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Alexa AI, Leferman CE, Ciubotaru AD, Sandu IA, Sandu CA, Bogdănici CM. Therapeutic challenges in epidermal inclusion cysts with periocular localization: case reports. J Med Life 2023; 16:1575-1578. [PMID: 38313165 PMCID: PMC10835546 DOI: 10.25122/jml-2023-0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 02/06/2024] Open
Abstract
Epidermal inclusion cysts in the periocular region are distinctive pathologies exhibiting varied clinical and radiological features, and they should be taken into consideration in the differential diagnosis of cystic lesions near the orbit. This article discusses the clinical and radiological details, along with the surgical results, of two individual cases of epidermal inclusion cysts, with different localization and without any preceding trauma, surgical history, or eyelid inflammation. In the first case, a substantial spherical structure closely connected to the tarsal plate was identified via excisional biopsy, whereas the second case involved a soft, oval tumor located at the outer right orbital corner, as determined clinically and validated through computed tomography. The histological examination showed cysts lined with a keratinized squamous layer, confirming an epidermoid cyst. The surgical removal of the cysts led to esthetically satisfactory outcomes in both cases. The particularity of the presented cases lies in the locations and considerable sizes of the tumors, which have complicated their surgical management. Such instances of epidermal inclusion cysts attached to the tarsus are rarely reported in the literature.
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Affiliation(s)
- Anisia-Iuliana Alexa
- Department of Ophthalmology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
| | | | - Alin Dumitru Ciubotaru
- Department of Neurology, "Grigore T. Popa" University of Medicine and Pharmacy Iași, Romania
| | - Ioana Alexandra Sandu
- Department of Medical Specialties II, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Calina Anda Sandu
- Department of Ophthalmology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
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2
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Wang KY, Xu TT, White LJ, Hodge DO, Dalvin LA. Incidence and clinical characteristics of pediatric ocular tumors in a Midwestern US population. J AAPOS 2023; 27:189.e1-189.e5. [PMID: 37453664 PMCID: PMC10528778 DOI: 10.1016/j.jaapos.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/07/2023] [Accepted: 05/07/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To investigate the incidence and clinical characteristics of pediatric ocular tumors in a US Midwestern county population. METHODS Retrospective population-based cohort study of all Olmsted County, Minnesota, pediatric patients (<18 years old) diagnosed with any ocular neoplasm from January 1, 2006, to December 31, 2015. Subjects were identified via the Rochester Epidemiology Project, a record-linkage system that captures virtually all medical care provided in this county. Medical records were reviewed to confirm diagnoses. Age- and sex-adjusted incidence rates were calculated and adjusted to the 2010 Olmsted County, Minnesota, pediatric population. RESULTS There were 87 incident pediatric ocular tumor diagnoses, yielding an overall age- and sex-adjusted incidence rate of 24.0 per 100,000 per year (95% CI, 19.0-29.1). Females accounted for 46 cases (53%) cases, and 62 (85%) were White. Incidence rate for ocular tumors overall did not differ by patient age (P = 0.08) or sex (P = 0.47). All tumors were benign lesions. The most frequent adnexal/orbital, ocular surface, and intraocular tumors were epidermal inclusion cyst in 18 (21%) cases, conjunctival nevus in 10 (12%), and choroidal nevus in 18 (21%), respectively. The mean follow-up duration was 25.5 months (range, 7 days to 138.6 months), and benign tumor growth occurred in one conjunctival nevus. There were no cases of malignant transformation. CONCLUSIONS Pediatric ocular tumors were rare with an estimated incidence of approximately 1 in 4,200 pediatric patients in Olmsted County, Minnesota. All lesions were benign, with benign growth in only 1% of cases, and no tumors underwent malignant transformation.
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Affiliation(s)
- Kenny Y Wang
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Timothy T Xu
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Launia J White
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
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3
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Diab MM, Allen RC, Abdel Ghafar AE, Elessawy KB. Comparison of three surgical techniques for internal angular dermoid cysts: a randomized controlled trial. Eye (Lond) 2022; 36:2253-2259. [PMID: 34802052 PMCID: PMC9674663 DOI: 10.1038/s41433-021-01851-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/10/2021] [Accepted: 11/09/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the outcomes of three techniques for removing internal angular dermoid cysts: lid crease, sub-brow, and direct mini-incision. METHODS In this single-center trial, 47 children with internal angular dermoids were enrolled and randomly assigned to one of three surgical groups: group A, sub-brow, group B, lid crease, and group C, direct mini-incision. Outcome measures were operative time, postoperative scar quality using Stony Brook Scar Evaluation Scale (SBSES), scar visibility, and family satisfaction. RESULTS In each group, fifteen patients completed follow-up and were analysed. The operation time (median/IQR) in Group C was significantly shorter (10/5 min) compared with group A (25/10 min) and B (35/20 min) (p < 0.001). Group B had the least visible scar at all follow-up visits. Both group B and C showed superior scar quality using SBSES compared with group A at 6 months (p < 0.001). All families in group B (100%) found the scar excellent compared to 11 families in group C (40%) and 6 families in group A (73.3%). Persistent postoperative inflammation was noticed in two patients in group C. No cases of recurrence were recorded. CONCLUSIONS Both the lid crease and direct mini-incision approaches result in superior scar quality with minimum visibility compared with the sub-brow technique, however, the lid crease technique shows a prolonged operation time particularly for cysts outside the rim.
