Giant Orbital Hydrocystoma in Children: Case Series and Review of the Literature

Orbital apocrine hidrocystoma. Report of two cases

INTRODUCTION

We report the clinical features and the management of two cases of orbital hidrocystoma in the setting of an enlarging orbital mass.

CASES DESCRIPTION

A 48-year-old man presented with a mass in the right upper medial orbital quadrant, firmly attached to the supraorbital incisure. A 70-year-old man had a well demarcated lesion in the upper lateral orbital quadrant adherent to the lacrimal gland. There was no history of previous orbital trauma. In both cases histopathology confirmed a diagnosis of apocrine hidrocystoma. Following surgery, the first patient complained of mild hypoesthesia in the territory of the supraorbital nerve that resolved spontaneously within 3 weeks. Surgery was uneventful in the other patient. No recurrence was seen during the follow up.

CONCLUSIONS

Apocrine hidrocystomas have been rarely described in the orbit, but should be considered in the differential diagnosis of orbital cystic masses. Recurrence is rare following complete surgical excision.

Pericanalicular eccrine hidrocystoma of the upper eyelid in a child

A rare case of pericanalicular eccrine hidrocystoma of the upper eyelid is reported in a child who underwent surgical excision and canalicular repair with a successful outcome.

Intraconal Orbital Hidrocystoma in an Infant

ABSTRACT

Intraconal orbital hidrocystoma is a very rare entity. Herein, a 6-month old boy with an intraconal apocrine hidrocystoma will be reported. The patient presented with a left-sided mild proptosis and significant anisometropic hypermetropia. Clinical examinations revealed choroidal folds and optic disc blurring in the left eye. Orbital MRI disclosed an intraconal well-defined cystic lesion that was hypointense in T1 and hyperintense in T2 weighted images. The lesion was excised completely through a lateral orbitotomy and diagnosed histologically as an apocrine hidrocystoma. Excepting partial improvement of anisometropia, other clinical signs were improved after surgery.

Eccrine hidrocystoma: a rare ophthalmic entity

Eyelid tumors are the most common neoplasm in routine ophthalmology practice and encompass a wide variety of benign and malignant tumors, predominant being benign tumors. Hidrocystomas are rare, benign, cystic lesions of the skin often found on the head and neck region and typically occurs on the face in adults between 30 and 70 years of age. They are further divided into two groups - apocrine and eccrine hidrocystoma; both closely mimic clinically and morphologically related cystic sweat gland tumors.  We present a “classic” case of eccrine hidrocystoma in a 60 year old female. The cysts are small, clear to blue and size ranging 1 to 6 mm in diameter. Histologically, the cysts are simple and lined by a 2 - 3 wall layers of cuboidal epithelium (non keratinizing), devoid of a myoepithelial layer. Eccrine lobules are often closely apposed, and occasionally the ducts enter the cysts. Immunohistochemically, they stain positive for S100 protein. Management of hidrocystomas mainly involves simple needle puncture with excision en mass. However, other treatment modalities are also available.

Congenital giant orbital eccrine hidrocystoma

Purpose

To describe the clinical presentation, management, and histopathological results of a congenital eccrine hidrocystoma.

Observations

A 4-year-old healthy boy presented with left upper eyelid ptosis and superonasal painless mass since birth. Computed tomography showed a hypodense cystic lesion located in the extraconal orbital compartment medially. Following complete excision, histopathology revealed an eccrine hidrocystoma.

Conclusions and Importance

Orbital eccrine hidrocystomas should be considered in the differential diagnosis of orbital cystic masses in the pediatric age group.

Giant eyelid eccrine hidrocystoma-induced progressive ptosis in childhood

An upper lid eccrine hidrocystoma presenting as early childhood progressive ptosis is very rare. We present a 9-year-old female child with droopy right upper lid since birth and progressive increase in symptoms. She had right upper lid ptosis (marginal reflex distance 1 of −1 mm) with fair levator function (8 mm) and abnormal cystic change on the conjunctival side. Computerized tomography imaging delineated the well-defined cystic lesion with homogeneous cavity with no contrast enhancement. Following the cyst excision, a giant eccrine hidrocystoma measuring 25 mm × 15 mm was removed, the largest reported in pediatric eyes. The case demonstrates the possibility of giant lid eccrine hidrocystomas presenting as progressive ptosis at a pediatric age and the need for early surgical intervention to prevent amblyopia.

Presentation of massive orbital hidrocystoma at birth: case report and review of the literature

Background

Hidrocystoma, or sudoriferous cyst, is an eyelid tumor originating from apocrine or eccrine sweat glands. Its presence in the orbit is relatively rare.

Case presentation

A full-term female child with severe right eye extrusion was referred to our department two hours after birth. We performed cyst aspiration under ultrasonic guidance; 15 cc straw-colored fluid was obtained and proptosis resolved significantly. Orbital magnetic resonance imaging (MRI) showed a large unilocular retrobulbar mass with hypo-intensity in T1 and hyper-intensity in T2. The case underwent further daily ocular assessment until day 5; when proptosis began to worsen again. On day 6, under general anesthesia, we performed aspiration and then the cyst was completely removed with an intact wall through a trans-conjunctival incision. The diameter of the aspirated cyst was about 4 cm. In pathologic consultation, a cystic cavity lined by a layer of sweat duct like epithelium with apical snouts consistent with the diagnosis of apocrine hidrocystoma was reported.

Conclusion

To date, in the literature, six other cases of orbital hidrocystoma have been reported in childhood with protean clinical pictures; none of which presented at birth. Herein, we introduce the first case report at birth and also provide a review on the literature. Our report strongly argues against the well reputed theory of traumatic origin for orbital hidrocystoma; it has been postulated that this tumor may be the result of sweat gland cells implantation through the orbit. We thereby suggest the possible presence of choristomatous ectopic sweat gland cells in the orbit during embryogenesis.