J Korean Ophthalmol Soc.  2008 Dec;49(12):2001-2005.

A Case of Primary Lipogranuloma in Eyelid

• Doh SH
• Lee SK
• Yang SW

Abstract

PURPOSE: We report one case of primary giant lipogranuloma in the whole upper lid.
CASE SUMMARY
A 37-year-old man with a left whole upper lid mass that developed 3 months prior to admission visited our hospital. Biopsy was performed, and lipogranuloma was diagnosed. We attempted to remove the lesion by non-surgical local triamcinolone injection with no effect, so we finally removed the lipogranuloma by surgical resection. In the postoperative histological findings, the upper lid mass showed variously sized multiple cystic spaces surrounded by macrophage infiltration and fibrosis consistent with lipogranuloma.
CONCLUSIONS
We report the first case of primary giant lipogranuloma in the upper eyelid in Korea. We considered repeated intralesional triamcinolone injections to be a better treatment method than surgical resection. Final surgical resection might be more effective, however, after an intralesional steroid injection to reduce the size of the lipogranuloma.

Keyword

Eyelid; Primary lipogranuloma; Triamcinolone injection

MeSH Terms

Adult
Biopsy
Eyelids
Fibrosis
Humans
Korea
Macrophages
Triamcinolone
Triamcinolone

Figure

• 

  Figure 1 . Non-tender firm left upper lid mass with scaly skin eruption.

• 

  Figure 2 . CT finding showing mild soft tissue swelling with linear hyperdensity (*) in the left superior palpabral lesion.

• 

  Figure 3 . Intraoperative findings. * Whitish firm multiple nodules and scattered invasion of the surrounding tissue including the orbicularis oculi muscle. ** Piecemeal resection because en bloc resection was impossible.

• 

  Figure 4 . This lesion is composed of variably sized empty spaces (lipid) surrounded by macrophages and fibrosis. * Variably sized lipogranuloma invading the orbicularis oculi muscle. ** Macrophage infiltration and fibrosis.

• 

  Figure 5 . Postoperative 7 months: Decreased rough skin surface and color changes.

Reference

References

1. Rodríguez-Mzartín M, Sáez-Rodríguez M, Carrasco JL. . Self induced paraffinoma in a schizophrenic patient. J Am Acad Dermatol. 2007; 56:127–8.

2. Son MG, Kim YD. Lipogranuloma of Eyelids after Paranasal sinus surgery, J Korean Ophthalmol Soc. 1999; 40:2935–41.

3. Heltzer JM, Ellis DS, Stewart WB, Spencer WH. Diffuse nodular eyelid lipogranuloma following sutureless transconjunctival blepharoplasty dressed with topical ointment. Ophthal Plast Reconstr Surg. 1999; 15:438–41.

4. Ozdal PC, Codere F, Callejo S. . Accurracy of the clinical diagnosis of chalazion. Eye. 2004; 18:135–8.

5. Steven G. Silverberg, Silverberg’s Principles and practice of Surgical Pathology and Cytopathology. 4th. Vol. 1. Churchill Livingstone: Elsevier;2006. p. 141.

6. Duke-Elder S. System of ophthalmology, 1st ed. Vol. 13. St. Louis: C.V. Mosby,. 1974; 242–7.

7. Lucas DR. Greer’s ocular pathology. 4th. Oxford: Blackwell;1989. p. 81–98.

8. Yeatts RP, Waller RR. Sebaceous carcinoma of the eyelid: pitfalls in diagnosis. Ophthal Plast Reconstr Surg. 1985; 1:35–42.

9. Koo L, Hatton MP, Rubin PA. "Pseudo-pseudochalazion": giant chalazion mimicking eyelid neoplasm. Ophthal Plast Reconstr Surg. 2005; 21:391–2.

10. Kersten RC, Ewing-Chow D, Kulwin DR, Gallon M. Accuracy of clinical diagnosis of cutaneous eyelid lesions. Ophthalmology. 1997; 104:479–84.

11. Broekaert D, Goeman L, Ramaekers FC. . An investigation of cytokeratin expression in skin epithelial cysts and some uncommon types of cystic tumours using chain-specific antibodies. Arch Dermatol Res. 1990; 282:383–91.

12. Baek SH. Lipogranuloma in the upper lids. J Korean Ophthalmol Soc. 2000; 41:517–20.

13. Fenton S, Canninga-van Dijk MR, Mourists MP. Lipogranuloma of the nasolacrimal system, an iatrogenic and preventable entity. Eye. 2003; 17:528–30.

14. Goldwyn RM. The paraffin story. Plast Reconstr Surg. 1980; 65:517–24.

15. Hintschich CR, Beyer-Machule CK, Stefani FH. Pafaffinoma of the periorbit-a challenge for the oculoplastic surgeon. Ophthal Plast Reconstr Surg. 1995; 11:39–43.

16. Lang S, Dreher A, Grevers G. Primary Lipogranuloma of the Forehead. Am J Otolaryngol. 1995; 16:354–6.

17. Ben Simon GJ, Huang L, Nakra T. . Intralesional triamcinolone acetonide injection for primary and recurrent chalazia: is it really effective? Ophthalmology. 2005; 112:913–7.