Chronic inflammation in dermoid cysts: a clinicopathologic study of 115 patients

PURPOSE. To analyze the frequency, pattern, and extent of chronic inflammation in orbital and periorbital dermoid cysts and to correlate these findings with clinical data. PATIENTS AND METHODS. We reviewed the clinical and histopathologic data of 115 consecutive patients with histopathologically confirmed orbital or periorbital dermoid cysts between 1980 and 1998. RESULTS. Sixty-one patients were male and 54 female. Their mean age at the time of surgery was 13 years. The lesion was located superotemporally in 71% of the patients. Patients presented most commonly with a palpable mass without clinical signs of inflammation. The mean cyst volume was 1276 mm(3) (range: 72 to 9900 mm(3)). Histopathologically, 50 lesions (43%) showed chronic granulomatous inflammation of the cyst wall. In 16% of them, the inflammatory response completely replaced the epidermal elements and the normal architecture of the cyst wall. Nine lesions showed spread of granulomatous cell infiltration to the surrounding tissue. Granulomatous inflammation was detected more frequently (p<0.001, chi-square test) with increasing age in patients younger than 30 years, being found in 25% of the patients aged 5 years or younger and in 80% of the patients between 16 and 30 years of age. It was also more common (p<0.001, chi-square test) in cysts larger than 1000 mm(3). CONCLUSION. The frequency of chronic granulomatous inflammation of dermoid cysts and its correlation with patient's age and cyst volume suggest that patients should be operated before the age of five years and that large dermoid cysts (>1000 mm(3)) should be removed early.