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Yun HJ, Kim JH, Woo KI, Kim YD. Correlation Between Radiologic and Histopathologic Features of Orbital Epidermoid and Dermoid Cysts. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00331. [PMID: 38285927 DOI: 10.1097/iop.0000000000002602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
PURPOSE Epidermoid cysts (EC) and dermoid cysts (DC) typically appear as well-circumscribed lesions on CT. This study aimed to clarify the radiologic and histopathologic characteristics of orbital EC and DC and to determine the correlations between them. METHODS The medical records of 69 patients who underwent surgery for orbital DC or EC at Samsung Medical Center between January 2001 and August 2016 were retrospectively reviewed. The size and location of the cysts, rim enhancement, homogeneity of contents, presence of hemorrhagic or calcific components, radiodensity of contents, and extent of bony remodeling were evaluated using CT. Additionally, the cyst lining and contents were examined histopathologically. RESULTS Among patients with orbital cysts, EC and DC were diagnosed in 10 (14.5%) and 59 (85.5%) patients, respectively. Further, 50.0% of EC and 79.7% of DC were located in the superotemporal quadrant of the orbit. On orbital CT, the average radiodensity of EC and DC was 18.9 ± 56.2 and -67.9 ± 63.3 HU, respectively. The cystic contents were more frequently homogeneous than heterogeneous in both EC and DC; however, the radiodensity of cysts differed significantly, which may be attributed to sebaceous gland activity. Focal bony notching, bone remodeling under pressure, and bony changes from dumbbell-shaped cysts were observed more frequently in DC than in EC. CONCLUSIONS Radiological and histopathological features are correlated in orbital EC and DC. Therefore, orbital EC and DC can be preoperatively differentiated using CT, based on the average radiodensity and bony remodeling.
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Affiliation(s)
- Hee Jee Yun
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Hee Kim
- Blue Eye Center, Paju, Gyeonggi-do Province, South Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Kim DH, Prat DL, Tadros S, Katowitz WR. Orbital and periorbital dermoid cysts: a retrospective analysis of 270 lesions. Orbit 2022; 41:341-345. [PMID: 35549983 DOI: 10.1080/01676830.2021.1912114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the clinical characteristics and intraoperative findings of periorbital and orbital dermoid cysts and their relationship to location and rupture. METHODS Retrospective review of 270 cases with orbital or periorbital dermoid cysts that presented over a period of 11 years. Patients were included if diagnosis of dermoid cyst was made by histopathologic analysis. Clinical characteristics and operative outcomes were recorded and analyzed with Chi-squared analyses or univariate regression. Multivariate binary logistic regression was performed to assess predictors of location and rupture. RESULTS Dermoids frequently occurred unilaterally and were more frequently described as mobile (61.5%), followed by fixed (30.8%), and partially fixed (7.7%). Dermoid rigidity was most commonly described as firm (75.5%), followed by cystic, soft, and rubbery. The most common dermoid location was superotemporal (60.4%). On Chi-squared analysis, superotemporal lesions were less likely to have orbital extension than non-superotemporal lesions (OR 0.28, 95% CI: 0.11-0.70, p = .01), less likely to undergo CT (OR 0.16, 95% CI: 0.06-0.41, p < .01) or MRI (OR 0.23, 95% CI: 0.13-0.41, p < .01), more likely to be described as mobile (OR 2.91, 95% CI: 1.32-6.43, p = .01), and less likely to rupture intraoperatively (OR 0.28, 95% CI: 0.11-0.73, p = .01). No variables were associated with rupture in multivariate analysis. CONCLUSION Superotemporal dermoid cysts are common in the pediatric population, less likely to have orbital extension, undergo imaging, and have intraoperative rupture when compared to other locations in the orbit.
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Affiliation(s)
- Diana H Kim
- Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daphna Landau Prat
- Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Samuel Tadros
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William R Katowitz
- Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wilde C, Vahdani K, Thaung C, Rose GE. Persistent orbital inflammation following complete excision of deep dermoid cysts. Orbit 2022:1-3. [PMID: 35043740 DOI: 10.1080/01676830.2022.2025855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
Piecemeal excision of dermoid cysts carries the risk of implanting epithelial fragments into orbital fat, which is well recognized to continue secreting oily debris, inciting chronic, often granulomatous inflammation. The authors present the clinical and histological details for two patients with persistent lipogranulomatous inflammation for years after piecemeal excision of deep orbital dermoid cysts, in the absence of any residual epithelium. The importance of copious saline lavage - to 'float-out" and reduce microscopic lipid droplets - is also emphasised.
