appears to be the second case published on such a bilateral lesion.