|Year : 2021 | Volume
| Issue : 3 | Page : 331-332
Capillary hemangioma masquerading as a dermoid cyst
Meenakshi Wadhwani1, Shubhangi Kursange1, Nidhi Mahajan2
1 Department of Ophthalmology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
2 Department of Pathology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
|Date of Submission||24-Jul-2020|
|Date of Decision||03-Sep-2020|
|Date of Acceptance||01-Oct-2020|
|Date of Web Publication||08-Dec-2021|
Dr. Meenakshi Wadhwani
Chacha Nehru Bal Chikitsalaya, New Delhi - 110 031
Source of Support: None, Conflict of Interest: None
Capillary hemangioma occurs in 1%–2% of neonates and in 10%–12% of infants within 1st year of life. They may present as a cutaneous, subcutaneous, or orbital lesion. The most common sites are eyelid or brow, with a predilection for the upper eyelid. We hereby report a case of a 1-year-old female child presenting in our outpatient department with swelling over the left eyebrow since birth gradually increasing in size. The lesion was firm in consistency, slightly mobile, nontender, superior orbital margin nonpalpable. Based on imaging, a diagnosis of dermoid cyst was made, but on excision, there was an absence of capsule surrounding it with positivity for human glucose transport protein 1 (GLUT1) on histopathology changing the diagnosis to hemangioma.
Keywords: Dermoid cyst, hemangioma, masquarade
|How to cite this article:|
Wadhwani M, Kursange S, Mahajan N. Capillary hemangioma masquerading as a dermoid cyst. Kerala J Ophthalmol 2021;33:331-2
| Introduction|| |
Capillary hemangioma is one of the most common benign periocular and orbital (CH) vascular tumors of childhood. In most of the cases, the natural progression starts with enlargement followed by spontaneous lapse without management over a period, without sequelae. Cutaneous Capillary hemangioma (CHs) can present as a small, red, raised isolated lesion, or as dark blue subcutaneous lesions and may extend into the orbit or huge mass that can result in visual impairment or rarely might be associated with systemic impairment or syndrome. We, hereby, describe the case report of a capillary hemangioma masquerading as a dermoid cyst.
| Case Report|| |
A 1-year-old female child presented in our outpatient department with swelling over the left eyebrow since birth gradually increasing in size. The vision and ocular examination of both the eyes was unremarkable except that there was a circumscribed lesion over the left eyebrow superomedially of approximately 2.5 cm in diameter, nonerythematous, smooth counter, with normal overlying skin and no dilated blood vessels over the surface. The lesion was firm in consistency, slightly mobile, nontender, superior orbital margin nonpalpable [Figure 1]a. The systemic examination was within normal limits. On doing noncontrast computed tomography (CT), orbit large ovoid soft-tissue, low-attenuation lesion in the medial aspect of the left orbit, measuring 2.1 cm × 2.9 cm, with no lobules/septa was seen with a differential diagnosis of angular dermoid [Figure 1]b. Excision biopsy of the mass was planned. Intraoperatively, an ill-defined mass with lobular appearance was noted, it was firmly attached to the underlying muscle. There was no surrounding capsule that doubted the presence of a dermoid cyst. A punch biopsy was taken and sent for histopathological examination [Figure 1]c. Histopathological examination revealed in (i) lobules of dilated capillaries extending into adjacent skeletal muscle bundles and adipose tissue. These capillaries are lined by plump endothelial cells. (ii) The cells are positive for GLUT 1, which is suggestive of hemangioma. The child was started on oral propranolol (in supervision of pediatrician for appropriate dosage) and topical timolol 0.25% after clearance from a cardiologist. The child is on regular follow-up with us and the size of lesion has decreased [Figure 1]d.
|Figure 1: (a) Preoperative photograph of the child revealing well-circumscribed lesion over the left eyebrow superomedially of size approximately 2.5 cm in diameter, nonerythematous, smooth contour. (b) Noncontrast computed tomography orbit showing large ovoid soft-tissue, low-attenuation lesion in the medial aspect of the left orbit, measuring 2.1 cm × 2.9 cm, with absence of lobules/septa seen. (c) Histopathological examination shows in (i) lobules of dilated capillaries extending into adjacent skeletal muscle bundles and adipose tissue. These capillaries are lined by plump endothelial cells. (ii) The cells are positive for GLUT 1 suggestive of hemangioma. (d) Postoperative photograph of the child showing regression of size of the cyst|
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| Discussion|| |
Capillary hemangioma occurs in 1%–2% of neonates and in 10%–12% of infants within the 1st year of life. They may present as a cutaneous, subcutaneous, or orbital lesion. Most common sites are eyelid or brow, with a predilection for the upper eyelid. Most often, natural course involves proliferative phase for initial 1 year, followed by stabilization and spontaneous involution over several years. Dermoid cysts are the congenital choristomas of orbit. Nearly 7% of the dermoid cyst occur in the head-and-neck region and 70% of the dermoids that occur in the periorbital region have a common location preference for the extra angular region. They generally arise at birth but may not be apparent until the first decade of life due to their location in deeper plains. A careful clinical examination including proper history for age of onset, color, and location is mandatory. If inconclusive, diagnostic modalities such as CT scan and magnetic resonance imaging should be undertaken. In the current case, the consistency of the cyst and CT scan misguided the ophthalmologist, the absence of capsule while taking excision biopsy and its firm attachment to muscle with absence of teratogenic tissue in the form of hairs made the surgeon suspicious for presence of infantile hemangioma that was confirmed by histopathological examination. This similar finding of a dermoid cyst being misdiagnosed as capillary hemangioma has also been reported by Hsu and Mohney and Al-Muhaylib et al. in a 3-month and a 3-year-old female child, respectively.,
Hence, an appropriate clinical imaging is important to make an accurate diagnosis, and infantile hemangioma should be kept as an important differential diagnosis in case of periocular swellings as the management of both the entities completely varies.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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