Epidermoid Cyst

E-Poster

Dr. Mihir Mujumdar (PG Student)Dr. Neeta Misra (Professor)

Intoduction• Epidermoid cysts generally presents as soft, freely movable, slowly

enlarging, nontender masses, most commonly in the supero-temporal periorbital margin.

• These are the most common orbital neoplasms in the pediatric age group, a majority of them presenting within the first decade of life.

• These tumors are basically choristomas and results from sequestration of surface ectoderm at bone suture lines or along the lines of embryonic closure.[1]

• Epidermoid cyst contains stratified squamous epithelium forming the wall of the cyst.

• The lesions often connect to bone sutures by way of fibrous attachments. The frontal–zygomatic suture is the most common attachment for the periorbital epidermoid.

• Although the supero-temporal quadrant is the most characteristic location, these lesions may occur in any periorbital location.

Introduction• These tumors are likely to remodel the orbital walls or rim due

to pressure effects, which may lead to fossa formation in orbital wall.

• Occasionally these tumors may extend into the temporal fossa or even into intracranial space due to extensive bone erosion. [2]

• Signs and symptoms depends upon the location of the tumor (periorbital or orbital tumors).

• Periorbital tumors are cosmetically unappealing while orbital tumors may present with diplopia and proptosis.[3]

• Another presentation of these tumors consists of orbital inflammation after blunt trauma. In this situation, trauma results in the rupture of the cyst, with the release of its contents into the soft tissues. Inflammatory foreign body reaction ensues.

Case Report• A five year old female child presented with a soft, non-

tender, freely movable, non-pulsatile, non reducible swelling, which was present since birth, over the left supero-temporal orbital margin.

• The swelling was smaller at birth, but it gradually increased to present size, within the course of five years.

Clinical Features• Size of the tumor is 5 x 5 x 2.5 cm.• Tumor has smooth surface with well defined margins.• Fluctuation test is positive.• Trans-illumination test is negative.• Temperature not raised as compared to contralateral

side.• No pus-point, scar-mark or dialated blood vessels

present over the swelling.• No history of discharge from the swelling.• No palpable regional lymph nodes are felt.• No similar swelling present over rest of the body.

Treatment• A horizantal incision made on the skin over the swelling and the

tumor exposed.• Blunt dissecction done around the tumor and intact lump was

excised.

Treatment• Muscle sutures were taken, followed by skin

sutures.

Histopathology

• Histopathological section of epidermoid cyst showed stratified squamous epithelium forming the walls of the cyst.

Post operative results• The swelling subsided after the tumor excision.• Skin sutures were removed on eighth post-

operative day.

Conclusion

• Although peri-orbital epiermoid cysts are usually painless, they impart a cosmetically challanged appearance.

• As there is no medical line of management of these tumors, they are to be managed surgically.

Refrences1. Gary E. Borodic; Principles and Practice of Ophthalmology,

Chapter 228, Cystic Lesions of the Orbit; Third Edition : 2903-2912.

2. Grove AS: Giant dermoid cyst of the orbit. Ophthalmology 1979; 86:1513–1520.

3. Rootman J: Diseases of the orbit. Philadelphia: JB Lippincott; 1988:489.