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Affiliation(s)
| | - Kaveh Vahdani
- Orbital Service, Moorfields Eye Hospital, London, UK
| | - Caroline Thaung
- Department of Histopathology, Institute of Ophthalmology, London, Mexico
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Orbital inflammatory disease in a child caused by a ruptured dermoid cyst misdiagnosed as orbital cellulitis. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.1013321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Dave TV, Gupta Rathi S, Kaliki S, Mishra D. Orbital and periorbital dermoid cysts: Comparison of clinical features and management outcomes in children and adults. Eur J Ophthalmol 2020; 31:2631-2638. [PMID: 33198489 DOI: 10.1177/1120672120964686] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare differences in clinical presentation and management outcomes of orbital and periorbital dermoid cysts in children and adults. METHODS A retrospective interventional comparative consecutive case series. 203 patients in (148 children [Age ⩽18 years] and 55 adults [Age >18 years]), who underwent excision biopsy for orbital/periorbital dermoid cyst were included. Outcome measures included the differences in demography, clinical presentations, radiological features, surgical outcomes and histopathology of cysts between children and adults with dermoid cysts. RESULTS The mean age noted at excision was 15 years in this cohort of 148 children and 55 adults. Commonest clinical finding observed was a subcutaneous painless mass (94%) and external angular dermoids were commonest in both groups 1 and 2 (51% and 56%). Diminution of vision (p = 0.007), proptosis (p = 0.008), extraocular motility limitation (p = 0.001), strabismus (p = 0.003) and relative afferent pupillary defect (p = 0.02) were significantly more in adults. Orbital involvement and dumbbell dermoids were not significantly different between children and adults. Radiologically, bony fossa formation (p = 0.03), temporal fossa extension (p = 0.04), full thickness bony defect (p = 0.03) and intraosseous presentation (p = 0.005) were significantly more in adults. Comparison of proportion of lesions having intra-operative rupture of dermoid cyst (p = 0.009) and evidence of inflammation on histopathology (p = 0.01) were significantly more in adults. However, recurrence rates were not different between children and adults. CONCLUSIONS Dermoid cysts are commoner in children, but can also present in adulthood. Secondary visual, orbital, radiologic changes and intra-operative rupture of dermoid cyst are more common in adults compared to children.
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Affiliation(s)
- Tarjani Vivek Dave
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Shweta Gupta Rathi
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Dilip Mishra
- Ophthalmic Pathology laboratory, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Betancourt-Torres M, Figueroa-Diaz L, Rodriguez-Mojica W. Paratesticular Dermoid Cyst Mimicking a Torsed Supernumerary Testis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923752. [PMID: 33070146 PMCID: PMC7582465 DOI: 10.12659/ajcr.923752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Patient: Male, 8-year-old Final Diagnosis: Dermoid cyst Symptoms: Pain Medication: — Clinical Procedure: Ultrasonography Specialty: Radiology
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Affiliation(s)
| | - Laura Figueroa-Diaz
- Department of Diagnostic Radiology, University of Puerto Rico, San Juan, Puerto Rico
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Simmons NL, Robb RM, Tybor DJ, Gilbert AL. Older age and larger cyst size in children with spontaneous rupture of periorbital dermoid cysts. J AAPOS 2019; 23:283-285. [PMID: 31520721 DOI: 10.1016/j.jaapos.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/28/2019] [Accepted: 06/01/2019] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Nathaniel L Simmons
- Department of Ophthalmology, Flaum Eye Institute University of Rochester, Rochester, New York.
