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ARTICLES
Year : 1975  |  Volume : 23  |  Issue : 4  |  Page : 32-33

Intra-orbital dermoid with malignant metaplasia


Osmania Medical College, Hyderabad, India

Correspondence Address:
B Dayananda Rao
Osmania Medical College, Hyderabad
India
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Source of Support: None, Conflict of Interest: None


PMID: 1031156

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How to cite this article:
Rao B D, Prabhakar V, Jagannatha Rao M V, Dinakar I. Intra-orbital dermoid with malignant metaplasia. Indian J Ophthalmol 1975;23:32-3

How to cite this URL:
Rao B D, Prabhakar V, Jagannatha Rao M V, Dinakar I. Intra-orbital dermoid with malignant metaplasia. Indian J Ophthalmol [serial online] 1975 [cited 2020 Sep 23];23:32-3. Available from: http://www.ijo.in/text.asp?1975/23/4/32/31437

Dermoid cysts are classically reckoned as one of the most benign of all neoplasms except in gynaecological pathology. But occasional reports of malignant metaplasia of intracraniat epidermoids and even more rarely of intracran­ial dermoids are encountered in literature.[1],[3] To the best of our knowledge such an occu­rance has not been reported in intra-orbital dermoids though Duke-Elder[2] does mention of such a possibility. The following case is, therefore worth presenting.


  Case Report Top


A forty five year old farmer, otherwise healthy was admitted in the Sarojini Devi Ophthalmic Hospital, Hyderabad under the care of one of us (MVJ) with a history of progressive proptosis and diminishing visual acuity of the left eye over a period of one year. Though, at first the proptosis was not painful, yet in a few months pain became a prominent feature, continuous boring and deep seated in character.

The left eye ball was pushed down and out and on careful palpation a discrete, firm, smooth and rounded mass of about 2 cms. in diameter could be felt in the upper and inner orbital margin quite independent of the eye ball itself. The mass could be moulded. Vision in the right eye was 6/6 and that in the left eye was limited to finger counting at four feet. The fields of vision were normal in the right eye and concentrically contracted in the left eye. Fundoscopy was normal in the right eve and the left eye showed a papilloedema of three dioptre. Exophthalmometry showed 6 mm. proptosis of the left eye. Skiagrams of the left orbit indicated an area of bone destruction in the inner and upper part of the orbit. Limited biopsy which showed histological features suggestive of an invasive squamous cell carcinoma or a secondary deposit in the orbit. A detailed search for a possible primary malignant focus was negative.

The patient was transfered to the Neuro-surgical Unit of the Osmania General Hospital, Hyderabad under the care of one of us (BDR) for further surgical explo­ration. The orbit was explored through a left frontal craniotomy. A typical dermoid cyst was found over the inner and upper aspects of the eye ball. The cyst con­tained the typical contents of a dermoid and did not reveal anything unusual. There were some dense adhe­sions of the cyst to the periosteurn and dura in some areas and this was attributed to previous episodes of inflammation or malignancy in view of the earlier biopsy report.

Post operative course was unevenful and the wound healed satisfactorily. There was some improvement in proptosis but the visual acuity never improved. Within a few weeks there was recurrence of severe pain. By the time he reported back to us after 6 weeks the tumour itself had recurred with gross destruction of the orbit, ulceration and displacement of eye ball. This necessitated an excentration of the eye ball (MVJ) and deep X-ray therapy. His condition steadily deterio­rated and he got himself discharged and he was lost to our follow-up. But we were later informed that he died early in June, 1973.

Histopathology

Sections taken in some areas showed the cyst wall lined by squamous epithelium with keratin. It also showed sebaceous glands-findings entirely consistent with a dermoid cyst [Figure - 1]. But sections obtained from other areas present an entirely different histologi­cal picture and showed clumps of poorly differentiated malignant cells infiltrating into the tissue. These cells are consistent with poorly differentiated malignant cells [Figure - 2].


  Discussion Top


Though malignant changes in intra-orbital dermoids are not reported, yet certain clinical features in this case did indicate pre-operatively such a possibility; severe pain, rapidly progres­sive loss of vision and proptosis. But such symptoms may also be ascribed to the cyst having got infected and consequent inflamma­tion. Histological study was conclusive and subsequent clinical progress, indeed, catas­trophic.


  Summary Top


A case of an intra-orbital dermoid under­going malignant metaplasia is reported.

 
  References Top

1.
Davidson, S.I. and Small, J.M., 1960, J. Neural. Neurosurg, and Psychiat., 23, 176.  Back to cited text no. 1
    
2.
Duke-Elder, S., 1971, System of Ophthalmology, Vol. XIII-The Ocular Adnexa-Page 4766­Henry Kimpton Co. London,  Back to cited text no. 2
    
3.
Gluszoz, A., 1962, J. Neuropath. Expt. Neuro­logy, 21, 303.  Back to cited text no. 3
    


    Figures

  [Figure - 1], [Figure - 2]



 

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