Periocular tumors are common in infancy. The most common periocular tumors are capillary hemangiomas, which are present in 1-2% of newborns and develop in 10%–12% of children by the age of 1 year old. Deep capillary hemangiomas may be more challenging to diagnose than superficial capillary hemangiomas and can be confused with other orbital lesions. Deep orbital hemangiomas can mimic teratoma, lymphangioma, rhabdomyosarcoma, metastatic neuroblastoma, and granulocytic sarcoma. In this paper, we describe 2 pediatric cases where previously diagnosed dermoid cyst and dacrocystocele were found to be capillary hemangiomas upon biopsy. Approaches to distinguish capillary hemangiomas from other periocular tumors are further discussed. To our knowledge, this is the first case report of periocular hemangiomas imitating a dermoid cyst and a dacrocystocele. These cases emphasize the importance of including infantile hemangiomas in the differential diagnosis of subcutaneous periocular abnormalities.
Periocular tumors are common in infancy, the most prevalent being infantile hemangiomas, which occur on any part of the body in 1-2% of newborns [
An otherwise healthy three-month-old female presented to our department for a six-week history of a right temporal brow mass. Her vision and ocular examination were unremarkable except for a 1.5 × 1.0 cm firm, rubbery mass along the right temporal brow (Figures
(a) Firm, oblong 1.5 × 1.0 cm sized rubbery mass over the right temporal brow. (b) Lesion found under the right brow. (c) Capillary hemangioma on the right shoulder and right neck. (d) Incision through the eyebrow on the temporal edge made to evaluate the tumor.
In the surgical suite, the patient was noted to have a capillary hemangioma on the right shoulder and a smaller one on the right neck (Figure
A four-month-old male born at 27 weeks gestation was examined in the neonatal intensive care unit for a several-day history of a nontender, bluish subcutaneous 1.5 × 1.0 cm mass located below the left medial canthus (Figures
(a) and (b) Nonerythematous, bluish lesion 1.5 × 1.0 cm below the nasal lower lid. (c) CT scan showing 11 × 9 mm lesion along left nasocanthal fold.
A nasal canthus duct exploration was undertaken with otolaryngology assistance. The right nasal cavity was patent and had no evidence of cyst or purulent secretion, while the left nasal cavity had some mucoid crusting. No purulent debris was expressed with palpation of the mass, and there was no cystic component noted intranasally. The mass on the cheek and lateral nose was determined to have no communication with the nasal canthus passage and was thought to be more consistent with an infantile hemangioma. The child was started on systemic propanolol, after which a decrease in size was observed.
Capillary hemangiomas occur in approximately 1-2% of neonates and up to 10–12% of infants within the first year of life [
Capillary hemangiomas are sometimes seen at birth but appear more commonly within the first few weeks of life and may enlarge quickly over the first year, after which the tumor begins to involute. Depending on the depth and location of the tumor, the clinical appearance may vary. Superficial hemangiomas produce an elevated strawberry-colored nodule, while deep orbital hemangiomas typically present as a fluctuant, compressible bluish mass [
Dermoid cysts manifest as a round, firm, smooth, and nontender mass that may be mobile or fixed to the underlying periosteum. The mass will typically be a slowly enlarging and painless subcutaneous cyst located superonasally or superotemporally to the eye [
The diagnosis of periocular disorders is generally made on clinical examination alone. A careful history that includes age of onset, color, and location, along with physical examination findings is generally sufficient in determining the pathological condition [
In this paper, two distinct patients with periocular lesions, initially diagnosed as a dermoid cyst and dacryocystocele, were later found to have infantile hemangiomas. The prevalent occurrence and widespread distribution of infantile hemangiomas can simulate other periocular disorders. It is important to obtain a complete history and appropriate imaging to help make an accurate diagnosis. Infantile hemangiomas should be considered in the differential diagnosis of any subcutaneous periocular abnormalities.
Both authors deny any conflict of interests or financial interests.