Congenital Dermoid Cyst

A 6-year-old boy presented with a painless, bluish swelling in the superotemporal orbital quadrant (A) that had been enlarging since infancy.

A nontender, firm, and nonmobile mass was palpated. The posterior edge of the swelling did not appear to extend around the bony margin into the deep orbit. A CT scan of the orbits demonstrated an oval cystic lesion that had a low-density lumen without contiguous extension into surrounding structures; there was no bony expansion or erosion (B). A congenital dermoid cyst was diagnosed.

Dermoid cysts are the most common periorbital mass lesions that occur in infants and children. Because these cystic lesions can leak spontaneously or rupture from trauma and cause a localized granulomatous inflammatory reaction, complete surgical excision early in the child's life is recommended.¹ The tumor must be removed in 1 piece because the contents of the cystic lesion are irritating. A CT scan needs to be obtained before surgery because some of these cysts are a superficial expression of a deeper, more extensive pathologic entity.

This patient underwent successful surgical removal of the intact dermoid cyst (C). Pathologic evaluation of the mass confirmed the clinical diagnosis. The tumor featured a cystlike structure with a thick, fibrous wall lined with squamous epithelium that contained keratin, hair follicles, glands, and cellular debris.

REFERENCE:1. Rootman J, Lapointe JS. Structural lesions. In: Rootman J, ed. Diseases of the Orbit: A Multidisciplinary Approach. Philadelphia: Lippincott; 1988:481-488.