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Affiliation(s)
- Mostafa M Diab
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt.
| | - Richard C Allen
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Ayman E Abdel Ghafar
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Kareem B Elessawy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Tooley AA, Tailor P, Tran AQ, Garrity JA, Eckel L, Link MJ. Differentiating intradiploic orbital dermoid and epidermoid cysts utilizing clinical features and machine learning. Indian J Ophthalmol 2022; 70:2102-2106. [PMID: 35647991 PMCID: PMC9359230 DOI: 10.4103/ijo.ijo_52_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose The purpose of this study was to characterize intradiploic dermoid and epidermoid orbital cysts to determine any differences in clinical, radiographic, or surgical features. Methods A retrospective review was performed of patients presenting with intradiplopic dermoid or epidermoid cysts. Additionally, a complete review of the literature was performed to identify cases of intradiplopic orbital dermoid and epidermoid cysts. Data collected included age, sex, presenting symptoms, location of intradiplopic cyst, ophthalmic findings, treatment, and follow-up. Clinical features of dermoid versus epidermoid cyst were compared. Additionally, machine-learning algorithms were developed to predict histopathology based on clinical features. Results There were 55 cases of orbital intradiploic cysts, 49 from literature review and six from our cohort. Approximately 31% had dermoid and 69% had epidermoid histopathology. Average age of patients with dermoid cysts was significantly lesser than that of patients with epidermoid cysts (23 vs. 35 years, respectively; P = 0.048). There was no difference between sex predilection, presenting symptoms, radiographic findings, or surgical treatment of dermoids and epidermoids. The majority of patients (64%) underwent craniotomy for surgical removal. Machine-learning algorithms KStar and Neural Network were able to distinguish dermoid from epidermoid with accuracies of 76.3% and 69%, respectively. Conclusion Orbital intradiploic cysts are more commonly epidermoid in origin. Dermoid cysts presented in younger patients; however, there were no other significant differences in features including ophthalmic or radiographic findings. Despite similar features, machine learning was able to identify dermoid versus epidermoid with good accuracy. Future studies may examine the role of machine learning for clinical guidance as well as new surgical options for intervention.
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Affiliation(s)
| | | | - Ann Q Tran
- Manhattan Ear, Eye and Throat Hospital, New York, NY, USA
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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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Turanzas NJ, von Holstein SL, Wiencke AK, Toft PB, Heegaard S, Kessel L. Epidemiology and clinical characteristics of congenital choristomas in the ocular adnexa of pediatric patients. Graefes Arch Clin Exp Ophthalmol 2022; 260:3069-3074. [PMID: 35445875 DOI: 10.1007/s00417-022-05652-3] [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: 12/09/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To investigate the epidemiology and clinical characteristics of infants presenting with conjunctival, palpebral, or orbital congenital choristomas (dermolipomas, epidermoids, and dermoid cysts) and children undergoing surgery for congenital choristomas in the ocular adnexa. METHODS We reviewed the medical files of congenital choristomas in children seen in The Capital Region of Denmark during a 5-year period (2014-2018). Children (< 18 years) were divided into two groups: those referred < 1 year of age (Group I) and those undergoing surgery to remove the lesion (Group II). Group I was used to calculate a population-based incidence of congenital choristomas by comparing our data to birth statistics from the Danish Medical Birth Registry. RESULTS A total of 97 children were included, 43 in Group I and 70 in Group II (including 16 patients from Group I). The total incidence of congenital choristomas was 1 in 2537 live born children. Most lesions were palpebral choristomas (27/43, 63%) located in the superotemporal region (17/27, 63%), followed by the superonasal region (7/27, 26%). The main reasons for surgical removal of a congenital choristoma were growth (28/70, 40%) or cosmesis (25/70, 36%). CONCLUSION The total incidence of congenital choristomas in the ocular adnexa of infants < 1 year of age, including both conjunctival and palpebral congenital choristomas, is about 1 in 2537 live born children in The Capital Region of Denmark. Hence, congenital choristomas are common masses found in the ocular adnexa.
