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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 56  |  Issue : 4  |  Page : 263-265

Caruncular dermoid: A report of a rare case


Department of Ophthalmology, Madurai Medical College, Madurai, Tamil Nadu, India

Date of Web Publication19-Feb-2019

Correspondence Address:
Dr. Shanmugam Rajeswari
Madakadu, Kokkiri Kattu Pudur, Vilakethi (PO), Sivagiri (Via), Erode, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_95_18

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  Abstract 


A dermoid is an overgrowth of normal, noncancerous tissue in an abnormal location. Dermoids occur all over the body. The one in and around the eye usually comprised skin, hair, and/or fat. Our patient had an unusual presentation of dermoid in caruncle of the left eye. The mass was excised and histology confirmed the diagnosis. The patient followed up postoperatively and was uneventful.

Keywords: Caruncle, choristoma, dermoid, lipodermoids


How to cite this article:
Sankar P S, Rajeswari S, Kavitha K. Caruncular dermoid: A report of a rare case. TNOA J Ophthalmic Sci Res 2018;56:263-5

How to cite this URL:
Sankar P S, Rajeswari S, Kavitha K. Caruncular dermoid: A report of a rare case. TNOA J Ophthalmic Sci Res [serial online] 2018 [cited 2019 Aug 18];56:263-5. Available from: http://www.tnoajosr.com/text.asp?2018/56/4/263/252502




  Introduction Top


Ocular choristomas are congenital lesions presenting as normal tissue in an abnormal site. They include limbal dermoid, lipodermoid, ectopic lacrimal gland, and episcleral osseous choristoma. Dermoids and lipodermoids are the most common orbital and epibulbar tumors in children. They can affect different areas of the eye, in particular the cornea, limbus, and bulbar conjunctiva.[1]

Lipodermoids are usually found near superior temporal quadrant of the globe that may be quite large and extend backward and forward, but tend not to affect the peripheral cornea. Histologically, a lipodermoid is adipose tissue which is covered by connective tissue. Whereas, a dermoid comprised collagen connective tissue covered by epidermal epithelium. Dermoid or a lipodermoid may be associated with Goldenhar syndrome characterized as an oculoauriculovertebral dysplasia. It is characterized by ocular lipodermoid or dermoid, preauricular skin appendages, fistulas, and vertebral malformations.

This article reports a case of a unilateral lipodermoid cyst, which is notable to its caruncular origin in a 17-year-old female.


  Case Report Top


A 17-year-old female presented to our outpatient department with chief complaints of a swelling in the left eye. The patient noticed the swelling 1 year back and increase in size of the swelling for the past 6 months. The patient did not mention any other ocular complaints and had no history of medical and ocular illness. There was no history of allergy/chronic drug intake. The patient was free of systemic symptoms. On examination, her visual acuity was OD 6/6, OD anterior segment was normal, and pupils are round and reactive to light with no relative afferent pupillary defect. Extraocular movements were full. On slit-lamp examination, lids/cornea/anterior chamber were normal with clear lens. Local examination revealed a whitish avascular lesion of approximately 1 cm × 1 cm, with a hair follicle being present over the caruncular region of the left eye [Figure 1]. Fundus examination revealed normal optic disc, normal macula, and normal peripheral retina. There were no preauricular appendages, facial or palatal clefts, or postural abnormalities. Computed tomography orbit was done to rule out intraorbital extension if any and was found to be normal without any extension.
Figure 1: Avascular mass with hair shaft (arrow) in caruncle of the left eye

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Surgical excision of the lesion was planned, after explaining the procedure and obtaining consent of the patient and her parents. Under van Lint's facial block and subconjunctival block, conjunctiva was raised with small incision. Dissection was made between the mass and mucosa. Adhesions between the conjunctiva, plica, and caruncle were released. The mass was excised in toto and was sent for excisional biopsy. The incision was sutured with 8-0 Vicryl suture. Postoperatively, the patient was treated with topical antibiotic drops and ointment and analgesics. Histology of the specimen showed layers of adipose tissue with hair shaft [Figure 2]. Adipose tissue layer was surrounded by epithelium and connective tissue [Figure 3]. Our clinical suspicion of a lipodermoid was confirmed. The ophthalmic condition was followed up at 1 week, 1 month, and 6 months after the surgery [Figure 4] and was found uneventful.
Figure 2: Histology of excised mass showing layers of adipose tissue (large arrow) and shaft of hair follicle (small arrow)

