Intraconal Orbital Hidrocystoma in an Infant.

ABSTRACT: Intraconal orbital hidrocystoma is a very rare entity. Herein, a 6-month old boy with an intraconal apocrine hidrocystoma will be reported. The patient presented with a left-sided mild proptosis and significant anisometropic hypermetropia. Clinical examinations revealed choroidal folds and optic disc blurring in the left eye. Orbital MRI disclosed an intraconal well-defined cystic lesion that was hypointense in T1 and hyperintense in T2 weighted images. The lesion was excised completely through a lateral orbitotomy and diagnosed histologically as an apocrine hidrocystoma. Excepting partial improvement of anisometropia, other clinical signs were improved after surgery.

Dermoscopy of Adnexal Tumors.

Cutaneous adnexal tumors include lesions with apocrine, eccrine, follicular, sebaceous, and mixed differentiation. Most are benign and sporadic, although malignant forms are occasionally observed and some cases develop in the setting of inherited syndromes. These tumors often cause immense diagnostic difficulty. Dermoscopy is a noninvasive technique that has greatly improved the diagnostic accuracy of different skin lesions, including these tumors. We provide a review of the literature on the dermoscopic structures and patterns associated with adnexal tumors. Most patterns associated with this kind of tumor are nonspecific and are observed in other nonadnexal tumors, especially in basal cell carcinomas.

Giant Orbital Hydrocystoma in Children: Case Series and Review of the Literature.

OBJECTIVE: To describe the clinical features, ancillary diagnostic studies, and treatment outcomes in a cohort of pediatric patients with giant orbital hydrocystomas. DESIGN: Retrospective case series. PARTICIPANTS: Pediatric patients with giant orbital hydrocystomas treated in the practice of one surgeon (PDL). METHODS: A retrospective review of the clinical charts of pediatric patients with orbital hydrocystoma was performed and diagnostic information collected. Results were reviewed and compared with reported clinical data in the literature. MAIN OUTCOME MEASURES: Clinical presentation and histopathological findings of pediatric orbital hydrocystomas. RESULTS: Three pediatric cases of giant orbital hydrocystoma were encountered, each with an unusual feature, including deep orbital location, occurrence following trauma, and eccrine pathology. CONCLUSION: Giant orbital hydrocystomas may present in the pediatric population. Ophthalmologists should be cognizant of this entity when evaluating a child with a large, cystic orbital mass.

A case of an apocrine hidrocystoma treated by sublabial approach.

Apocrine hidrocystomas are uncommon cystic proliferations of the apocrine secretory glands. Maxilla is an unexpected involvement site for these tumors. Our study represents the first case of an apocrine hidrocystoma of the maxilla excised by an intraoral (sublabial) approach, being the first to define the radiologic findings of apocrine hidrocystoma on this region. This case is an extremely rare type in terms of the unusual symptomatology, location and size of the tumor. In this article, clinical presentation, surgical findings, histopathological features and treatment of this rare lesion were discussed.

Pigmented apocrine hidrocystoma of the caruncle.

PURPOSE: To describe the clinical and immunopathologic features of the first convincing apocrine hidrocystoma of the caruncle that happened to be pigmented. METHODS: Case report with clinical evaluation, ultrasound biomicroscopy, and paraffin-embedded tissue stained with hematoxylin and eosin, periodic acid-Schiff, and immunohistochemical markers. RESULTS: Ultrasound biomicroscopy identified a cyst occurring in a 56-year-old white woman. Histopathologically, it was lined by an inner eosinophilic columnar epithelium that was gross cystic disease fluid protein-15-positive and evinced apical decapitation secretion and periodic acid-Schiff-positive, diastase-resistant cytoplasmic granules. Fontana- and MART-1-positive melanin granules were demonstrated. There was an outer layer of smooth muscle actin-positive myoepithelial cells. An adjacent apocrine gland was discovered with identical staining characteristics but without melanin granules. CONCLUSIONS: Classical apocrine gland cysts can exceptionally develop in the caruncle. The light dispersion of cytoplasmic melanin found in the lining cells may have contributed to the cyst's clinical pigmentation, which is otherwise generally regarded as the result of the Tyndall effect, wherein blue wavelengths of light reflect from a colloidal solution of lipofuscin and cell debris.

