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EPIDERMOID AND DERMOID TUMOURS OF THE ORBIT

1958; BMJ; Volume: 42; Issue: 4 Linguagem: Inglês

10.1136/bjo.42.4.225

1468-2079

PaulR. Carey,

Teratomas and Epidermoid Cysts

IN neuro-surgical practice patients presenting with orbital and orbito-cranial lesions are frequently encountered.In every case the nature, the source, and the anatomical extent of the underlying lesion must be ascertained before treatment is begun.Among the many causes oft unilateral proptosis (Jackson, 1950(Jackson, , 1951) ) are epidermoid and dermoid tumours of the orbit.It is the purpose of this paper to review the clinical picture, diagnosis, and treatment of five epidermoid and two dermoid tumours which were encountered in a series of 293 cases of orbital and orbito-cranial lesions seen in the neuro-surgical service of Mr. Harvey Jackson.These five epidermoid and two dermoid tumours comprised 6-3 per cent. of the proven orbital tumours in this same series.Epidermoid and dermoid tumours consist of two main parts: capsule and contents.The capsule is usually opaque, white, and glistening, but in the case of dermoids may vary from yellow to brown in colour.The contents of epidermoid tumours consist of concentric laminae of keratin and epi- thelial debris which have a white soapy or waxen appearance, but dermoid tumours may contain in addition to the keratin and epithelial debris, sebaceous material, hair, and oily fluid.Most investigators agree that both epidermoid and dermoid tumours develop from misplaced epithelial rests, as Remak (1854) first suggested.Horrax (1922) was of the opinion that the degree or the depth of the epithelial layer forming the misplaced epithelial rests determined the type of tumour which might arise from it.Bostroem (1897) stated that the difference depended not only on the actual depth, but also on the embryonic antiquity of the rest, and that a younger and more primitive cell layer would have the characteristics of a dermoid rather than an epidermoid growth.It is logical, as suggested by Critchley and Ferguson (1928), that if only squamous epithelium is included then an epidermoid tumour arises; if, however, the foetal inclusion contains epithelium and dermis, than a dermoid tumour with fat cells, sebaceous glands, sweat glands, and hair follicles develops.