Orbit, 2014; 33(3): 193–195 ! Informa Healthcare USA, Inc. ISSN: 0167-6830 print / 1744-5108 online DOI: 10.3109/01676830.2013.872151
C ASE REPORT
Dermolipoma of the Lower Eyelid Devjyoti Tripathy1 and Ruchi Mittal2 1
Oculoplastics, Orbit & Ocular Oncology Services, LV Prasad Eye Institute, Bhubaneswar, Odisha, India and 2 Ophthalmic Pathology Services, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
ABSTRACT Purpose: To report a rare case of isolated dermolipoma of the lower eyelid. Design: Case report. Results: A young otherwise healthy girl presenting with a slowly progressive, painless lesion of the left lower eyelid of about 3 years’ duration had undergone conservative management elsewhere for symptoms of intermittent, mild irritation associated with the mass without any significant benefit. Increase in the size of the lesion in the recent past had been noted. Mass excision with histopathology showed it to be consistent with a dermolipoma. Conclusions: An eyelid dermolipoma is distinctly uncommon in occurrence. Nonetheless, it should be considered in the differential diagnosis of benign mass lesions of the eyelid. Keywords: Choristoma, dermolipoma, eyelid
INTRODUCTION
intermittent, mild irritation in her left eye. Conservative treatment instituted elsewhere had not been of any significant benefit to her. An increase in the size of the lesion had been noticed by her over the past several months. There were no other associated ocular or systemic complaints. The patient had a best corrected visual acuity of 20/20, N6 in both eyes needing refractive correction for compound myopic astigmatism. Intraocular pressures were 14 mm of Hg in both eyes. The mass, located over the central third of the left lower tarsal conjunctiva, was soft, non-tender and slightly elevated (Figure 1A). It measured 10 mm 8 mm 3 mm and the surface appeared finely stippled due to the presence of hair follicles (Figure 1B). On slit lamp examination, the overlying tarsal conjunctiva, apart from the presence of the hair follicles, appeared to be essentially normal. There was no obvious conjunctival surface keratinisation. Clinically, the mass appeared to be attached to the underlying tarsal plate. The rest
Choristomas of the ocular surface are known to be the commonest epibulbar tumors of childhood.1 Dermolipomas are a variant of epibulbar choristomas and typically involve the bulbar subconjunctival space. Epibulbar dermolipomas in Goldenhar’s syndrome may sometimes involve the fornices and extend onto the eyelids. Isolated occurrence of an eyelid dermolipoma, however, is distinctly uncommon. Herein, the authors describe a case of an isolated lower eyelid dermolipoma.
CASE REPORT A 17-year-old girl presented to the authors’ outpatient clinic with the complaint of a slowly progressive, painless lesion in her left lower eyelid of about 3 years’ duration. She reported symptoms of
Received 5 July 2013; Accepted 2 December 2013; Published online 7 January 2014 Correspondence: Devjyoti Tripathy, Oculoplastics, Orbit & Ocular Oncology Services, LV Prasad Eye Institute, Patia, Bhubaneswar 751024, Odisha, India, Tel: +91-674-3987999. Fax: +91-674-3987130. E-mail: [email protected]
193
194 D. Tripathy and R. Mittal
FIGURE 1. (A) A slightly elevated soft tissue mass seen over the central one-third of the left lower tarsal conjunctiva; (B) Stippled surface of the mass indicating presence of hair follicles.
an occasional pilosebaceous unit was noted (Figure 3B). Based on these features, the histopathological diagnosis of a dermolipoma was made.
