Abstract
The epidermal or epidermoid cyst is a proliferation of epidermal cells within an enclosed space. It develops slowly and may be the result of either the inclusion of ectodermal remnants during the closure of the neural tube or epidermal inclusions following trauma or a surgical procedure. Discovered most often in adolescence or adulthood, the eyelid epidermal cyst presents as a painless swelling that progressively increases in size and is mobile. Eyelid location is predominantly in the upper tarsus due to retention of meibomian gland material. The authors report a case of a large inferior eyelid epidermal cyst of traumatic origin in a 24-year-old patient whose ultrasound examination had concluded to a hemangioma of the eyelid. The report of this case aims at highlighting its rarity, the interest of imagery and the modalities of management in an under medicalized context.
Highlights
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Epidermal cyst is a proliferation of epidermal cells within an enclosed space.
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Epidermal cysts of traumatic origin of the lower eyelid is rare.
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Its diagnosis is histological after surgical exeresis.
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The bilobed form is a first in the literature.
1
Introduction
Epidermoid cysts are a proliferation of epidermal cells in an enclosed space. They are either of dysembryoplastic origin by ectodermal inclusion during neural tube closure or of accidental origin following trauma or surgery [ ]. Eyelid epidermal cysts are rare and are most often found in adolescence or adulthood. The upper Eyelid location is the most frequent due to inclusion of meibomian fragments [ , ].Their histological diagnosis is made by the presence of laminated keratinized material and the absence of dermal appendages, which differentiates them from dermoid cysts [ , , ]. They are treated surgically by complete excision; recurrence is possible in case of incomplete excision. In very rare cases, malignant transformation is possible [ , ], requiring both complete and early removal and long postoperative follow-up.
2
Observation
We received Z.Z, a 24-year-old female patient, on February 2, 2021, for two masses of the lower left eyelid that had been progressively installed for 10 years. These masses were painless, affecting the patient aesthetically and in downward vision. The patient reported in the medical history a notion of trauma of the left orbito-palpebral region in her early childhood.
Clinical examination revealed two unequal-sized masses of the left lower eyelid, one nasal, the other lateral, separated by a furrow. These masses were firm, non-pulsatile, non-inflammatory, mobile and crossed by venous lacerations suggesting a venous origin ( Fig. 1 ). The lateral swelling was ovoid in shape, approximately 3 × 4 centimeters with blue areas. The medial mass measured about 2 × 1.5 cm with the same characteristics as the previous one. The ophthalmological exploration noted the absence of ectropion, of diplopia or visual acuity disorders. Visual disturbance in downward looking, due to the size of the swellings, was noted. The Doppler ultrasound concluded to a hemangioma and the angioscanner prescribed could not be realized due to lack of financial means. Surgical removal under general anesthesia was indicated. Intraoperatively, a cord connecting the two nodular formations ( Fig. 2 ) and a malodorous pasty content were discovered, eliminating the diagnosis of hemangioma ( Fig. 3 ). These cysts had no relationship to the underlying tarsus ( Fig. 4 ). Histology revealed a cystic wall lined with keratinized squamous epithelium with a lumen containing numerous laminated corneal scales in favour of an epidermal cyst. The postoperative follow-up was satisfactory both functionally and aesthetically ( Fig. 5 ). No signs of recurrence were noted after a 6-month follow-up.
