Orbital apocrine hidrocystoma with immunohistochemical confirmation

Feijó, Eduardo Damous; Nery, Ana Carla de Souza; Caiado, Fábio Ramos; Preihs, Aline Maria; Campos, Paulo Henrique Borges; Pereira, Augusto; Limongi, Roberto Murillo

doi:10.5935/0034-7280.20160048

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Revista Brasileira de Oftalmologia

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Relato de Casos • Rev. bras.oftalmol. 75 (3) • Apr-Jun 2016 • https://doi.org/10.5935/0034-7280.20160048 copy

Orbital apocrine hidrocystoma with immunohistochemical confirmation

Hidrocistoma apócrino orbitário com confirmação imunohistoquímica

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The authors report the first case in Brazilian literature of orbital apocrine hidrocystoma with immunohistochemistry confirmation. The tumor had been growing slowly and progressively, there was no history of impaired vision, diplopia, watering, discharge, or prior trauma. There was no proptosis and extraocular mobility was normal. The radiologic study by orbital computerized tomography revealed an extraconal nodule, with partially defined limits, with cystic and solid areas in the superomedial right orbit. An anterior orbitotomy, with full excision of the tumor was performed. A histopathology examination revealed apocrine hidrocystoma and immunohistochemistry confirmed the diagnosis. After surgery, the patient had total remission of symptoms.

Keywords:
Hydrocystoma/diagnosis; Hydrocystoma/surgery; Orbit/surgery;Tomography, x-ray computed; Immunohistochemistry; Case reports

Author	Patient	Location	CT findings	Pathologic finds	IHC findings
Vignes et al.¹1 Vignes JR, Franco-Vidal V, Eimer S, Liguoro D. Intraorbital apocrine hidrocystoma. Clin Neurol Neurosurg. 2007;109(7):631-3.2007	Male, 33y	Intraorbital, extraconal	Intraorbital, extraconal, cystic lesion	Eosinophilic cytoplasm, a multilaminar epithelial cyst lining.	IHC was not done
Jakobiek et al.22010	Female, 57y	Anterior orbit, left upper eyelid	Cystic superonasal mass in the left upper eyelid and the anterior orbit extending to about the equator of the globe	Cyst contained an amorphous eosinophilic material. Double layer of cells without mitotic activity or nuclear pleomorphism.	CK7+ SMA+ GCDFP15 + CD34 + and CD68+
Valenzuela et al.⁷7 Valenzuela AA, Heathcote JH. Apocrine hidrocystoma of the orbit. Orbit. 2011; 30(6):316-7.2011	Male, 41y	Intraorbital, extraconal	Intraorbital, extraconal, cystic lesion	Eosinophilic cytoplasm, a multilaminar epithelial cyst lining, decapitation secretion	IHC was not done
Ssi-Yan-Kai et al. ⁸8 Ssi-Yan-Kai IC, Pearson AR. Recurrent giant orbital apocrine hidrocystoma. Eye. 2012 ;26(6):895-6.2012	Female, 46y	Intraorbital, extraconal, medial wall	A large, cystic mass of about 18-mm diameter occupying the infero-nasal orbital quadrant	No description, just the diagnosis of apocrine hidrocystoma	IHC was not done
Behshad et al.³3 Behshad S, Weil NC, Ho ST, Mayhall GK, Valenzuela AA. A Cyst you can't miss: a rare presentation of an orbital apocrine hidrocystoma. Orbit. 2015;34(4):229-31.2015	Male, 41y	Intraorbital, extraconal, supero-medial orbit	A well-defined cystic lesion localized in the supero-medial anterior orbit	No description, just the diagnosis of apocrine hidrocystoma	IHC was not done
Ferraz et al.⁴4 Ferraz LB, Burroughs JR, Satto LH, Natsuaki KL, Meneguin RL, Marques ME, Schellini SA. Three adult cases of orbital hidrocystoma presenting with blepharoptosis. J Clin Med. 2015;4(1):150-8.2015	Male, 46y	Right supraorbital margin	No description	Single tall columnar cuboidal cell epithelial layer with apical snouting in the lining cells and decapitation secretion	IHC was not done
	Female, 17y	Among the fibers of the levator muscle	No description	Simple columnar epithelium and decapitation secretion
	Man, 67y	Adherent to levator muscle	No description	Dual-layered epithelial cells and the absence of goblet cells in the cyst wall

Immunohistochemical markers	Function summary
Citokeratin 7 (CK7).	Type II keratin of simple non-keratinizing epithelia. The cytokeratin 7 is a positive marker in glandular epithelium.
Gross Cystic Disease Fluid Protein 15) (GCDFP15)	Also called BRST2, prolactin-induced protein (PIP). It is an excellent marker of apocrine differentiation. It is a glycoprotein originally isolated in human breast gross cystic fluid.
S100 Protein (S100)	Acidic protein, 100% Soluble in ammonium sulfate at neutral pH (derivation of name). It is present in eccrine glands inner layer. Common marker of neural tissue / lesions and melanoma.
Smooth Muscle Actin (SMA)	Identify myoepithelial cells in normal, neoplastic or diseased breast, salivary glands or sweat glands.

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[1] Corresponding author: Eduardo Damous Feijó Hospital Oftalmológico de Anápolis - Av. Faiad Hanna, 235. Cidade Jardim, Anápolis, GO, Brazil. Zip code: 75080-410. Email: eduardodff@yahoo.com.br