J Korean Ophthalmol Soc.  2010 Jul;51(7):998-1002. 10.3341/jkos.2010.51.7.998.

A Case of Orbital Mucocele Lined With Two Types of Epithelial Cells After Orbital Wall Fracture Repair

• Kim M
• Lee MJ
• Kim CJ
• Kim NJ
• Choung HK
• Khwarg SI

• KMID: 2213789
• DOI: http://doi.org/10.3341/jkos.2010.51.7.998

Abstract

PURPOSE
The authors report a case of orbital mucocele lined with two types of histological epithelial cells developed after repair of the orbital wall fractures.
CASE SUMMARY
A 53-year-old man presented with proptosis of the left eye for two years. The patient had a history of left orbital inferomedial wall fracture repair ten years earlier at a different hospital. Examination revealed 4 mm proptosis and superior globe displacement of the left eye. Restriction of left ocular movements on elevation, depression and adduction were observed. A computed tomography scan demonstrated a large, non-enhancing, cystic tumor in the left inferior orbit with the inferior and medial wall displaced toward the paranasal sinus. An orbital cystic tumor was excised with the removal of previously-inserted orbital implant via a transconjunctival and transcaruncular approach. The inferior, and medial orbital walls were reconstructed using a MEDPOR(R) TITAN(TM) implant. The initial pathologic diagnosis was epidermal cyst. Histopathologic re-review revealed an orbital cyst lined with both stratified squamous epithelium and pseudostratified ciliated columnar epithelium, thus diagnosis was changed to orbital mucocele. Proptosis and restriction in ocular motility improved postoperatively.
CONCLUSIONS
Mucocele formation should be considered in patients in whom a cyst developed after orbital fracture repair.

Keyword

Implant; Mucocele; Orbital fracture repair

MeSH Terms

Depression
Displacement (Psychology)
Epidermal Cyst
Epithelial Cells
Epithelium
Exophthalmos
Eye
Humans
Middle Aged
Mucocele
Orbit
Orbital Fractures
Orbital Implants

Figure

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  Figure 1. Preoperative appearance of the patient showing superior displacement (A) and exophthalmos (B) of the left eye.

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  Figure 2. Preoperative Orbital CT. (A) Axial view demonstrates large, non-enhancing soft tissue mass with relative low density occupying inferolateral extraconal portion of the left orbit. (B) Coronal view showed haziness of the maxillary sinus and a large, non-enhancing, cystic tumor in the left inferior orbit with the inferior and medial wall displaced toward the paranasal sinus. Previously implanted silastic sheet (arrowhead) and polyethylene sheets (arrow) are observed.

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  Figure 3. Histopathology of the cyst. (A) Low magnification view shows an unilocular cyst which had even wall thickness of 1 mm. (B) There are multiple needle-shaped spaces consistent with cholesterol clefts and inflammatory cells in the adjacent soft tissue of the cyst. (C) Stratified squamous epithelium lining the cystic cavity. (D) Pseudostratified ciliated columnar epithelium in the other area of the cyst wall (H&E staining, magnification ×40 (A, B), ×400 (C, D)).

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  Figure 4. Eleven months postoperative appearance of the patient showing improved superior displacement (A) and exophthalmos (B) of the left eye.

Reference

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