Sudoriferous cyst of the orbit of adult origin after trauma.

A rare case of sudoriferous cyst of the orbit occurring in an adult, who had facial trauma, is reported. Several factors suggest its adult onset. The only other case reported in an adult is of presumed childhood origin. Very few congenital cases have been reported. A 65-year-old lady presented with recent onset of left-sided ptosis and a painless mass below the left supraorbital margin. The patient had traumatic ptosis after a road traffic accident 13 years ago. The ptosis was surgically repaired, which resulted in symmetrical palpebral apertures. Computed tomographic scan revealed a well-defined cystic mass in the anterior orbit. The mass was removed in toto by anterior orbitotomy. Histopathological examination revealed a single cyst lined by double-layered cuboidal epithelium in some areas and transitional epithelium at others. A periodic acid Schiff (PAS) positive, diastase-resistant glycocalyx lined the inner epithelium. Apical snouting suggested an apocrine nature. This confirmed a diagnosis of sudoriferous cyst.

Ultrasound biomicroscopy of eyelid eccrine hidrocystoma.

CASE REPORT: A 58-year-old white female noted a lesion on her left lower eyelid, present for 3 months. Examination disclosed a dark-blue, subepithelial, smooth mass along the cilia near the punctum. The lesion did not transmit light and was thought to be a solid mass, such as a deep-blue nevus or melanoma versus a cystic mass with internal debris. Ultrasound biomicroscopy showed a fairly circumscribed echolucent mass measuring 3.2 x 3.5 mm suggestive of a cyst with numerous internal echo impedances. Following resection, histopathologic evaluation disclosed a cyst lined by a dual layer of eccrine sweat ductal epithelium, consistent with eccrine hidrocystoma. COMMENTS: Eyelid hidrocystomas can be pigmented and can be confused clinically with melanocytic tumors. Ultrasound biomicroscopy can provide helpful diagnostic information about the internal architecture of such lesions.

High-frequency ultrasound imaging of periocular hidrocystomas.

BACKGROUND: High-frequency ultrasound has improved our ability to manage and diagnose anterior segment tumors. Hidrocystomas are unusual cystic tumors that can affect the conjunctiva and eyelid. When they appear pigmented and rapid in onset, it is important to differentiate them from malignant tumors, such as melanoma. CASE REPORTS: Three patients were referred to The New York Eye Cancer Center for evaluation of pigmented lesions on their eyes. The tumors affected the conjunctiva or eyelid and were of recent onset ranging from 1 week to 6 months. The hidrocystomas displayed hypoechoic high-frequency ultrasound patterns, which corresponded to the cystic nature revealed through histopathological analysis. Differential diagnoses are discussed and include benign and malignant tumors. CONCLUSION: Cystic tumors are a common finding of the eye; however, pigmented hidrocystoma is an uncommon diagnosis. Although histopathological study is often required for definitive diagnosis of these lesions, much information can be gained through pre-surgical evaluation, particularly high-frequency ultrasound. Intra-lesional cyst formation was characteristic in these three tumors. Further study of the high-frequency ultrasound characteristics of pigmented eyelid and conjunctival tumors will help determine if these ultrasound characteristics are diagnostic.

Rectal hidrocystoma.

We describe the endorectal sonographic and magnetic resonance (MR) imaging findings of a hidrocystoma of the rectal wall, a tumor that arises in sweat glands and may occur in a perianal location. To our knowledge, occurrence in the rectum has not been reported previously. The unusual appearance of a solid lesion with a central fluid-filled cavity may suggest the diagnosis of a hidrocystoma.