[Intraorbital dermoid cyst. Case report and review of the literature]

Atypical intraorbital dermoid and epidermoid cyst: A single institution cross-sectional retrospective study

Purpose

Intraorbital epidermoid and dermoid cyst (DC) has been reported in the literature rarely. The current study evaluates clinicopathologic, radiologic, and management of intraorbital DC cases over ten years.

Methods

In this cross-sectional study, the medical records of patients with intraorbital DC treated at the academic referral center for ocular surgery were retrospectively reviewed. Data reviewed included the patient's demographic characteristics, clinical features, imaging, surgical technique, and pathology report.

Results

Nine patients with a rare presentation of intraorbital DC were reviewed within the study period in five presentations (five intraosseous, one intraconal, one dumbbell-shaped with a large part in anterior orbit, one juxta levator palpebral muscle, and one recurrent case with intracranial extension). They ranged from 8 to 53 years of age, with a median of 29 years, and five (55.6%) were female. Histopathological evaluation revealed two cysts were epidermoid.

Conclusion

The current study provides more clinical and radiologic manifestations of rare presentations of DC that highlight the importance of high clinical suspicion in the approach to atypical DC.

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The mean age of patients with intraorbital dermoid/epidermoid cyst was higher than periocular that usually present in early infancy.

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The most clinical signs of patients with intraorbital dermoid/epidermoid cyst were hypophthalmos, proptosis, lid puffiness, and ptosis.

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In addition to the atypical clinical presentation of intraorbital dermoid/epidermoid cyst, the radiological investigation is doubted potentially and can be caused mixed missed cases. So histopathological evaluation is essential for confirmation of the diagnosis.

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It may be difficult or impossible to excise a complete intraosseous dermoid/epidermoid cyst. In such cases, evacuating cyst contents allowed for easier dissection around the lesion. In addition, burring the bone is necessary in cases where there is an intimate connection of the cyst wall to the bone.

[Orbital dermoid cysts: Clinical spectrum and outcome]

INTRODUCTION

Dermoid cysts are benign congenital orbital tumors, they are classified as choristomas. Clinical manifestations vary according to location and size.

MATERIALS AND METHODS

We retrospectively analyzed 43 cases of dermoid cysts surgically treated between July 1998 and March 2009.

RESULTS

Mean patient age was 18.64 years. Among patients, 48.83% were male. Preseptal location was most common (41 cases). One of the two cases of intraorbital location required orbitotomy. We observed no complications or recurrence.

DISCUSSION

Dermoid cysts are most often seen in young patients. The mean age of our patients was relatively high. The majority of dermoid cysts are periorbital in location. Superficial orbital dermoid cysts are more frequent, present earlier in life and are more easily identified than deep dermoid cysts. Imaging plays a major role in the management of deep orbital tumors. Complete surgical excision has remained the mainstay of treatment.

CONCLUSION

Dermoid cysts are benign orbital tumors. Superficial dermoid cysts are the most common type. Deeper cysts require a more challenging diagnostic and therapeutic approach.