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Clinical, radiological and
pathological examination of periocular dermoid cysts: evidence of
inflammation from an early age.
Eye.
2002 ;16(5):507-12
INTRODUCTION: Periocular dermoid cysts are common and leakage of the lipid
or keratin contents leads to an inflammation-often asymptomatic-around the
cyst, which may cause adherence of the dermoid cyst to neighbouring
structures. PURPOSE: To investigate the frequency of clinical and
radiological signs of inflammation with periocular dermoid cysts, to
relate this to the histopathological examination of the excised specimens,
and to assess whether the degree of inflammation is related to age at
presentation. PATIENTS AND METHODS: A retrospective non-comparative series
of 124 patients with periocular dermoid cysts that had undergone imaging.
Case-notes were reviewed for clinical and histopathological details and
there was independent review of the radiological imaging. RESULTS: Surgery
was undertaken at between 1 and 66 years of age, most patients being under
10 years, and the duration of symptoms varied from 4 weeks to 30 years.
Symptoms of inflammation-mainly intermittent lid swelling with localised
redness and pain-occurred in all age groups, the proportion being greatest
in the fourth decade. Clinical signs of inflammation at the time of clinic
visit were relatively few, although 8% had some localised erythema and 7%
had tenderness at the site of lesion. In more than two-thirds of the
excised cysts, pathological examination demonstrated various degrees of
chronic inflammation, even in those cysts removed before the age of 5
years. CONCLUSION: Even if the patient does not have symptoms or signs of
inflammation, most periocular dermoid cysts show histological evidence of
inflammation due to leakage of the lipid and keratin contents from the
cyst, the incidence being similar at all ages.
Covered rupture of
periocular dermoid cysts. Clinico-histologic study.
Klin Monatsbl Augenheilkd.
1993 Dec;203(6):403-7
BACKGROUND: Dermoid cysts are common periocular tumours that occur in
childhood and can, in case of rupture, result in persistent granulomatous
inflammation. Histologically signs of chronical inflammation of the wall
of the dermoid cyst are occasionally found in dermoid cysts that show no
clinical symptoms. The aim of this study is to analyze frequency and
etiology of this inflammation. PATIENTS AND METHODS: The charts of 21
patients that were operated on because of a dermoid cyst at Heidelberg
University Eye Hospital between 1986 and 1993 have been examined
concerning anamnesis, clinical symptoms, localisation of the cyst and
incidents during operation. The dermoid cysts were assessed
macroscopically, and histologically by means of serial sections (three
cuts every 200 microns). RESULTS: Histologically 8 patients (38%), of
which only one had clinical symptoms, showed an inflammation of the wall
of the cyst. The serial histological sections revealed a hidden rupture,
that is a damage of the epithelium with a remaining pseudo-capsule of
connective tissue, in these 8 patients. Hidden ruptures occurred
proportionately most often at the age of 20 to 40. All cysts with a volume
of more than 2197 mm3 showed a hidden rupture. CONCLUSIONS: Hidden
ruptures seem to be the reason for inflammations of the wall of a dermoid
cyst. By way of the rupture, the content of the cyst gets into contact
with the surrounding tissue, which results in a granulomatous reaction to
the foreign body with remaining pseudo-capsule, to begin with.
Etiologically a hidden rupture is promoted by the growth of the dermoid
cyst and the pubertal enlargement of the sebaceous glands in the wall of
the cyst. As a hidden rupture may result in a complete one with
corresponding clinical symptoms, and as the risk to rupture a cyst during
operation is higher in case of a cyst with hidden rupture, we recommend an
early operative removal of dermoid cysts, if possible at the age of 3 or
4, but at least within the first 10 years.
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