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Figure 3: Histology of the mass with epithelial and connective tissue layers

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Figure 4: Left eye at 1 week follow-up visit

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  Discussion Top


Epibulbar dermoids and lipodermoids are choristomas which contain epithelium-derived tissues. Dermolipoma exhibits a yellow clinical appearance because of its deep fatty layer. The case of lipodermoid cyst that we reported is unique because of its caruncular location in an adolescent girl.

Lesions of caruncle are uncommon. The vast majority of lesions of caruncle are benign. Differential diagnosis of caruncular lesions is congenital epidermoid cyst and dermoid. Acquired lesions are inflammatory condition, epithelial lesions, cysts, melanocytic tumors, sebaceous tumors, oncocytoma, myeloproliferative disorders, vascular lesions and neural tumors.[2] Among most commonly encountered lesions are nevus, pigmented caruncle, squamous papilloma, nonspecific chronic inflammation, and granuloma. Nevi are most frequently encountered lesionswhich are characterized by a brown pigmented mass and histologically nests of melanocytic cells within the epithelium.[3] Next one, pigmentation of the basal layer of epithelium without melanocytic hyperplasia or atypia. Squamous papilloma was characterized histologically by typical fibrovascular fronds with acanthotic epithelium. According to one literature, 42 cases of caruncular lesions were followed. The results are pigmented lesion (20 cases, 48%), nevus (10 cases), caruncular tumor (3 cases), caruncular lesion (2 cases), basal cell carcinoma (2 cases), granuloma (2 cases), papilloma (1 case), cyst (1 case), and malignant lesion (1 case).[4]

In the presence of lipodermoids and any other ocular abnormalities or systemic conditions, it is essential to consider GoldenharGorlin syndrome.[5] This rare congenital syndrome occurs sporadically and is not inherited. However, genetic transmission (autosomal dominant) and chromosomal abnormality have also been reported. The syndrome was first introduced by Goldenhar in 1952 and is characterized by ocular anomalies, auricular appendages, aural fistula, and vertebral anomalies. Dermoid or lipodermoid cysts are the major ocular features of Goldenhar syndrome that are usually located in the inferotemporal quadrant and are most often unilateral. Epibulbar dermoid is found in 30%–60% of cases with ocular manifestation of Goldenhar syndrome. Lipodermoid cysts and solid dermoid tumors usually involve the epibulbar conjunctiva. The present case is unique, due to the caruncular origin of the lipodermoid cyst. Lipodermoids rarely need surgical excision. In our case, the caruncular lipodermoid cyst was excised regarding cosmesis. It is necessary to reassure these patients that the condition has a benign nature.


  Conclusion Top


Lesions of caruncle are rare, which make clinical diagnosis very difficult. Reported preoperative diagnosis is correct only in 50% of cases because a large pathologic variety of lesions are encountered in caruncle. Malignant lesions are very uncommon and can be fatal. Any change in size, color, vascularity, and pain of caruncular lesion should be closely followed and surgically excised. On account of enormous variety of cases, close collaboration between ophthalmologist and pathologists may be needed in difficult cases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rajabi MT, Ramezani K. Lipodermoid cyst: A report of a rare caruncular case. Middle East Afr J Ophthalmol 2015;22:528-30.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Gorlin RJ, Jue KL, Jacobsen U, Goldschmidt E. Oculoauriculovertebral dysplasia. J Pediatr 1963;63:991-9.  Back to cited text no. 2
    
3.
Balogh M. Lipodermoid: A case report. Clin Eye Vis Care 1995;7:79-82.  Back to cited text no. 3
    
4.
Levy J, Ilsar M, Deckel Y, Maly A, Pe'er J. Lesions of the caruncle: A description of 42 cases and a review of the literature. Eye (Lond) 2009;23:1004-18.  Back to cited text no. 4
    
5.
Goldenhar M. Associated malformations of eye and ear. J Genet Hum 1952;1:243-82.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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