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| CASE REPORT |
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| Year : 2018 | Volume
: 20
| Issue : 2 | Page : 157-158 |
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A case of epibulbar osseous choristoma
AS Parihar1, Shelly Verma2, Arti Trehan3, Prashant Vashisht4
1 Department of Ophthalmology, INHS Dhanvantari, Port Blair, India
2 Department of Ophthalmology, INHS Asvini, Mumbai, India
3 Department of Pathology, Army Hospital (R&R), New Delhi, India
4 Department of Ophthalmology, INHS Kalyani, Vishakhapatnam, Andhra Pradesh, India
| Date of Submission | 26-Apr-2018 |
| Date of Acceptance | 04-Oct-2018 |
| Date of Web Publication | 10-Jan-2019 |
Correspondence Address:
Surg Cdr A S Parihar
Department of Ophthalmology, INHS Dhanvantari, Port Blair
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmms.jmms_29_18
Osseous choristoma of the eye is a rare entity with few case reports being published in the literature. We report one such case in a 14-year old female who had a small growth in the right eye present since birth, which gradually increased in size. Excision biopsy was done. Histologically, the mass was composed of mature bone with surrounding benign adipocytes. Keywords: Epibulbar mass, ocular choristoma, osseous choristoma
How to cite this article:
Parihar A S, Verma S, Trehan A, Vashisht P. A case of epibulbar osseous choristoma. J Mar Med Soc 2018;20:157-8 |
| Introduction | |  |
Choristomas are congenital lesions representing normal mature tissue elements present at sites where they are not normally present. Their occurrence in the eye is the most common cause of epibulbar and orbital tumors in children. Epibulbar forms may affect the cornea, limbus, or subconjunctival space. Epibulbar osseous choristomas are rare, with around 77 cases been reported in literature.[1],[2],[3]
| Case Report | | |
A 14-year-old female presented with a mass at the upper temporal aspect of the right eye globe. It was present since birth and was gradually increasing in size over the past few years with no associated symptoms of local pain, discharge. On examination, a globular, firm nodule (9 mm × 14 mm) with posterior edge beyond lateral canthus, nontender, immobile was noticed. Vision was 6/6 unaided in both eyes, both anterior and posterior segments were normal.
Provisional clinical diagnosis of dermolipoma was made. She underwent magnetic resonance imaging orbit to look for intraorbital and intracranial extension of the lesion. It showed about 10 mm × 9 mm × 3 mm sized fat intensity lesion in anterior superolateral aspect without intraconal or intracranial extension, most likely representing lipoma [Figure 1].
After informed consent, she underwent an excision biopsy of the mass. Intraoperatively, the lesion was adherent to conjunctiva but not to the sclera and the muscles. The mass and the adherent conjunctiva were removed totally and edges of remaining conjunctiva sutured [Figure 2].
On histopathological examination, lobules of benign adipocytes surrounding a central area of mature bone with osteocytes were seen [Figure 3]. Overlying, it was fibrocollagenous tissue lined by stratified cuboidal epithelium on one side [Figure 4]. Thus, the diagnosis of complex osseous choristoma was made. | Figure 3: Histopathological examination (H and E stain, ×10 showing lobules of adipocytes [a] and mature bone [b])
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 | Figure 4: Histopathological examination (H and E, ×10, showing fibrocollagenous tissue lined by stratified cuboidal epithelium)
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| Discussion | | |
One of the uncommon forms of ocular choristomas is osseous choristomas, which are usually sporadic. Their common location is in the superior temporal region of the episclera.[4],[5] Von Grafe first described the epibulbar osseous choristomas in 1863. They arise from congenital nests of pluripotent mesoderm. Gayre et al. analyzed 51 cases of epibulbar osseous choristomas and reported 69% to be females, 76% had in the right eye, and in 74% lesion was superotemporal.[6]
The lesions being noticed at birth are often slow growing. They are usually are unilateral but rarely may be bilateral.[4] Clinically, they have to be differentiated from epibulbar and limbal dermoids, epithelial inclusion cysts, prolapsed orbital fat, papillomas, and dermolipomas. Surgical excision is usually indicated for confirmation of diagnosis or may be for cosmetic reasons for which the patient usually first seeks medical attention.
Most of the lesions are firm to hard in consistency. Histologically, these contain mature lamellated bone with Haversian systems and may be surrounded by a thin connective tissue capsule.[7] Thus, in most cases, the histopathological examination is required to confirm the true nature of the lesion.
| Conclusion | | |
Osseous choristomas are the rarest forms of ocular choristomas, usually sporadic, and found at the superior temporal region of the episclera. Hence, episcleral osseous choristoma should be considered as one of the differentials when an epibulbar mass is seen in any gender and age, especially when localized superotemporally.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Ponnudurai T, Louisraj S, Salman A. Epibulbar osseous choristoma: A case report. Int Med Case Rep J 2017;10:337-9.  |
| 2. | Balci O, Oduncu A. A case of epibulbar osseous choristoma with review of literature. Int Ophthalmol 2014;34:1145-8. |
| 3. | Vachette M, Moulin A, Zografos L, Schalenbourg A. Epibulbar osseous choristoma: A clinicopathological case series and review of the literature. Klin Monbl Augenheilkd 2012;229:420-3. |
| 4. | Kim BJ, Kazim M. Bilateral symmetrical epibulbar osseous choristoma. Ophthalmology 2006;113:456-8. |
| 5. | Moon JH, Yoon DY, Choi CS, Yun EJ, Park SJ, Seo YL, et al. Bilateral ocular osseous choristomas. Pediatr Radiol 2005;35:1145-6. |
| 6. | Gayre GS, Proia AD, Dutton JJ. Epibulbar osseous choristoma: Case report and review of the literature. Ophthalmic Surg Lasers 2002;33:410-5. |
| 7. | Ortiz JM, Yanoff M. Epipalpebral conjunctival osseous choristoma. Br J Ophthalmol 1979;63:173-6. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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