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25 October 2019 : Case report  Mexico

Giant Ocular Lipodermoid Cyst in Encephalocraniocutaneous Lipomatosis: Surgical Treatment and Genetic Analysis

Rare disease

Andrea Córdoba1ABCDEF, Enrique O. Graue-Hernández1AEF, Alejandro Navas1AEF*, Oscar F. Chacon-Camacho2CDE, Juan C. Zenteno23CDE, Arturo Ramirez-Miranda1AEF, Jose Antonio Bermudez-Magner4CD, Thania Ordaz-Robles2CD, Sofia Pérez-Solórzano1AEF, Andrew Olivo-Payne1ABEF

DOI: 10.12659/AJCR.918684

Am J Case Rep 2019; 20:1566-1571

Abstract

BACKGROUND: Encephalocraniocutaneous lipomatosis is a rare neurocutaneous disorder characterized by cutaneous, ocular, and central nervous system anomalies; its molecular etiology was recently identified. This report describes the surgical treatment and genetic characterization of a giant ocular lipodermoid cyst secondary to encephalocraniocutaneous lipomatosis.

CASE REPORT: An 11-year-old girl with past medical history of absence seizures presented with a reddish protruding mass in her right eye involving the temporal conjunctiva and the peripheral temporal cornea; eyelid closure was not possible due to mass protrusion. She also presented skin tags at the level of the external canthus and 3 alopecic areas at the level of the scalp compatible with nevus psiloliparus. No family history was reported. A dermoid cyst was suspected and excisional biopsy was performed under general anesthesia. A large conjunctival and lamellar corneoscleral resection was done, followed by a corneal tectonic graft. Molecular analysis was carried out, including PCR and Sanger sequencing on DNA obtained from the mass. After surgery, the patient achieved complete eyelid closure, reduction of ocular surface symptoms, and improved aesthetic appearance. Histological analysis confirmed a lipodermoid cyst; genetic tests confirmed a mosaic activating mutation in FGFR1 (c.1638C>A, p.Asn546Lys). The diagnosis was encephalocraniocutaneous lipomatosis.

CONCLUSIONS: ECCL is a rare condition; an accurate diagnosis comprising clinical and genetic aspects can facilitate the monitoring of possible complications, improve the multidisciplinary treatment, and provide valuable information for future therapy developments. In this case, the patient’s quality of life improved significantly, ocular symptoms disappeared, and a good esthetic appearance was achieved.

Keywords: Conjunctival Diseases, Corneal Diseases, Dermoid Cyst, Lipomatosis, Biopsy, Child, Corneal Transplantation, DNA Mutational Analysis, Eye Diseases, Eye Neoplasms, Neurocutaneous Syndromes, Polymerase Chain Reaction, Receptor, Fibroblast Growth Factor, Type 1, Seizures

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923