| | - Richard M Robb
- Department of Ophthalmology, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | - David J Tybor
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Aubrey L Gilbert
- Department of Ophthalmology, Kaiser Permanente Northern California, Vallejo, California
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Tengku-Fatishah A, Abdullah B, Sanjeevan N, Nurul-Shuhada AH, Sharifah-Emilia TS, Haron J, Shatriah I. Dermoid cyst simulating recurrent dacryocystitis in a toddler. Can J Ophthalmol 2019; 54:e196-e199. [PMID: 31358169 DOI: 10.1016/j.jcjo.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Amir Tengku-Fatishah
- Departments of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Baharudin Abdullah
- Departments of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nadarajah Sanjeevan
- Departments of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | | | - Juhara Haron
- Departments of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ismail Shatriah
- Departments of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
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Akbari SHA, Somasundaram A, Ferguson CJ, Roland JL, Smyth MD, Strahle JM. Focal traumatic rupture of a dermoid cyst in a pediatric patient: case report and literature review. Childs Nerv Syst 2018; 34:2485-2490. [PMID: 29961083 DOI: 10.1007/s00381-018-3879-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/22/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Dermoid cysts are rare congenital teratomas that can occasionally rupture and cause chemical meningitis, neurological deficit, or hydrocephalus. Rarely, dermoid cysts in the pediatric population can rupture spontaneously and even more rarely rupture due to trauma. To date, there are only five documented cases of traumatic rupture of a dermoid cyst. A 2-year-old male presented with 5 days of left eye ptosis and ophthalmoplegia after suffering a fall and was found to have a ruptured left anterior clinoid dermoid cyst that was surgically resected. The patient had significant improvement postoperatively. SIGNIFICANCE To the authors' knowledge, this is the first reported case in the literature of a ruptured dermoid cyst after trauma in a pediatric patient and the first case of a traumatically ruptured dermoid cyst presenting with neurological deficit.
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Affiliation(s)
- Syed Hassan A Akbari
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, St. Louis, MO, 63110, USA.
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA.
| | - Aravind Somasundaram
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, St. Louis, MO, 63110, USA
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA
| | - Cole J Ferguson
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA
| | - Jarod L Roland
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, St. Louis, MO, 63110, USA
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA
| | - Matthew D Smyth
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, St. Louis, MO, 63110, USA
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA
| | - Jennifer M Strahle
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, St. Louis, MO, 63110, USA
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, St. Louis, MO, 63110, USA
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Maeng MM, Godfrey KJ, Kazim M. Multilobular dermoid cyst of the orbit. Orbit 2018; 38:328-330. [PMID: 30215530 DOI: 10.1080/01676830.2018.1509098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Michelle M Maeng
- a Edward S. Harkness Eye Institute, Columbia University Medical Center , New York , New York , USA
| | - Kyle J Godfrey
- a Edward S. Harkness Eye Institute, Columbia University Medical Center , New York , New York , USA
| | - Michael Kazim
- a Edward S. Harkness Eye Institute, Columbia University Medical Center , New York , New York , USA
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Lin PH, Kitaguchi Y, Mupas-Uy J, Takahashi Y, Kakizaki H. Rescue technique for complete removal of an accidentally ruptured orbital dumbbell deep dermoid cyst: A case report. Am J Ophthalmol Case Rep 2018; 10:55-58. [PMID: 29780914 PMCID: PMC5956660 DOI: 10.1016/j.ajoc.2018.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 01/22/2018] [Accepted: 01/29/2018] [Indexed: 11/06/2022] Open
Abstract
Purpose To report a rescue technique for complete removal of an accidentally ruptured orbital dumbbell deep dermoid cyst. Observations A 33-year-old female presented with left proptosis with retrobulbar discomfort for 3 months. Computed tomography images showed an orbital dumbbell deep dermoid cyst. A lateral orbitotomy was performed under general anesthesia. The cyst was ruptured during osteotomy of the lateral orbital rim. The cyst was opened vertically from the ruptured site using a Stephen's tenotomy scissors to visually confirm the internal wall of the cyst and to keep the epithelial lining intact while separating the external wall of the cyst from the bone. There was a small defect of the epithelial lining at the inferoposterior margin of the cyst. Granulomatous inflammation of the lacrimal gland was found adjacent to the defect site. The cyst was completely removed and the lacrimal inflammation subsided after the operation. Conclusions and importance Opening of the cyst is a useful technique to remove the entire epithelial lining of an accidentally ruptured dumbbell dermoid cyst.
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Affiliation(s)
- Pei-Hsuan Lin
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Yoshiyuki Kitaguchi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Jacqueline Mupas-Uy
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
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