DISCUSSION
FIGURE 2. Scanner magnification photomicrograph shows two fragments of excised tissue with epithelial and adipose tissue components (stain, hematoxylin & eosin, 40).
of the ocular (anterior and posterior segments) examination was unremarkable. The systemic examination was within normal limits. The patient underwent excision of the mass under infiltrative local anaesthesia. At surgery, the mass was found to contain fat and was also adherent to (but easily separable from) the posterior surface of the tarsal plate. It was excised piecemeal and was submitted for histopathological analysis. Microscopic examination of multiple fragments revealed a mass covered by keratinized stratified squamous to stratified columnar epithelium (Figures 2 and 3). The mass comprised largely of mature adipose tissue interspersed with coarse bundles of collagen (Figures 3A and B). Presence of
Dermolipomas are a variant of choristomas. Choristomas form a group of congenital benign tumors composed of mature normal tissue elements occurring at an abnormal location.2 Ocular surface choristomas may be classified into limbal dermoids, dermolipomas (lipodermoids), complex choristomas and osseous choristomas.3,4 Dermolipomas are believed to arise from the abnormal sequestration of ectodermal tissue within embryonic lines of fusion during early gestational development.5 As evident by the nomenclature, a dermolipoma contains dermal appendages and fatty tissue. Ocular surface dermolipomas may be covered by keratinized or non-keratinized stratified squamous epithelium. They are typically located in the temporal or superotemporal bulbar subconjunctival space often in close relation to the lateral rectus muscle or the lacrimal gland.6 Isolated dermolipomas of the eyelid are extremely rare. To the best of our knowledge, only one other report existing in the current literature describes this entity.7 Our case is similar to the one previously described as regards the age at presentation. This could possibly be ascribed to the fact that choristomas, though congenital in origin, have been described to exhibit growth during puberty.4 The ocular surface symptoms in our case were milder presumably due to the absence of keratinisation of the Orbit
Dermolipoma of the Lower Eyelid 195
FIGURE 3. (A) High magnification photomicrograph shows stratified squamous (arrow marked) to stratified columnar epithelium, covering the mass. The mass is predominantly composed of mature adipocytes interspersed with coarse bundles of collagen (stain, hematoxylin & eosin, 200); (B) Occasional pilosebaceous units can be appreciated (asterix marked) (stain, hematoxylin & eosin, 400).
conjunctival surface. This was in contrast to the previously reported case where the patient was initially diagnosed to have chronic conjunctivitis with ectopic cilia.5 Eyelid dermolipomas appear to be more easily amenable to complete surgical excision with less complications as compared to subconjunctival dermolipomas which have been reported to present with complications like blepharoptosis, diplopia and keratoconjunctivitis sicca8,9 post-excision. In summary, this case illustrates that dermolipomas are also a part of the wide spectrum that characterizes benign growths of the eyelids. In spite of their rarity, they should be considered in the differential diagnosis of benign mass lesions of the eyelid.
DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
!
2014 Informa Healthcare USA, Inc.
REFERENCES 1. Cunha RP, Cunha MC, Shields JA. Epibulbar tumors in children: a survey of 282 biopsies. J Pediatr Ophthalmol Strabismus 1987;24:249–254. 2. Kim BJ, Kazim M. Bilateral symmetrical epibulbar osseous choristoma. Ophthalmology 2006;113:456–458. 3. Hadjadj E, Conrath J, Denis D. Bilateral osseous choristoma. J Pediatr Ophthalmol Strabismus 1999;36: 347–348. 4. Gayre GS, Proia AD, Dutton JJ. Epibulbar osseous choristoma: case report and review of the literature. Ophthalm Surg Lasers 2002;33:410–415. 5. Eijpe AA, Koornneef L, Bras J, et al. Dermolipoma: characteristic CT appearance. Doc Ophthalmol 1990;74: 321–328. 6. Fry CL, Leone Jr CR. Safe management of dermolipomas. Arch Ophthalmol 1994;112:1114–1116. 7. Maeng H, Lee LK, Woo K, Kim Y. A unique case of dermolipoma located in the lower eyelid. Ophthal Plast Reconstr Surg 2010;4:288–289. 8. Beard C. Dermolipoma surgery, or, ‘‘an ounce of prevention is worth a pound of cure’’. Ophthal Plast Reconstr Surg 1990;6:153–157. 9. McNab AA, Wright JE, Caswell AG. Clinical features and surgical management of dermolipomas. Aust NZ J Ophthalmol 1990;18:159–162.
