To analyze the characteristics and treatment outcomes of pediatric orbital dermoid cysts. Chart review of consecutive pediatric biopsy-proven dermoid cysts surgically removed at the Department of Ophthalmology, Maggiore Hospital, between 2000 and 2007. We excised dermoid cysts from 30 children (30 eyes) whose mean age at the time of surgery was 24 months (range 6-84). The most common presentation of the cyst was a palpable or partially palpable mass (100%), followed by a superior lid ptosis (10%). Twenty patients (67%) had superficial cysts with margins well-definable by palpation, and 10 patients (33%) had deep cysts that extended beyond the orbital rim with an incomplete palpation of margins requiring imaging studies. The most frequent localization of the cysts was the superior temporal zygomatico-frontal suture (86.6%), followed by the superior nasal frontal suture (10%). Complete removal of the cysts was achieved and confirmed histopathologically, and there were no recurrences among the patients at a mean follow-up of 28 months (range 6-73). One child, however, developed a temporary orbital hematoma. The superficial cysts had an anatomic mean diameter of 10 mm (range 2.5-15), and the mean age of the patients at surgery was 19 months (range 6-31). The deep cysts had a larger diameter with a mean of 14 mm (range 10-30) (P = 0.008), and the children were older at presentation with a mean age of 34 months (range 15-84) (P = 0.03). There was a statistically significant difference (P < 0.05) between the two groups (superficial and deep) when comparing age and diameter. Cysts with palpably distinct margins (superficial) can be easily and completely excised with no recurrence. Cysts with indistinct margins need detailed computed tomography or magnetic resonance imaging investigation because they may require deep orbital dissection. Complete excision of the cyst's capsule may be difficult as a result. In our review we have not found cysts with intracranial extension.
To report on the diagnostic challenge of an adenoid cystic carcinoma arising from the eyelid. A 77-year-old male was referred to our center with a clinical diagnosis of upper eyelid chalazion for a lesion that had appeared 2 years before. A loss of cilia was observed over the cutaneous area of induration, but there was no reddening or ulceration. Incisional biopsy was performed and the specimen was submitted in formalin for histopathological examination. On light microscopy, the lesion was composed of basaloid epithelial and myoepithelial cells that were arranged in strands or nests and associated with cystic spaces that contained a deeply eosinophilic secretory substance and an Alcian blue-positive material, characteristic of adenoid cystic carcinoma. After histological diagnosis, tumor re-excision was performed to ensure adequacy of resection margins, as well as a sentinel lymph node procedure, resulting in complete excision of the malignant tumor. No recurrence was observed during the first 18 months after surgery. Adenoid cystic carcinoma is a rare and aggressive epithelial malignancy, which tends to grow slowly and should be considered in the differential diagnosis of eyelid tumors simulating chalazion.
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