Association of epibulbar choristomas with linear cutaneous nevi. Review of the literature

Searching beyond nevi - A rare case of neurocutaneous ocular syndrome

Epidermal nevus syndrome is a rare congenital disorder affecting only a few hundred people in the world. It has ophthalmic, dermatological, and neurological manifestations, with varied presentation. Here, we report a case of two-year-old child who presented with epibulbar mass in left eye, pigmented nevi over left side of the body and alopecia over left side of parieto-temporal scalp. Imaging confirmed epibulbar mass and presence of calcification of choroid on ipsilateral side with presence of arachnoid cyst of brain with underlying pachygyria. Neurological examination was normal and dermatologist confirmed presence of verrucous nevi over skin. Excisional biopsy of epibulbar mass revealed a complex choristoma with presence of lacrimal gland tissue. Underlying ocular findings were near normal with normal posterior segment. It is a rare form of epidermal nevus syndrome with near normal ocular findings in the presence of anterior and posterior choristoma, which has not been reported.

Epibulbar complex and osseous choristoma: Clinicopathological study with interesting associations

Materials and methods

A retrospective cohort study of cases with tissue diagnosis of epibulbar choristoma in 2 centers presenting during the period: 2000–2016 with focus on cases of complex and osseous choristoma. Demographic and clinical data were collected by the resident from medical records. The histopathological slides were reviewed by 2 pathologists and cases of complex and osseous choristoma were analyzed by biostatical staff.

Results

120 epibulbar choristomas were identified. 13/120 patients (10.8%) with complex choristoma and 2/120 patients (1.7%) with osseous choristoma. 15 cases were further analyzed: 7 were males and 8 were females. Mean age at presentation was 7.6 year. Commonest location was temporal in 66.6%. The presence of smooth muscle component was associated with a larger size choristoma (p = 0.042). 73.3% had other ophthalmic manifestations (mostly eyelid anomalies) while 9 systemic associations (mostly Goldenhar's syndrome) were found in 8/13 cases of complex choristoma.

Conclusion

Epibulbar complex and osseous choristomas are rare. Histopathologically, the presence of smooth muscle significantly correlates with the lesion size. Complex choristoma is more likely to be associated with systemic manifestations. Further genetic studies for this condition are recommended.

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Choristomas are congenital tumors that may affect the epibulbar area.

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They arise from ectopic pluripotent cells differentiating into simple or complex choristoma.

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We present our cases to highlight interesting ophthalmic and/or systemic associations.

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This might open the door for future molecular genetic testing.

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Significant association is found between smooth muscle component and larger size choristoma.

Congenital complex corneal choristoma associated with unilateral bony calvarial defects, subcutaneous nodules, and alopecia

Complex corneal choristoma is a rare finding and its relationship with systemic disease is poorly understood. We present a 3-day-old boy with the constellation of left-sided congenital complex corneal choristoma, limbal dermoid, ipsilateral bony skull defects, and bilateral subcutaneous vascularized nodules with overlying alopecia and scalp nevi. To our knowledge this is the first case of complex choristoma involving the presence of associated bony calvarial defects. This presentation may contribute to a greater understanding of the systemic findings associated with the condition. Furthermore, it may shed light on the possible syndromic spectrum associated with complex choristoma and its underlying pathophysiology.

Ocular and systemic manifestations of encephalocraniocutaneous lipomatosis

Encephalocraniocutaneous lipomatosis is a congenital neurocutaneous syndrome with epibulbar choristomas and connective tissue nevi of the eyelids as common ophthalmic manifestations. Systemic manifestations occur ipsilateral to the ocular lesions and include lipomas of the cranium and central nervous system, alopecia of the scalp, and abnormalities of the central nervous system. We treated a child with encephalocraniocutaneous lipomatosis who required removal of an epibulbar choristoma. Pathologic evaluation of the epibulbar choristoma in our patient showed the presence of ectopic lacrimal gland tissue and cartilage. Encephalocraniocutaneous lipomatosis should be considered, together with Goldenhar's syndrome and sebaceous nevus syndrome, in the differential diagnosis of conditions associated with epibulbar choristomas.

Epibulbar complex choristoma involving the bulbar conjunctiva and cornea

A male infant was born with a fleshy mass between the temporal bulbar conjunctiva and cornea in the right eye. Four weeks after birth the patient underwent excision of the epibulbar tumor and a lamellar keratoplasty. Histopathologic examination of the excised tumor revealed cartilage, lobules of lacrimal gland, and adipose tissue, indicating an epibulbar complex choristoma. Although the graft remained almost completely transparent, right amblyopia ensued. Epibulbar complex choristoma involving the conjunctiva and cornea is a rare condition.

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.