Shields J A, Kaden I H, Eagle R C, Shields C L
Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Ophthalmic Plast Reconstr Surg. 1997 Dec;13(4):265-76.
The dermoid cyst is one of the most common space-occupying orbital lesions, but there has been no large series that details the clinical, pathologic, and therapeutic aspects of this condition. Furthermore, despite the various presentations and types of dermoid cysts, there is no clinically applicable classification of these lesions. We performed a retrospective histopathologic study of 197 consecutive orbital and periorbital dermoid cysts excised at Wills Eye Hospital during a 32-year period, correlated the histopathologic findings with the recorded clinical and radiographic observations, and devised a clinically applicable classification of orbital dermoid cysts. The mean age at excision was 17 years (range, 5 months to 85 years), and the most frequent clinical finding was a painless subcutaneous mass, present in 89% of cases. In 72% of patients, the mass was located in the superotemporal orbital region and produced no abnormalities of vision or intraocular pressure. Computed tomography and magnetic resonance imaging, performed mainly in the more recent cases, disclosed a characteristic round to ovoid cystic lesion with a well-defined lining. Histopathologically, 165 of the cysts (84%) were lined by keratinizing, stratified squamous epithelium. Ten (5%) were lined by nonkeratinizing epithelium resembling conjunctival epithelium. Hair shafts were present in the wall or lumen of the cyst in 195 (99%) of specimens, sebaceous glands in 148 (75%), and sweat glands in 39 (20%); inflammation was present in 75 cases (38%). Based on these personal observations and a review of the literature, a classification of orbital dermoid cysts is proposed that we believe will provide guidance for the ophthalmologist in the management of these lesions.
皮样囊肿是最常见的眼眶占位性病变之一，但尚无大型系列研究详细阐述该疾病的临床、病理及治疗方面。此外，尽管皮样囊肿有多种表现形式和类型，但目前尚无适用于临床的此类病变分类。我们对威尔斯眼科医院在32年期间连续切除的197例眼眶及眶周皮样囊肿进行了回顾性组织病理学研究，将组织病理学结果与记录的临床及影像学观察结果相关联，并设计了一种适用于临床的眼眶皮样囊肿分类方法。切除时的平均年龄为17岁（范围为5个月至85岁），最常见的临床发现是无痛性皮下肿块，见于89%的病例。72%的患者中，肿块位于眶颞上区域，未引起视力或眼压异常。计算机断层扫描和磁共振成像主要用于较近期的病例，显示出特征性的圆形至椭圆形囊性病变，边界清晰。组织病理学上，165个囊肿（84%）内衬角化复层鳞状上皮。10个（5%）内衬类似结膜上皮的非角化上皮。195个标本（99%）的囊肿壁或腔内有毛干，148个（75%）有皮脂腺，39个（20%）有汗腺；75例（38%）有炎症。基于这些个人观察及文献回顾，我们提出了一种眼眶皮样囊肿的分类方法，相信这将为眼科医生处理这些病变提供指导。
