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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 4  |  Issue : 1  |  Page : 65-68

Congenital sudoriferous cyst of the orbit: A case report and review of literature


Swiss Cleft Centre, BSES MG Hospital, Mumbai, Maharashtra, India

Date of Web Publication2-May-2017

Correspondence Address:
Parit S Ladani
Swiss Cleft Centre, BSES MG Hospital, S. V. Road, Opp. Andheri (W) Railway Station, Andheri West, Mumbai - 400 058, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-2125.205409

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  Abstract 

Apocrine gland cyst (sudoriferous cyst and apocrine hidrocystoma) is fairly uncommon in the eyelid, where it derives from the apocrine glands of Moll. In rare instances, an apocrine gland cyst can occur in the anterior portion of the orbit. If an orbital cyst affects the globe or extraocular muscles, it should be excised as soon as possible to prevent strabismus and amblyopia. Herewith, we are presenting the case of sudoriferous cyst in a 9-year-old child managed with surgical excision.

Keywords: Apocrine hidrocystoma, Moll's gland, orbit, sudoriferous cyst


How to cite this article:
Ladani PS, Sailer H, Thadani SM, Shah M. Congenital sudoriferous cyst of the orbit: A case report and review of literature. J Cleft Lip Palate Craniofac Anomal 2017;4:65-8

How to cite this URL:
Ladani PS, Sailer H, Thadani SM, Shah M. Congenital sudoriferous cyst of the orbit: A case report and review of literature. J Cleft Lip Palate Craniofac Anomal [serial online] 2017 [cited 2021 Dec 2];4:65-8. Available from: https://www.jclpca.org/text.asp?2017/4/1/65/205409


  Introduction Top


Apocrine gland cyst is fairly uncommon in the eyelid (5% of the eyelid masses), where it derives from the apocrine glands of Moll. Shields and Shields have described that this type of cyst typically occurs at the lid margin but rarely appears within the orbit.[1]

Apocrine gland cyst is also a choristomatous lesion and derived from the apocrine sweat glands of the eyelid or other parts of the body where such modified sweat glands occur.[2],[3],[4],[5]

Very few cases of sudoriferous cyst in the orbit have been reported in the literature. The purpose of this paper is to report the unique occurrence of an orbital sudoriferous cyst.


  Case Report Top


A 9-year-old female child visited our unit with the complaint of swelling over her left eyelid. Upper eyelid was partially closed due to lump, and swelling was fluctuant on palpation. There was visual axis encroachment in conjunction with lateral displacement of eyeball [Figure 1]. Computed tomography (CT) scan of the orbit [Figure 2] showed a well-defined, anteriorly situated cystic swelling of 1.4 cm × 1.5 cm × 1.3 cm at the superior-medial wall of the left orbit. The left eyeball was compressed and displaced to the inferior-lateral portion of the eye socket.
Figure 1: Preoperative view

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Figure 2: Computed tomography scan of the orbit

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The mass was excised through an approach through the skin [Figure 3]. It was found to be attached with two stalks to the upper eyelid where it was carefully dissected and removed [Figure 4]. Wound close with 6-0 prolene suture [Figure 5]. The specimen was a grayish polypoid mass with fibrous band-like stalks and filled with a clear fluid [Figure 6]. Histopathologically, the specimen consisted of a solitary cyst with a very thin cystic wall. Microscopically, it was lined by a double layer of nonkeratinizing cuboidal and/or flattened epithelium, with features identical to the glands of Moll [Figure 7]. The innermost cells displayed a granular and distinctly eosinophilic cytoplasm with apical expansions while the outer wall was composed of fibrous tissue. The diagnosis of a sudoriferous cyst was thus confirmed.
Figure 3: Incision marking

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Figure 4: Wound after removal of cyst

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Figure 5: Wound closure

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Figure 6: Specimen

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Figure 7: A cross section of the cyst filled with cystic fluid shows a unilocular cystic mass which consists of a thin fibrous wall (H and E, ×14)

