Introduction
Dermoid cysts are congenital, benign orbital neoplasms that often occur temporally along the frontozygomatic suture. They comprise keratinized stratified squamous epithelium and other dermal derivatives. They are one of the most frequent orbital lesions in children, but dermoid cysts of the caruncle are uncommon. Embryonic epithelial nests can become entrapped and produce cysts when fetal suture lines shut during embryogenesis.
What Is Dermoid Cyst?
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A dermoid cyst is a normal tissue development surrounded by a pocket of cells known as a sac. This tissue develops in or beneath your skin at an unexpected place.
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A dermoid is anything that resembles skin. A cyst is a bulge or mound that contains fluid or another substance. Dermoid cysts often contain a greasy yellow substance.
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Dermoid cysts can develop anywhere on the body. The ones near your skin's surface may seem like tiny bumps. Dermoid cysts can also form further into the body.
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A dermoid cyst may appear to be a tumor at first. However, these cysts are typically not hazardous. A dermoid cyst may require surgery to be removed.
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Choristomas that comprise epithelium-derived tissues include epibulbar dermoids and lipodermoids. Because of its thick fatty layer, dermolipoma has a yellow clinical look. The caruncular placement of the lipodermoid cyst in an adolescent female makes our case distinctive.
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Caruncle lesions are infrequent. The great majority of caruncle lesions are harmless. Congenital epidermoid cysts and dermoids are the differential diagnoses for caruncular lesions.
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Inflammatory conditions, epithelial lesions, cysts, melanocytic tumors, sebaceous tumors, oncocytoma, myeloproliferative illnesses, vascular lesions, and brain tumors are examples of acquired lesions.
What Is Caruncular Dermoid Cyst?
The ocular caruncle is a pink oval structure that is a modified cutaneous tissue medial to the semilunar plica. Because of its tissue diversity, the ocular caruncle can birth many benign and malignant lesions. While the majority of them are benign, clinical diagnosis can be challenging. Over eighty percent of dermoid cysts are seen on the head and neck. A periorbital dermoid cyst is the most frequent form of dermoid cyst. This form of cyst develops on the border of one of the brows. Ocular caruncular lesions are most typically inflammatory, with epithelial and melanocytic lesions being less prevalent. Some benign lesions are clinically exaggerated malignant,' while others are clinically underestimated as 'benign,' necessitating a thorough pathological examination of all lesions.
What Is the Caruncular Dermoid Cyst Pathophysiology?
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Dermoid cysts are encapsulated cystic lesions that are formed of keratinized stratified squamous epithelium with dermal appendages and adnexal structures such as hair follicles, sebaceous glands, sweat glands, smooth muscle, and fibro adipose tissue.
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Keratin and hair are seen in the cyst lumen. Dermoid cysts are called choristomas, lesions of normal tissue emerging in an unusual position.
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Still, when located at the caruncle, they are better classed as hamartomas since dermal appendages can be seen there.
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These cystic lesions are epithelially walled with dermal appendages on histology, and while the appendages are native to the caruncle, the keratinizing epithelium is not.
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Like other superficial dermoids, these in the caruncle may show as a slowly progressing, non-tender mass.
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Patients are more likely to detect them when they are yellow and emerge between the medial palpebral fissure.
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Bilateral lesions can also be observed on both caruncles. These superficial lesions appear as a painless, smooth lump.
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Granulomatous inflammation may be evident if the cyst leaks or ruptures.
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Palpable bulk, often yellow, and inflammation (redness, swelling) are symptoms.
What Are the Differential Diagnosis of Caruncular Dermoid Cyst?
Because of the rarity with which it is recorded, caruncular dermoid cysts are frequently overlooked as a clinical diagnosis. Because of the probable differential diagnosis, excisional biopsy is the preferred approach—asymptomatic and non-tender. The vast majority of caruncular lesions, including dermoid cysts, are harmless. Nevi, papillomas, and epithelial cysts are the most prevalent of these benign lesions. However, physicians should know that malignant lesions such as melanoma can arise and be lethal while examining caruncular lesions.
Early studies estimated that up to 27 percent of these lesions were malignant; however, more current data show substantially lower rates (2.7-5.4 percent). Differential diagnosis of caruncle dermoid cysts varies. Clinically, sebaceous gland hyperplasia and adenoma look similar to dermoid cysts, although they differ pathologically. While clinically and pathologically, steatocystomas resemble dermoid cysts. Steatocystomas often have a more corrugated eosinophilic cuticle. They also usually appear throughout puberty and are not present at birth.
What Is the Management of Caruncular Dermoid Cyst?
Complete surgical excision is the basis of therapy. Excess caruncle or surrounding plica semilunaris should be excised cautiously to prevent scarring and medial scar tissue. The cyst may return if the capsule is not entirely removed. After surgical excision, the prognosis is favorable. Complex lacrimal corneal choristomas are segmental, transparent, and highly vascular lesions that can be unilateral, bilateral, or unilateral and unilateral. They are distinguished from dermoids and lipodermoids by the presence of smooth muscle and cartilage. Once on the cornea, the mass can spread deep into the stroma, making removal difficult. Herniation of orbital fat is commonly thought to be a result of aging. When the lid is opened, this noncongenital lesion is visible in the superior fornix, similar to lipodermoids.
The epibulbar conjunctiva is commonly involved in lipodermoid cysts and solid dermoid tumors. If a dermoid cyst ruptures during surgery, the region's irrigation can usually prevent a lipo granulomatous inflammatory response. On the other hand, these lesions in the caruncle are significantly smaller and may typically be excised completely.
Conclusion
Caruncle lesions are uncommon, making clinical diagnosis challenging. Because caruncle has a wide pathologic diversity of lesions, reported preoperative diagnosis is only 50 percent accurate. Dermoid cysts are normally innocuous but might create difficulties depending on their size and location. If one has a dermoid cyst, see a doctor about the best treatment options. A dermoid cyst may usually be removed surgically by a doctor. Cyst removal can lessen the likelihood of subsequent symptoms. Malignant lesions are extremely rare and can be lethal. Any caruncular lesion's size, color, vascularity, or discomfort change should be monitored regularly and surgically removed. Due to the wide range of situations, close coordination between ophthalmologists and pathologists may be required in complex instances.
