Orbital teratoma

Intraoral Approach for a Congenital Teratoma in the Orbit Extending into the Pterygopalatine Fossa

This article reports an intraoral approach for a congenital mature teratoma in the orbit, extending into the pterygopalatine fossa and the zygoma remodeling due to biological and functional matrix theory during the neonatal period. The operation took place on the 56th postnatal day due to gradual proptosis of the left eye from the socket. The entire orbital tumor could be surgically removed via the inferior orbital fissure, which had been expanded by the pressure of the tumor. This case suggests that orbital tumors expanding into pterygopalatine fossa can be removed by the intraoral approach because the bone of infants is so soft. The eyeball of the patient was temporarily depressed after the operation, but that was improved by tissue remodeling with time. Therefore, it is recommended that reconstructive surgery for an infant should be performed at the age of 12 months or older.

Orbital cysts of childhood—classification, clinical features, and management

There is little in the literature about the clinical spectrum of orbital cysts of childhood and no comprehensive classification has been proposed. The authors propose a classification of orbital cysts of childhood and review their clinical features, pathology, and management. The major categories in the classification include cysts of surface epithelium, teratomatous cysts, neural cysts, secondary cysts, inflammatory cysts, and noncystic lesions with cystic component. Cysts of the surface epithelium are further divided into simple epithelial cyst (epidermal, conjunctival, respiratory, and apocrine gland), and dermoid cyst (epidermal and conjunctival). Epidermal dermoid cyst (dermoid) is by far the most common orbital cystic lesion in children, accounting for over 40% of all orbital lesions of childhood and for 89% of all orbital cystic lesions of childhood that come to biopsy or surgical removal. Neural cysts include those associated with ocular maldevelopment (congenital cystic eye and colobomatous cyst) and those associated with brain and meningeal tissue (cephalocele and optic nerve meningocele). The most important secondary cyst is mucocele that can occur in children with cystic fibrosis. Inflammatory cysts are generally due to parasitic infestations and are more common in tropical areas of the world. Noncystic lesions that can have a cystic component include adenoid cystic carcinoma, rhabdomyosarcoma, lymphangioma, and others. Each type of cyst has rather characteristic, but not pathognomonic, clinical features. Computed tomography and magnetic resonance imaging can help differentiate a cystic lesion from a solid tumor, suggest the type of cyst, and help in planning management. The pathology varies with the cells that line the cyst and with the inflammatory agent. Management varies from local excision to observation, depending on the location and type of cyst. Orbital cysts of childhood can be classified into categories, based mainly on their histopathology. The clinical, radiologic, and histopathologic features can be correlated with the classification in order to better evaluate a child with a cystic lesion in the orbit.

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.

Ocular choristomas

Choristomas are congenital lesions representing normal tissue(s) in an abnormal location. They are the most common epibulbar and orbital tumors in children. Epibulbar choristomas affect the cornea, limbus or subconjunctival space, and range in appearance from a small, flat lesion to a large mass filling most of the epibulbar region. Astigmatism is often present. Choristomas may be associated with coloboma, Goldenhar syndrome or epidermal nevus syndromes; those associated with the latter are often bilateral and extensive. Choristomas are occasionally familial. Surgery may be indicated to improve vision or cosmesis, or to impede growth. Although choristomas most commonly involve the epibulbar area, they can affect many areas of the eye and orbit, and often affect more than one area.

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.

Teratoma orbitae. Report of a case

A case of orbital teratoma was noted at birth. The neoplasm with a normally developed eye at its apex protruded between distended eyelids from an enlarged but intact orbit. The tumour was successfully extirpated on the day after birth. Histological examination revealed components from all 3 germinal layers and no sign of malignancy.