Copyright of Orbit is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
C ASE REPORT
Dermolipoma of the Lower Eyelid Devjyoti Tripathy1 and Ruchi Mittal2 1
Oculoplastics, Orbit & Ocular Oncology Services, LV Prasad Eye Institute, Bhubaneswar, Odisha, India and 2 Ophthalmic Pathology Services, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
ABSTRACT Purpose: To report a rare case of isolated dermolipoma of the lower eyelid. Design: Case report. Results: A young otherwise healthy girl presenting with a slowly progressive, painless lesion of the left lower eyelid of about 3 years’ duration had undergone conservative management elsewhere for symptoms of intermittent, mild irritation associated with the mass without any significant benefit. Increase in the size of the lesion in the recent past had been noted. Mass excision with histopathology showed it to be consistent with a dermolipoma. Conclusions: An eyelid dermolipoma is distinctly uncommon in occurrence. Nonetheless, it should be considered in the differential diagnosis of benign mass lesions of the eyelid. Keywords: Choristoma, dermolipoma, eyelid
INTRODUCTION
intermittent, mild irritation in her left eye. Conservative treatment instituted elsewhere had not been of any significant benefit to her. An increase in the size of the lesion had been noticed by her over the past several months. There were no other associated ocular or systemic complaints. The patient had a best corrected visual acuity of 20/20, N6 in both eyes needing refractive correction for compound myopic astigmatism. Intraocular pressures were 14 mm of Hg in both eyes. The mass, located over the central third of the left lower tarsal conjunctiva, was soft, non-tender and slightly elevated (Figure 1A). It measured 10 mm 8 mm 3 mm and the surface appeared finely stippled due to the presence of hair follicles (Figure 1B). On slit lamp examination, the overlying tarsal conjunctiva, apart from the presence of the hair follicles, appeared to be essentially normal. There was no obvious conjunctival surface keratinisation. Clinically, the mass appeared to be attached to the underlying tarsal plate. The rest
Choristomas of the ocular surface are known to be the commonest epibulbar tumors of childhood.1 Dermolipomas are a variant of epibulbar choristomas and typically involve the bulbar subconjunctival space. Epibulbar dermolipomas in Goldenhar’s syndrome may sometimes involve the fornices and extend onto the eyelids. Isolated occurrence of an eyelid dermolipoma, however, is distinctly uncommon. Herein, the authors describe a case of an isolated lower eyelid dermolipoma.
CASE REPORT A 17-year-old girl presented to the authors’ outpatient clinic with the complaint of a slowly progressive, painless lesion in her left lower eyelid of about 3 years’ duration. She reported symptoms of
Received 5 July 2013; Accepted 2 December 2013; Published online 7 January 2014 Correspondence: Devjyoti Tripathy, Oculoplastics, Orbit & Ocular Oncology Services, LV Prasad Eye Institute, Patia, Bhubaneswar 751024, Odisha, India, Tel: +91-674-3987999. Fax: +91-674-3987130. E-mail: [email protected]
193
194 D. Tripathy and R. Mittal
FIGURE 1. (A) A slightly elevated soft tissue mass seen over the central one-third of the left lower tarsal conjunctiva; (B) Stippled surface of the mass indicating presence of hair follicles.
an occasional pilosebaceous unit was noted (Figure 3B). Based on these features, the histopathological diagnosis of a dermolipoma was made.
