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Lacrimal gland dermoid


Key points

  • Definition: Lacrimal gland dermoids (LGDs) represent congenital, non-neoplastic choristomas, containing cytologically normal tissue not normally found at that location.

  • Synonym: anterior orbital dermoid (AOD).

  • Classic clue: Young child presents with smooth scalloping of orbital wall by adjacent unilateral lacrimal-gland mass having hyperdense wall, decreased attenuation center, increased T1 signal intensity, and no postcontrast enhancement.

Imaging

Computed tomography features

  • LGDs are typically unilateral well-defined cyst-like masses containing fluid or fat.

  • LGDs may contain calcifications.

  • LGDs are habitually filled with hypodense material (see Figure 41-1 ).

    FIGURE 41-1 ■, Contrasted nonenhanced computed tomography shows well-circumscribed ovoid right lacrimal gland mass filled with fat attenuation material in this typical noninfected dermoid. The mass causes exophthalmos and medial globe displacement.

  • LGDs are typically nonenhancing postcontrast, but may exhibit enhancement if infected.

  • Central cavity may contain keratin and other cystic debris.

  • LGDs commonly cause scalloping or sclerosis of adjacent bone.

  • LGDs may cause proptosis with medial displacement of globe (see Figure 41-1 ).

  • LGDs may show “dirty fat” when infected (see Figure 41-2 ).

    FIGURE 41-2 ■, Axial contrasted computed tomography shows enlarged left lacrimal gland with central area of low attenuation, approximating fat. Infected lacrimal gland dermoid with “dirty fat” in center.

Magnetic resonance imaging features

  • LGDs are well circumscribed initially retaining lacrimal gland shape.

  • T1 increase secondary to fatty components is nearly pathognomonic for dermoid in this location.

  • T2 hyperintense to extraocular muscles (EOMs).

  • T1 + Gd exhibits no enhancement (unless infected).

  • Internal debris can cause heterogeneous intracystic signal.

  • Dedicated orbital imaging thin-section, fat saturation, Gd-enhanced, axial, and coronal sequences are essential for the best evaluation.

Clinical issues

Symptoms

  • Frequently found in the first year of life.

  • Present as a palpable painless nodule near the lacrimal gland.

  • May become infected (see Figure 41-2 ).

Treatment

Surgery

  • Surgery is the accepted standard treatment.

  • Excision is recommended to prevent impromptu rupture or cutaneous fistula formation.

  • Leakage of cyst contents can cause significant inflammation and postoperative recurrence.

  • Lesions excised with the capsule intact rarely recur.

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