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The patient was referred to ophthalmologist for treatment of amblyopia after surgery. After 7 months [Figure 8], there was a significant improvement in globe position and correction of visual axis and amblyopia.
Figure 8: 7 months postoperative

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  Discussion Top


Sudoriferous cysts, also known as apocrine gland cysts and apocrine hidrocystomas, are derived from the sweat glands of Moll. They probably result from the obstruction of excretory ducts with the retention of clear fluid.[1],[2] They are divided into two types, apocrine and eccrine, and represent 4%–5% of all eyelid tumors in adults and 1% in children but are less common in the orbit itself. Symptoms appear as fluctuant swelling beneath the eyelid or in the canthal area.[1],[2],[4],[6],[7],[8] Shields and Shields reported that it is probably not possible to differentiate a small cystic lesion without bone involvement from other orbit cysts even with a CT or an magnetic resonance imaging (MRI).[1] However, Rosen and Li reported sudoriferous cysts in adults and associated bony remodeling of the inferior orbit rim and floor by use of CT and MRI.[3] In this case, the CT scan showed that the cyst compressed the eyeball and displaced the globe and allowed for the rectus muscle to be found.

The management of apocrine gland cyst is usually a simple observation if the lesion is small and asymptomatic but occasionally requires complete local excision if the lesion is symptomatic or cosmetically unacceptable.[1] If an orbital cyst affects the globe or extraocular muscles, it should be excised as soon as possible to prevent strabismus and amblyopia, especially in infant.[9] In past reports, Saunders had excised a congenital sudoriferous cyst from an 18-month-old child,[4] and Mims et al. have operated on a 24-month-old child.[2]

The histopathology of this report lesion had features typical of a sudoriferous cyst. Grossly, it had a thin wall and contained clear fluid. Microscopically, the lesion was a solitary cyst lined by two layers of nonkeratinizing cuboidal epithelial cells with apical snouts on the luminal side of the cell. The cyst was periodic acid–Schiff positive, with diastase-resistant granules on their apical surface, similar to what has been previous reported.[10]


  Conclusion Top


It is recommended by us that congenital orbital cyst should be excised as early as possible and regular follow-up to be done to evaluate for strabismus and amblyopia.

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

Cleft Children Internationl (CCI).

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shields JA, Shields CL. Orbital cysts of childhood – Classification, clinical features, and management. Surv Ophthalmol 2004;49:281-99.  Back to cited text no. 1
    
2.
Mims J, Rodrigues M, Calhoun J. Sudoriferous cyst of the orbit. Can J Ophthalmol 1977;12:155-6.  Back to cited text no. 2
    
3.
Rosen WJ, Li Y. Sudoriferous cyst of the orbit. Ophthal Plast Reconstr Surg 2001;17:73-5.  Back to cited text no. 3
    
4.
Saunders JF. Congenital sudoriferous cyst of the orbit. Arch Ophthalmol 1973;89:205-6.  Back to cited text no. 4
    
5.
Haider E, Saigal G, Gill D, Brown E, Daniel S. Congenital orbital sudoriferous cyst: Radiological findings. Pediatr Radiol 2005;35:1142-4.  Back to cited text no. 5
    
6.
Doxanas MT, Green WT, Arentsen JJ, Elsas FJ. Lid lesions of childhood: A histopathologic survey at the Wilmer Institute (1923-1974). J Pediatr Ophthalmol 1976;13:7-39.  Back to cited text no. 6
    
7.
O'Brain CS, Braley AE. Common tumors of the eyelids. J Am Med Assoc 1936;107:933.  Back to cited text no. 7
    
8.
Reese AB. Discussion of “Common tumors of the eyelids”. J Am Med Assoc 1936;107:937.  Back to cited text no. 8
    
9.
Chung JK, Lee SJ, Kang SK, Park SH. Congenital sudoriferous cyst within the orbit followed by esotropia. Korean J Ophthalmol 2007;21:120-3.  Back to cited text no. 9
    
10.
Spencer WH. Ophthalmic Pathology: An Atlas and Textbook. 3rd ed., Vol. 3. Philadelphia: WB Saunders; 1986. p. 2254-6.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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