|Year : 1957 | Volume
| Issue : 3 | Page : 60-63
Pathology of ocular dermoids
Kamal Kumar Mallik
Department of Ophthalmology, Medical College Hospitals, Calcutta, India
|Date of Web Publication||9-May-2008|
Kamal Kumar Mallik
Department of Ophthalmology, Medical College Hospitals, Calcutta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mallik KK. Pathology of ocular dermoids. Indian J Ophthalmol 1957;5:60-3
Dermoid is taken to be one of the teratoid tumours. It is classified into three groups - dermoid cyst, solid dermoid and dermolipoma. The dermoids form about 9 per cent. of all ocular neoplasms and cysts operated in this hospital during the last six years (1951-1956).
| Observations|| |
37 cases of ocular dermoids were operated in this hospital during the last six years. 33 specimens were examined both macroscopically and microscopically. In the other four specimens histopathological examination could not be done but on macroscopical examination hair was found. In addition to the common structures found in solid dermoids discussed below, a cyst is taken to have a definite cyst wall with its oily contents and a dermolipoma has an abundance of adipose tissue in the corium. Congenital epithelial plaques are excluded as they do not contain any ectodermal derivatives such as hair-follicles, sebaceous glands, sweat glands. The sections are stained by hematoxylin and eosin.
Dermoids can be found in all age groups though more common in adolescent period. It may be present during childhood but many of the patients complain of it during adolescence when it becomes bigger in size. In the present series the youngest member is three months old whereas the upper limit is as high as 70 years. Dermoid cysts are more common in adults. [Table - 1] shows the age distribution. In this series the most common site for the ocular dermoids seems to be the limbus (14 cases) and the outer canthus (13 cases).
Dermoid cyst is a soft, yellowish, globular swelling of varying shape and size (in two of our cases they were as big as a hen's egg). It may arise from the lid (mainly upper), outer angle of the orbit, eye brow, occasionally from the conjunctiva and rarely from the limbus. Hair may project outside from the cyst wall. The cyst contains greasy material mostly sebum, when it is called 'Oil cyst'. When it contains yellowish atheromatous material composed of desquamated epithelium or solid epithelial debris, it is known as 'Epidermoid Cyst' or `Pseudo-cholesteatoma'. In epidermoid cyst hair is rarely found. In the cut section of the cyst a projection, called the dermoid process is seen. Hair is found to come out from it. The wall of the cyst is lined by stratified squalors epithelium with papillae formation. The epithelium is rarely kcratinised. In the stroma, fibrous tissue, elastic fibres, hair-follicles. sebaceous glands, occasionally sweat glands, nerve tissue, blood vessels and plain muscle fibres are found. In one of our cases an implantation cyst was found at the limbus in which a well defined inclusion of epidermis in the formation of a cyst was noted. In two other cases sebaceous glands were found to be encircled by round cells, fibroblasts and foreign body giant cells. It was in response to the accumulation of sebaceous material from the ruptured sebaceous glands. Garner (1951) reported a case of dermoid cyst with two chambers placed anteriorly with rudimentary structures of mesodermal origin posteriorly.
Solid dermoids are whitish, pale, fleshy growths mostly found at the limbus with hair projecting out. Histologically almost all the structures of dermoid cyst except the cystic pattern are found. The epidermal layer is usually thin having rete pegs and there is pigment deposition in the basal cell layer. The corium is more compact. In two of our cases aberrant lacrimal glands (glands of Woolfring) were noted. In one of the cases there was abundance of sebaceous and sweat glands which became cystic. Another section displayed the presence of a capsule encircling the solid dermoid.
Dermolipoma is a soft, yellowish, small structure found mostly at the outer and upper part of the bulbar conjunctiva. In addition to the common structures there is abundance of fatty tissue in dermolipoma. It contains much less amount of hair-follicles and sebaceous glands (22%) in comparison with the other two groups (80%). Dermolipoma usually grows less rapidly than the other dermoids. Kremencugskaja (1927) reported two cases of cystic dermoids with abundance of fatty tissue. Bock (1951) also reported multiple epibulbar dermolipomas with marked under-development of one side of the face in one of the twins.
| Discussion|| |
In general pathology. dermoids are derived from three germinal layers of the embryonic remnant. but in the eye dermoids rarely show the presence of all these layers. In the present series of work, dermoids are found to contain mainly the ectoderm with mesoblastic element. Duke-Elder (1952) takes them to be teratomata originated from one layer e.g. ectoderm. The dermoids of the eye are not so common as that of the genital organs. It is only 3.5 per cent, of the total dermoids of the body. (Duke-Elder 1938). In the present series of 37 cases, 2 cases were of dermoid cysts, 15 cases of solid dermoids and the remaining 10 cases of dermolipomas.
The occurrence of ectodermal derivatives such as cartilage and bone are rare in ocular dermoids. Borley (1939) and Alcala Lopez (1948) reported on two cases of ocular dermoids with tooth. Mann (1937) classified dermoids of the eye in three groups - epi-bulbar or limbal, corneal and anterior segmental. In the present series 70 per cent. of the limbal dermoids were of the solid type, 60 per cent. of the dermoids arising from the outer canthus of the eye were dermolipoma and all the dermoids arising from the orbit were dermoid cysts. [Table 3].
In 40 per cent. of the cases, the presence of the growth was found from birth and in 60 per cent. of the cases, a definite tendency to rapid rate of growth during the adolescent period was noted. It is explained by Himwich (1921) that the growth of a teratoma depends upon the competition between the teratoid focus and the host tissue. During childhood the host tissue takes the upper hand and the tumour remains quiescent. but in the adolescent period the tumour grows more rapidly. Incidence of multiple dermoids are rare. I found only one case who got both dermolipoma and solid dermoid, the solid dermoid arising from the limbus and the dermolipoma from the outer canthus of the right eye. Corti (1949) reported as many as eight dermoids in a single case. Unlike teratoma of the genital glands, malignant change is very rare in ocular dermoids. In more of the cases in our series a malignant change could be found.
| Conclusion|| |
Solid dermoids are more commonly found at the limbus and the dermolipomas are seen mostly at the outer canthus of the eye, whereas dermoid cysts are formed mostly, if not wholly, in the orbit. Though many of the dermoids are present from birth there is a definite increase in the rate of growth during adolescence. The ectodermal appendages are less common in dermolipoma than in the other two groups. The most common sites for ocular dermoids are the limbus and the outer canthus.
| Summary|| |
37 cases of ocular dermoids have been investigated from the histological point of view. They are grouped under dermoid cyst. solid dermoid and dermolipoma according to their histopathological characteristics. The different etiological factors are also discussed.
I am thankful to the Principal of the Calcutta Medical College and Hospitals for permitting me to publish the hospital records. I am also grateful to the Professor of Ophthaimology and Dr. P. K. Sarker, Clinical Pathologist to the department of Ophthalmology, Calcutta Medical College and Hospitals for all the facilities and the guidance given to me.
| References|| |
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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1], [Table - 2]