Multilobular dermoid cyst of the orbit

Abstract

Dermoid cysts are histologically defined as surface epithelium encapsulating an inner lumen. They are well described in the literature as discrete, single masses, either circumscribed or dumbbell-shaped, with or without a longstanding fistula. Chronic granulomatous inflammation is often a feature of dermoid cysts, contributing to local soft tissue and bony destruction. Isolated multicystic dermoids are not well described. We present a case of a multilobular dermoid characterized both radiographically and histopathologically. These findings may be attributed to repeated rupture and reformation of the dermoid cyst. When possible, our experience favours early excision of orbital dermoid cysts to minimize morbidity.

Cystic Lesions of the Orbit

“…Deep orbital cysts are often asymptomatic until adulthood when they present either secondary to mass effect 14 . Symptoms include progressive proptosis, globe displacement, ptosis, diplopia, reduced visual acuity, and, rarely, an acute inflammatory syndrome secondary to cyst rupture 7,11–15,17 …”

“…11,13,14 Dermoid cysts are characterized by adnexal components, including hair follicles or glandular structures. 7,15 Epidermoid cysts, though clinically and radiologically similar to dermoid lesions, are most often traumatic in etiology and are differentiated by the absence of adnexal structures. 8 Clinical Presentation The clinical presentation of dermoid and epidermoid cysts varies depending on the location and depth of the lesion.…”

“…Histologically, both dermoid and epidermoid cysts are lined with keratinized stratified squamous epithelium and encapsulated by a fibrous wall and may demonstrate chronic inflammatory features. 7,15 Dermoid cysts are differentiated by the presence of skin adnexal components, which are absent in epidermoid lesions, thus definitive diagnosis is histologic. 7,18 Management The approach to dermoid and epidermoid cysts is the same.…”

“…Lesions most commonly occur along the frontozygomatic suture, though they may also arise from the medial wall along the frontoethmoidal and frontolacrimal sutures, or within the deep orbital soft tissue 11,13,14 . Dermoid cysts are characterized by adnexal components, including hair follicles or glandular structures 7,15 . Epidermoid cysts, though clinically and radiologically similar to dermoid lesions, are most often traumatic in etiology and are differentiated by the absence of adnexal structures 8 …”

“…14 Symptoms include progressive proptosis, globe displacement, ptosis, diplopia, reduced visual acuity, and, rarely, an acute inflammatory syndrome secondary to cyst rupture. 7,[11][12][13][14][15]17 Investigations Epidermoid cysts are generally fluid-filled with an isodense center on CT. 8 Dermoid cysts characteristically appear as a wellcircumscribed mass with radiolucent fatty content, arising from suture lines (Figs. 1B, C).…”