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Intraorbital Expansion of an Intradiploic Frontal Epidermoid Cyst: A Case Report and Short Review of the Literature

Elias Antoniades, Angeliki Cheva, Panagiotis Sarlis, Andreas Kontosis, Evangelia Kalloniati, Ioannis Patsalas

(First Neurosurgical Clinic, AHEPA University Clinic, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece)

Am J Case Rep 2021; 22:e931615

DOI: 10.12659/AJCR.931615

BACKGROUND: Calvarial epidermoid cysts (EC) are encased remnants of ectoderm at the third week of gestation. There are also reports which consider them sequelae of head trauma. They are benign lesions. As they develop, they exert a mass effect to adjacent anatomical structures.
CASE REPORT: We report the case of a 58-year-old male patient with left-sided exophthalmos. His radiologic examinations depicted an oval cystic lesion (7×5×5.5 cm) arising from the left frontal bone and abutting the ipsilateral orbital roof.
Our patient underwent a total extirpation of the lesion through a frontal craniectomy. Cranioplasty was then performed with a Porex® graft. The pearl-hued lamellae of the lesion macroscopically resembled keratin tissue. Histopathological findings supported the diagnosis of an epidermoid cyst. Postoperatively, our patient had no neurologic deficits and a computed tomography scan showed no residual effects.
CONCLUSIONS: Large calvarial EC with intraorbital expansion in adults are rare clinical entities. Gross total resection with the infiltrated bone and cranioplasty is the treatment of choice, which also establishes the diagnosis.

Keywords: Exophthalmos, Methylmethacrylate, Mucoepidermoid Tumor

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