Internal Angular Dermoid Indenting on the Globe

Angular dermoid cysts are common periorbital tumours in children. They are tumours of embryonic origin that arise along bony sutures as a result of abnormal ectodermal sequestration during development. Angular dermoid cysts usually present in early childhood, are characteristically small benign and slow growing lesion. External angular dermoid present in the superotemporal quadrant is more common compared to internal angular dermoid in the superonasal quadrant. Early surgical excision is recommended and performed in the majority of cases, particularly to restore facial cosmesis. Here we report an unusual case of a large internal angular dermoid cyst indenting the globe in a 3-year-old girl presented with left upper eyelid mass at medial angle since one year of age. The cyst was excised completely by anterior orbitotomy through a small superior lid crease incision.

Traumatic sacral dermoid cyst rupture with intracranial subarachnoid seeding of lipid particles: illustrative case

BACKGROUND Intracranial deposits of fat droplets are an unusual presentation of a spinal dermoid cyst after spontaneous rupture and are even more uncommon after trauma. Here, the authors present a case with this rare clinical presentation, along with a systematic review of the literature to guide decision making in these patients. OBSERVATIONS A 54-year-old woman with Lynch syndrome presented with severe headache and sacrococcygeal pain after a traumatic fall. Computed tomography of the head revealed multifocal intraventricular and intracisternal fat deposits, which were confirmed by magnetic resonance imaging (MRI) of the neuroaxis; in addition, a ruptured multiloculated cyst was identified within the sacral canal with proteinaceous/hemorrhagic debris, most consistent with a sacral dermoid cyst with rupture into the cerebrospinal fluid (CSF) space. An unruptured sacral cyst was later noted on numerous previous MRI scans. In our systematic review, we identified 20 similar cases, most of which favored surgical treatment. LESSONS Rupture of an intraspinal dermoid cyst must be considered when intracranial fat deposits are found in the context of cauda equina syndrome, meningism, or hydrocephalus. Complete tumor removal with close postoperative follow-up is recommended to decrease the risk of complications. CSF diversion must be prioritized if life-threatening hydrocephalus is present.

Atypical Presentation of a Midline Nasal Dermoid with Intracranial Extension

Although rarer than their lateral orbital counterparts, dermoid cysts are part of any differential diagnosis of a midline nasal mass in the pediatric population. Here we present a case of a nasal dermoid with intracranial extension that presented as a mass appearing at the nasal-cheek junction. This atypical presentation for a nasal dermoid highlights the need for clinicians to remain vigilant and consider midline dermoid cyst as a diagnosis despite an off-midline position on the face.