Teratoma orbitae. Report of a case

Mature orbital teratoma with an ectopic tooth and primary anophthalmos

PURPOSE

To describe the clinicopathologic features and management of an unusual case of orbital teratoma.

METHODS

A 7-year-old girl presented with a history of an orbital mass since birth. CT scan showed a large mass lesion involving the right orbit, with absence of the eyeball. An ectopic tooth was identified within the tumor. Lid-sparing exenteration surgery was performed.

RESULTS

Histopathologic examination of the excised mass showed presence of elements from all three germ layers, consistent with a diagnosis of mature orbital teratoma. Normal ocular structures were not identified on histopathology. At one year follow-up, there was no tumor recurrence.

CONCLUSION

We report an extremely rare and interesting case of a mature orbital teratoma, which was associated with primary anophthalmos and an ectopic tooth.

Congenital orbital teratoma

BACKGROUND

The occurrence of proptosis at birth is unusual and may be associated with a variety of tumours and structural abnormalities. Congenital orbital teratoma is a rare cause of congenital proptosis.

METHODS

A case report is presented of a female infant with gross right proptosis.

RESULTS

Computed tomography demonstrated a characteristic multicystic structure with no intracranial involvement. Histological examination found tissues derived from all three germ cell layers, consistent with a congenita orbital teratoma. The tumour was successfully removed preserving the globe and vision.

CONCLUSIONS

This report is an example of how early surgical intervention may allow preservation of the globe and vision in some patients with congenital orbital teratoma.

Orbital germ cell tumors revisited: a clinicopathological approach to classification

Orbital teratomas are unilateral, congenital germ cell tumors, which present at birth with moderate to massive proptosis, leading to exposure keratopathy. They enlarge the orbit diffusely. Primary orbital teratomas cause axial or vertical proptosis, are usually unassociated with bony defects, and do not extend outside the orbit. Recurrence is unusual after an early excision without enucleation or exenteration. Combined orbital teratomas additionally involve periorbital and intracranial spaces, cause lesser degrees of proptosis, and typically are associated with defects of orbital bones. Their intracranial part is small as compared to the orbital one. A significant risk of recurrence exists even after a combined craniotomy, orbitotomy and plastic reconstructive surgery. Intracranial teratomas with secondary orbital spread present prenatally with polyhydramnois and hydrocephalus, due to a massive primary tumor replacing parts of the brain, and typically lead to stillbirth. One orbital teratoma with malignant change has been well documented. Included twins, monsters rather than neoplasms, represent parts of a second fetus in the orbit. Orbital yolk sac carcinomas or endodermal sinus tumors are malignant neoplasms affecting children, which frequently invade periorbital and intracranial spaces, and which may respond to chemotherapy and irradiation. Finally, a teratoma or a yolk sac carcinoma may rarely present as an intraocular tumor.

Congenital orbital teratomas

Teratomas of the orbit, rare congenital tumors consisting of normal tissues derived from all three germ cell layers, are probably choristomas rather than true neoplasms, and must be considered in the differential diagnosis of neonatal orbital masses. They typically grow rapidly after birth, causing destructive proptosis and exposure keratopathy; however, they may take a slowly progressive course, expanding slightly over several years. We studied two cases of histopathologically proven orbital teratomas. In one patient, a 2-month-old girl, the tumor was solid and enlarged rapidly after birth. In the other patient, a 15-year-old girl, the mass was cystic and grew at a very slow rate. In the latter case, vision was preserved, presumably because of the ease with which the tumor could be bluntly dissected from the ocular tissue. We believe that, when possible, early and complete extirpation is the procedure of choice, to ensure the greatest likelihood of visual preservation and symmetric orbital growth.

Congenital orbital teratoma: a review and report of two cases

Congenital orbital teratomas are rare tumors derived from more than one germinal cell layer. These tumors may arise within the orbit, or may originate intracranially and extend into the orbit. Recent advances in ultrasonography have made in utero diagnosis possible. We present the case reports of a primary orbital teratoma and an intracranial teratoma with secondary orbital involvement. The clinical features, histopathologic findings, treatment, and pathogenesis of orbital teratomas are discussed.