DISCUSSION
FIGURE 2. Scanner magnification photomicrograph shows two fragments of excised tissue with epithelial and adipose tissue components (stain, hematoxylin & eosin, 40).
of the ocular (anterior and posterior segments) examination was unremarkable. The systemic examination was within normal limits. The patient underwent excision of the mass under infiltrative local anaesthesia. At surgery, the mass was found to contain fat and was also adherent to (but easily separable from) the posterior surface of the tarsal plate. It was excised piecemeal and was submitted for histopathological analysis. Microscopic examination of multiple fragments revealed a mass covered by keratinized stratified squamous to stratified columnar epithelium (Figures 2 and 3). The mass comprised largely of mature adipose tissue interspersed with coarse bundles of collagen (Figures 3A and B). Presence of
Dermolipomas are a variant of choristomas. Choristomas form a group of congenital benign tumors composed of mature normal tissue elements occurring at an abnormal location.2 Ocular surface choristomas may be classified into limbal dermoids, dermolipomas (lipodermoids), complex choristomas and osseous choristomas.3,4 Dermolipomas are believed to arise from the abnormal sequestration of ectodermal tissue within embryonic lines of fusion during early gestational development.5 As evident by the nomenclature, a dermolipoma contains dermal appendages and fatty tissue. Ocular surface dermolipomas may be covered by keratinized or non-keratinized stratified squamous epithelium. They are typically located in the temporal or superotemporal bulbar subconjunctival space often in close relation to the lateral rectus muscle or the lacrimal gland.6 Isolated dermolipomas of the eyelid are extremely rare. To the best of our knowledge, only one other report existing in the current literature describes this entity.7 Our case is similar to the one previously described as regards the age at presentation. This could possibly be ascribed to the fact that choristomas, though congenital in origin, have been described to exhibit growth during puberty.4 The ocular surface symptoms in our case were milder presumably due to the absence of keratinisation of the Orbit
Dermolipoma of the Lower Eyelid 195
FIGURE 3. (A) High magnification photomicrograph shows stratified squamous (arrow marked) to stratified columnar epithelium, covering the mass. The mass is predominantly composed of mature adipocytes interspersed with coarse bundles of collagen (stain, hematoxylin & eosin, 200); (B) Occasional pilosebaceous units can be appreciated (asterix marked) (stain, hematoxylin & eosin, 400).
conjunctival surface. This was in contrast to the previously reported case where the patient was initially diagnosed to have chronic conjunctivitis with ectopic cilia.5 Eyelid dermolipomas appear to be more easily amenable to complete surgical excision with less complications as compared to subconjunctival dermolipomas which have been reported to present with complications like blepharoptosis, diplopia and keratoconjunctivitis sicca8,9 post-excision. In summary, this case illustrates that dermolipomas are also a part of the wide spectrum that characterizes benign growths of the eyelids. In spite of their rarity, they should be considered in the differential diagnosis of benign mass lesions of the eyelid.
DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
!
2014 Informa Healthcare USA, Inc.
REFERENCES 1. Cunha RP, Cunha MC, Shields JA. Epibulbar tumors in children: a survey of 282 biopsies. J Pediatr Ophthalmol Strabismus 1987;24:249–254. 2. Kim BJ, Kazim M. Bilateral symmetrical epibulbar osseous choristoma. Ophthalmology 2006;113:456–458. 3. Hadjadj E, Conrath J, Denis D. Bilateral osseous choristoma. J Pediatr Ophthalmol Strabismus 1999;36: 347–348. 4. Gayre GS, Proia AD, Dutton JJ. Epibulbar osseous choristoma: case report and review of the literature. Ophthalm Surg Lasers 2002;33:410–415. 5. Eijpe AA, Koornneef L, Bras J, et al. Dermolipoma: characteristic CT appearance. Doc Ophthalmol 1990;74: 321–328. 6. Fry CL, Leone Jr CR. Safe management of dermolipomas. Arch Ophthalmol 1994;112:1114–1116. 7. Maeng H, Lee LK, Woo K, Kim Y. A unique case of dermolipoma located in the lower eyelid. Ophthal Plast Reconstr Surg 2010;4:288–289. 8. Beard C. Dermolipoma surgery, or, ‘‘an ounce of prevention is worth a pound of cure’’. Ophthal Plast Reconstr Surg 1990;6:153–157. 9. McNab AA, Wright JE, Caswell AG. Clinical features and surgical management of dermolipomas. Aust NZ J Ophthalmol 1990;18:159–162.
Copyright of Orbit is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
