J Korean Ophthalmol Soc.  2016 Jul;57(7):1154-1158. 10.3341/jkos.2016.57.7.1154.

A Case of a Cyst Containing a Parasite and Misdiagnosed as a Dermoid Cyst

• Park Y
• Sung YM
• Paik JS
• Yang SW

• KMID: 2317579
• DOI: http://doi.org/10.3341/jkos.2016.57.7.1154

Abstract

PURPOSE
To introduce a case of a cyst containing a parasite misdiagnosed as a dermoid cyst, which is to the best of our knowledge, the first report in Korea of a parasite in a cyst located at the medial side of the orbit.
CASE SUMMARY
A 31-year-old male visited the hospital with a 2-year history of a slowly growing mass at the medial side of the right orbit. The patient had a history of mass excision in the same location 18 years previously, however, biopsy was not performed at that time. Orbital computed tomography and magnetic resonance imaging revealed a 5.0 × 1.4 × 1.8 cm³ well-defined T1 high signal intensity unilocular cyst, thus our first impression was a dermoid cyst. The cyst was surgically removed with anterior orbitotomy. The cyst ruptured during the operation, and thus complete aspiration of the cystic fluid and in situ irrigation with antibiotics were performed. Histopathological examination revealed a fragmented adult parasite worm with chronic granulomatous change.
CONCLUSIONS
A differential diagnosis for orbital cyst based on clinical and radiological results is difficult. Thus, histopathological confirmation is required. A cyst containing a parasite located in the orbit has rarely been reported. A full examination of all infected patients must be conducted for parasite infection.

Keyword

Cyst with parasite; Orbital cyst

MeSH Terms

Adult
Anti-Bacterial Agents
Biopsy
Dermoid Cyst*
Diagnosis, Differential
Humans
Korea
Magnetic Resonance Imaging
Male
Orbit
Parasites*
Anti-Bacterial Agents

Figure

• 

  Figure 1. Clinical photograph. Slightly elevated cystic mass invading the medial side of the orbit.

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  Figure 2. Radiologic images of the patient. (A) Computed tomography, coronal view image. The black arrow indicates a unilocular cystic mass with fluid-fluid level. (B) Magnetic resonance imaging, T2-enhanced image. The fluid inside the cyst had fluid-fluid level, showing high signal density on T1 and the same density with fat on T2.

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  Figure 3. Cross-sectional view of the removed cyst. An approximately 2-cm3-sized unilocular cyst was excised from the medial side of the right orbit.

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  Figure 4. Microscopic images of the cyst under a light microscope. (A) Black arrow shows the parasite fragments, showing Periodic acid Schiff (PAS) stain positive (PAS stain, ×40). (B) Higher magnification of fragmented parasite (PAS stain, ×200).

Reference

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