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Affiliation(s)
- Nathali J Turanzas
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Sarah Linea von Holstein
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne Katrine Wiencke
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Bjerre Toft
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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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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8
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Feldmann ML, Chankiewitz E, Sonntag SR, Emmert S, Ranjbar M, Grisanti S, Kakkassery V. [Benign Tumors of the Eyelid]. Klin Monbl Augenheilkd 2022; 239:111-130. [PMID: 34798665 DOI: 10.1055/a-1671-0923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Benign tumors of the eyelids are manifold. They can severely impair the anatomical unit of upper and lower eyelid, which basically serves to protect the eyeball. Furthermore, they can induce reduction of visual acuity or cause a subjectively more or less strong aesthetic disturbance of appearance. Patients may visit the ophthalmologist by themselves or referred by a dermatologist or a general practitioner. Therefore, knowledge of the clinical signs and symptoms of benign tumors are mandatory to discriminate against malign tumors or to identify possible associated disease. In this article, the incidence, clinic, risk factors, symptomatology, histopathologic features, and probabilities of malignant transformation and recurrence of the most common benign eyelid tumors are presented. Objective of this article is to illustrate when to do further work-up to rule out systemic disease and when to do biopsy to rule out malignancy. Finally, the publication is giving an outlook on the use of artificial intelligence to diagnose lid tumors in the future.
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Feldmann ML, Chankiewitz E, Sonntag SR, Emmert S, Ranjbar M, Grisanti S, Kakkassery V. Benigne Lidtumoren. AUGENHEILKUNDE UP2DATE 2021. [DOI: 10.1055/a-1310-9303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungBenigne Lidtumoren sind vielfältig. In diesem Beitrag werden die häufigsten benignen Augenlidtumoren hinsichtlich Inzidenz, Klinik, Risikofaktoren, Symptomatik, histopathologischen Besonderheiten und Entartungs- sowie Rezidivwahrscheinlichkeit beleuchtet. Herausgearbeitet wird, wann eine systemische Abklärung erforderlich bzw. eine Probe zum Ausschluss eines Malignoms empfohlen ist und wie die Nachsorge auch im Hinblick auf eine spätere Entartung der Wucherung erfolgen sollte.
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10
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Vitulli F, D’Avella E, Solari D, Franca RA, Romano A, Bonavolontà P, Cavallo LM. Primary ectopic orbital craniopharyngioma. Acta Neurochir (Wien) 2021; 164:1979-1984. [PMID: 34467436 DOI: 10.1007/s00701-021-04969-y] [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: 06/10/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Craniopharyngiomas (CP) ectopic localizations off the midline outside the sellar-suprasellar region are very rare and most often associated to secondary tumor dissemination, being primary ectopic CPs extremely unusual. We herein report the first case of a primary ectopic craniopharyngioma within the orbit. A 15-year-old patient presented with progressive right ptosis, proptosis, and retro ocular pain. Magnetic resonance imaging (MRI) showed a predominantly cystic lesion, occupying the superolateral right corner of the orbit, outside the intraconal space with no evidence of intracranial involvement. An endoscopic transorbital eyelid approach was adopted. Pathology report disclosed a primary ectopic craniopharyngioma.
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Cutrone M. Quadri dermatologici della regione perioculare. MEDICO E BAMBINO 2021; 40:247-254. [DOI: 10.53126/meb40247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Un piccolo atlante in 36 immagini
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Affiliation(s)
- Mario Cutrone
- Ospedale dell'Angelo, Aulss 3 (Mestre - Venezia) e Ospedale San Bortolo Aulss 8 (Vicenza)
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12
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A Case Series of Intramuscular Orbital Choristomatous Cysts. Ophthalmic Plast Reconstr Surg 2021; 37:e51-e53. [PMID: 32675726 DOI: 10.1097/iop.0000000000001742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intramuscular choristomatous cystic lesions within the orbit are rare but may require removal due to their volume effects. The authors describe 2 such cases of intramuscular cysts in adult patients. Both patients presented with symptoms due to local mass effects with swelling, proptosis and diplopia. Imaging confirmed cystic intramuscular masses. Surgical removal involved intraoperative decompression of the cyst to aid dissection with excision of some muscle fibers. Histology confirmed a keratinized stratified squamous lined dermoid cyst within lateral rectus for case 1 and stratified squamous non-keratinized conjunctival epithelium (simple primary conjunctival cyst) within inferior oblique for case 2.
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13
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Davis MJ, Abu-Ghname A, Davies LW, Xue AS, Masoumy M, Lam S, Buchanan EP. Midline Intranasal Dermoid Cyst With Intracranial Extension. J Craniofac Surg 2020; 31:e241-e244. [DOI: 10.1097/scs.0000000000006184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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