|
 
 |
| CASE REPORT |
|
| Year : 2017 | Volume
: 9
| Issue : 1 | Page : 31-33 |
|
Keratin cyst: An unusual cause of eyelid mass
Abhishek Das, Akshay Bhandari, Surekha Bangal
Department of Ophthalmology, Rural Medical College, Pravara Institute of Medical Sciences, Ahmednagar, Maharashtra, India
| Date of Web Publication | 19-Sep-2017 |
Correspondence Address:
Abhishek Das
Department of Ophthalmology, Rural Medical College, Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/sjopthal.sjopthal_16_17
Keratin cyst is a keratin-containing cyst lined by epidermis also known as epidermal cyst. Epidermal cysts are slow growing, benign tumors that result from the proliferation of surface epidermal cells within the dermis. They are usually located over scalp, face, neck, chest, back, and extremities. It differs from dermoid cyst where they lack dermal appendages. It occurs 1 in 2000 adults.[5] An 80-year-old female presented with chief complaints of painless swelling on the left upper eyelid for 8 years. From the past 8 years, the patient was aware of the swelling, but it has increased in size in the past 1 year. The swelling was nontender and local temperature was not raised. There were no pulsations or bruits over the swelling. Surgical excision was done. Histopathological examination revealed single, globular, and soft to cystic mass with cheesy material inside. Section showed cyst walled lined by cornified, distinct granular layers and contained lamellar keratin. Keratin cyst is a rare cause of eyelid mass because eyelid is not the usual location of the cyst. Surgical excision of the cyst with intact capsule is the treatment of choice as there is a least chance of recurrence.
Keywords: Blepharoptosis, epidermal cyst, excision, eyelid, keratin cyst
How to cite this article:
Das A, Bhandari A, Bangal S. Keratin cyst: An unusual cause of eyelid mass. Sudanese J Ophthalmol 2017;9:31-3 |
| Introduction | |  |
Keratin cyst is a keratin-containing cyst lined by epidermis also known as epidermal cyst. It is usually located over scalp, face, neck, chest, upper back, and extremities. It also occurs on breast, vulva, clitoris, penis, scrotum, and perineum. It rarely occurs in eyelid presenting as a mass.[1],[2],[3],[4] The prevalence rate is 1 cyst in 2000 adults.[5] It differs from dermoid cyst only in that the dermal appendages are lacking. They are slow growing, benign tumors that result from the proliferation of surface epidermal cells within the dermis.[1],[2],[3],[4] Histopathologically, the cyst is lined by true epidermis composed of several layers of stratified squamous epithelium including the granular layer. Within the cyst is keratinous material, which is arranged in laminated layers. A foreign body type reaction with multinucleate giant cells may be present in the dermis surrounding the cyst in response to spillage of cyst contents. Usually, these cysts are asymptomatic; however, it may become inflamed or secondarily infected. Most of the cysts of the eyelid are diagnosed as epidermal inclusion cysts, dermoid cysts, pilar or sebaceous cysts or as chalazion.[6] The diagnosis of epidermal cysts is not made very often. This differential diagnosis should be kept in mind while operation on a cyst of the upper lid.
| Case Report | | |
An 80-year-old female presented with chief complaints of painless swelling on the left upper eyelid for 8 years [Figure 1]. From the past 8 years, the patient was aware of the swelling but it has increased in size in the past 1 year. There was no history of trauma, surgery, or eyelid inflammation present. On examination, a well-defined swelling at the left upper lid was palpated just below the eyebrow which measured approximately 1.5 cm × 2.0 cm × 1.5 cm and was globular in shape with a smooth surface. It was soft in consistency, nonfluctuant, nontranslucent, fixed to the overlying skin, freely mobile, and free from the underlying structures such as tarsus and orbital bones. The swelling was nontender and local temperature was not raised. There were no pulsations or bruits over the swelling, and mechanical ptosis was a prominent feature. Examination of anterior and posterior segment of both eyes revealed no abnormality. The right eye had best-corrected visual acuity of 6/18 and the left eye had visual acuity of finger counting at 1 m, with intraocular pressure 12 mmHg on applanation tonometry. Systemic examination was normal. There was no preauricular or submandibular lymphadenopathy on examination. Renal function tests and rest of the blood counts were normal. Blood eosinophil count was normal (5%). | Figure 1: Preoperative clinical photograph showing lid swelling with ptosis
Click here to view |
Surgical excision of the cyst with intact capsule was planned. A horizontal incision of 6–7 mm was taken. The cyst was dissected carefully from the skin and subcutaneous tissue. The base of the cyst was identified and excised with intact capsule. Skin sutured with 6-0 vicryl. Histopathological examination revealed 1.5 cm single, globular, soft to cystic mass with cheesy material inside. Section showed cyst wall lined by cornified with distinct granular layers and contains lamellated keratin. Underlying it, fibrocollagenous stroma along with few eccrine-apocrine glands was seen and lumen of cyst shows keratin flakes [Figure 2]. The patient had an uneventful postoperative recovery with no complaints [Figure 3]. Visual acuity of the patient improved as ptosis disappeared postoperatively. The patient is undergoing regular follow-up for 6 months, and there has been no evidence of recurrence of the condition. | Figure 2: Preoperative clinical photograph showing lid swelling with ptosis
Click here to view |
 | Figure 3: The cyst is lined by true epidermis composed of several layers of stratified squamous epithelium and lumen contains keratinous material
Click here to view |
| Discussion | | |
In our case, the keratin cyst was located at the superior aspect of the eyelid which is not a usual presentation. It was huge enough to cause mechanical ptosis thereby reducing visual acuity of that eye. The central punctum was absent. There are several proposed mechanisms for epidermal cyst formation. It may arise from one of the following causes such as occlusion of the infundibular portion of the hair follicle, implantation of epidermal cells into the dermis following penetration injury, and trapping of epidermal cells along embryonal fusion planes. Human papillomavirus, especially types 57 and 60 have also been identified in the palmoplantar epidermoid cyst.
Histopathologically, the cyst is lined by true epidermis composed of layers of stratified squamous epithelium and contains keratinous material.
The treatment is the excision of the cyst with intact capsule along with the cyst wall. Recurrence of the cyst is possible if the proper precautions are not taken while excising it surgically in toto.
| Conclusion | | |
Keratin cyst is a rare cause of eyelid mass because eyelid is not the usual location of the cyst. Surgical excision of the cyst with intact capsule is the treatment of choice as there is a least chance of recurrence.
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 | | |
| 1. | Braun-Falco O. Dermatology. Berlin, Germany: Springer; 2000. p. 1423-40.  |
| 2. | Shields JA, Bakewell B, Augsburger JJ, Donoso LA, Bernardino V. Space-occupying orbital masses in children. A review of 250 consecutive biopsies. Ophthalmology 1986;93:379-84. |
| 3. | Kronish JW, Sneed SR, Tse DT. Epidermal cysts of the eyelid. Arch Ophthalmol 1988;106:270. |
| 4. | Behera M, Panja M. Epidermal cyst of upper eyelid: A case report with literature review. J Clin Exp Ophthalmol 2016;7:597. |
| 5. | Yanoff M, Duker JS. Ophthalmology. 3 rd ed. Elsevier Health Sciences; 2009. p. 1424. |
| 6. | Majumdar M, Khandelwal R, Wilkinson A. Giant epidermal cyst of the tarsal plate. Indian J Ophthalmol 2012;60:211-3. [Full text] |
[Figure 1], [Figure 2], [Figure 3]
|
Search Pubmed for