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CASE REPORT  
Year : 2022  |  Volume : 65  |  Issue : 3  |  Page : 671-672
An unusual case of respiratory epithelial cyst of orbit presenting as a lid swelling in a child


1 Department of Ophthalmology, Chacha Nehru Bal Chikitsalya, New Delhi, India
2 Department of Pathology, Chacha Nehru Bal Chikitsalya, New Delhi, India

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Date of Submission23-Jul-2021
Date of Decision18-Nov-2021
Date of Acceptance10-Jan-2022
Date of Web Publication08-Jun-2022
 

   Abstract 


This case highlights the importance of histopathological examination in all cases of choristoma undergoing excision.

Keywords: Choristoma,dermoid cyst,, respiratory epithelial cyst

How to cite this article:
Wadhwani M, Khatri A. An unusual case of respiratory epithelial cyst of orbit presenting as a lid swelling in a child. Indian J Pathol Microbiol 2022;65:671-2

How to cite this URL:
Wadhwani M, Khatri A. An unusual case of respiratory epithelial cyst of orbit presenting as a lid swelling in a child. Indian J Pathol Microbiol [serial online] 2022 [cited 2022 Aug 15];65:671-2. Available from: https://www.ijpmonline.org/text.asp?2022/65/3/671/351619




A 5-year-old male with a cystic swelling of the right upper lid for the past year presented to the ophthalmology department of a tertiary care hospital [Figure 1]a. Contrast-enhanced computed tomography revealed a cystic swelling with a provisional diagnosis of choristoma with no intracranial extension. The cyst was excised under general anesthesia, and the contents were sent for histopathological examination [Figure 1]b. Microscopic examination revealed cyst lined by flattened to stratified squamous epithelial lining with unremarkable adnexal structures [Figure 1]c, besides this cyst wall was lined focally by pseudostratified ciliated columnar epithelium (thick arrow) with goblet cells suggestive of respiratory epithelium cyst [Figure 1]d. Rest of the findings of the anterior and posterior segments of both eyes were unremarkable. Respiratory epithelium cyst should be considered as a differential diagnosis of an ocular cystic mass.[1],[2],[3] A choristoma is a normal tissue present at an abnormal location with the most common differential diagnosis of dermoid cyst. These choristomatous cysts are most commonly found in the pediatric age group after mucoceles. The dermoid cysts are generally lined by keratinized stratified squamous epithelium. The occurrence of ciliated columnar epithelium in the orbital region should be considered as choristomatous. Respiratory epithelium lined cysts are supposed to arise from the endoderm that has become sequestered in orbit in the course of development of paranasal sinuses during the third and fourth month of intrauterine life. Also, it can develop due to extension of paranasal sinus mucosa following bone erosion due to trauma or expanding mucocele.[4],[5] Although previously two cases of this respiratory epithelium cyst have been reported in the pediatric age group, these cases were presented as esotropia and infraorbital swelling, respectively. To the best of our knowledge, the current case is the third case in pediatrics with this type of cyst and presenting with a lid swelling.[2],[4] These cysts generally follow a benign course and recurrence of ocular symptoms are rare.[5]
Figure 1: (a) Preoperative photograph of the child showing swelling on right upper lid (arrow). (b) Intraoperative photograph of the child with cyst near right upper lid (arrow). (c) Cyst lined by flattened to stratified squamous epithelial lining with unremarkable adnexal structures (Haematoxylin and Eosin, 100X). (d) Cyst wall also lined focally by pseudostratified ciliated columnar epithelium (thick arrow) with goblet cells (thin arrow). (Haematoxylin and Eosin, 400X).

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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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Goh RL, Hardy TG, Williams RA, McNab AA. Respiratory epithelial cysts of the orbit. Orbit 2016;35:245-9.  Back to cited text no. 1
    
2.
Shields JA, Shields CL. Orbital cysts of childhood--classification, clinical features, and management. SurvOphthalmol 2004;49:281-99.  Back to cited text no. 2
    
3.
Kemp PS, Allen RC, Longmuir SQ. Cryptic respiratory epithelial cyst of the lateral orbit in a 3 year old with strabismus and amblyopia. J Pediatr Ophthalmol Strabismus 2014;51:e19-21.  Back to cited text no. 3
    
4.
Weegerink N, Van Goethem J, De Schepper S, Van de Velde T, Schmelzer B. Nine-year-old girl with a respiratory epithelial cyst of the orbit. B-ENT 2016;12:77-81.  Back to cited text no. 4
    
5.
Newton C, Dutton JJ, Klintworth GK. A respiratory epithelial choristomatous cyst of the orbit. Ophthalmology 1985;92:1754-7.  Back to cited text no. 5
    

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Correspondence Address:
Arti Khatri
Chacha Nehru Bal Chiktsalaya, New Delhi-110031
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpm.ijpm_757_21

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