Clinical Quiz
The query of ectodermal ectopia Shivali V. Kashikar Department of Radiology, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha Maharashtra, India
A 13-year-old girl presented with a slowly growing mass in the outer part of the right eye [Figure 1]. The parents had noticed the mass since she was 2 years old. The mass was pink, soft in consistency, and hair were seen in it on slit lamp examination. Computed tomography [Figure 1] and magnetic resonance imaging [Figure 2] was done.
Questions 1. What is the diagnosis based on imaging characteristics? 2. What are the differential diagnoses?
Figure 1: A pink epibulbar mass in the lateral canthal area
Figure 2: Computed tomography of the orbit showing the lentiform, hypodense mass (arrow)
Figure 3: T1-weighted magnetic resonance image showing the hyperintense mass
Figure 4: T2-weighted magnetic resonance image showing the hyperintense mass
Access this article online Quick Response Code: Website: www.ojoonline.org
For answers please see page 212. DOI: 10.4103/0974-620X.122282
Copyright: 2013 Kashikar S. V. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Correspondence: Dr. Shivali V. Kashikar, Behind Maganwadi, Ramnagar, Wardha - 442 001, Maharashtra, India. E-mail: [email protected]
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Oman Journal of Ophthalmology, Vol. 6, No. 3, 2013
Answers for Clinical Quiz Answers 1. Orbital dermolipoma. Computed tomography of the orbits shows a hypodense, lentiform mass of size 1.1 × 0.5 cm giving fat attenuation [Figure 2]. It is medial to the lacrimal gland, anterior to the insertion of lateral rectus without any calcification in it. On magnetic resonance imaging, it is hyperintense on T1-[Figure 3] and T2-weighted imaging [Figure 4] and showed suppression on fat saturated imaging. Histopathology showed presence of squamous epithelium and adipose tissue. 2. The differential diagnoses of fat-containing epibulbar masses are limbal dermoid, subconjunctival fat prolapse and lipoma.
Discussion Dermolipoma is presumed to be a congenital solid choristoma developing due to sequestration of the ectoderm in the conjunctiva at the time of embryonic development of the eyelid.[1] The commonest location for both subconjunctival fat prolapse and dermolipoma is the lateral canthal area below the temporal or superotemporal bulbar conjunctiva. Subconjunctival fat prolapse affects elderly
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obese men and presents as a unilateral or bilateral soft yellowish mass having a convex anterior margin which becomes prominent with retropulsion of the globe. On the contrary, dermolipoma is a congenital lesion with a female preference and presenting early in life. It manifests as a unilateral soft or firm pinkish-yellow mass with a straight or slightly concave anterior margin. It is frequently accompanied by fine hairs on the surface. It is not freely movable, cannot be repositioned into the orbit, and lesion size is not affected by retropulsion of the globe.[2] Histologically, dermolipoma show stratified squamous epithelium and various amounts of collagenous connective tissue and a disproportionate amount of adipose tissue in the subepithelial stroma. Surgical resection of dermolipoma should be done conservatively as wide or complete excision may cause complications which are unacceptable for an essentially cosmetic problem.[1]
References 1.
2.
Eijpe AA, Koornneef L, Bras J, Verbeeten B Jr, Peeters FL, Zonneveld FW. Dermolipoma: Characteristic CT appearance. Doc Ophthalmol 1990;74:321-8. Kim YD, Goldberg RA. Orbital fat prolapse and dermolipoma: Two distinct entities. Korean J Ophthalmol 1994;8:42-3.
Oman Journal of Ophthalmology, Vol. 6, No. 3, 2013
Copyright of Oman Journal of Ophthalmology is the property of Medknow Publications & Media Pvt. 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.
The query of ectodermal ectopia Shivali V. Kashikar Department of Radiology, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha Maharashtra, India
A 13-year-old girl presented with a slowly growing mass in the outer part of the right eye [Figure 1]. The parents had noticed the mass since she was 2 years old. The mass was pink, soft in consistency, and hair were seen in it on slit lamp examination. Computed tomography [Figure 1] and magnetic resonance imaging [Figure 2] was done.
Questions 1. What is the diagnosis based on imaging characteristics? 2. What are the differential diagnoses?
Figure 1: A pink epibulbar mass in the lateral canthal area
Figure 2: Computed tomography of the orbit showing the lentiform, hypodense mass (arrow)
Figure 3: T1-weighted magnetic resonance image showing the hyperintense mass
Figure 4: T2-weighted magnetic resonance image showing the hyperintense mass
Access this article online Quick Response Code: Website: www.ojoonline.org
For answers please see page 212. DOI: 10.4103/0974-620X.122282
Copyright: 2013 Kashikar S. V. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Correspondence: Dr. Shivali V. Kashikar, Behind Maganwadi, Ramnagar, Wardha - 442 001, Maharashtra, India. E-mail: [email protected]
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Oman Journal of Ophthalmology, Vol. 6, No. 3, 2013
Answers for Clinical Quiz Answers 1. Orbital dermolipoma. Computed tomography of the orbits shows a hypodense, lentiform mass of size 1.1 × 0.5 cm giving fat attenuation [Figure 2]. It is medial to the lacrimal gland, anterior to the insertion of lateral rectus without any calcification in it. On magnetic resonance imaging, it is hyperintense on T1-[Figure 3] and T2-weighted imaging [Figure 4] and showed suppression on fat saturated imaging. Histopathology showed presence of squamous epithelium and adipose tissue. 2. The differential diagnoses of fat-containing epibulbar masses are limbal dermoid, subconjunctival fat prolapse and lipoma.
Discussion Dermolipoma is presumed to be a congenital solid choristoma developing due to sequestration of the ectoderm in the conjunctiva at the time of embryonic development of the eyelid.[1] The commonest location for both subconjunctival fat prolapse and dermolipoma is the lateral canthal area below the temporal or superotemporal bulbar conjunctiva. Subconjunctival fat prolapse affects elderly
212
obese men and presents as a unilateral or bilateral soft yellowish mass having a convex anterior margin which becomes prominent with retropulsion of the globe. On the contrary, dermolipoma is a congenital lesion with a female preference and presenting early in life. It manifests as a unilateral soft or firm pinkish-yellow mass with a straight or slightly concave anterior margin. It is frequently accompanied by fine hairs on the surface. It is not freely movable, cannot be repositioned into the orbit, and lesion size is not affected by retropulsion of the globe.[2] Histologically, dermolipoma show stratified squamous epithelium and various amounts of collagenous connective tissue and a disproportionate amount of adipose tissue in the subepithelial stroma. Surgical resection of dermolipoma should be done conservatively as wide or complete excision may cause complications which are unacceptable for an essentially cosmetic problem.[1]
References 1.
2.
Eijpe AA, Koornneef L, Bras J, Verbeeten B Jr, Peeters FL, Zonneveld FW. Dermolipoma: Characteristic CT appearance. Doc Ophthalmol 1990;74:321-8. Kim YD, Goldberg RA. Orbital fat prolapse and dermolipoma: Two distinct entities. Korean J Ophthalmol 1994;8:42-3.
Oman Journal of Ophthalmology, Vol. 6, No. 3, 2013
Copyright of Oman Journal of Ophthalmology is the property of Medknow Publications & Media Pvt. 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.
