Lateral canthal choristomas associated with colobomas of lateral canthus

Choristomas are congenital lesions presenting normal tissue in an abnormal location. A conjunctival dermolipoma is a congenital choristomas tumor usually localized in the temporal aspects of the bulbar conjunctiva, near the lateral canthus. It may be associated with developmental anomalies of the second branchial arch, such as Goldenhar syndrome. The association between dermolipoma and lateral canthal cleft without other congenital anomalies is uncommon. The purpose of this paper is to present a series of isolated choristomas in the lateral canthus associated with a lateral cleft. We present 3 cases of dermolipoma at the lateral canthus associated with isolated lateral cleft. The dermolipomas’ appearance ranges from a flat lesion to a large pedunculated tumor, obliterating the lateral conjunctival fornix. A partial removal of the dermolipoma was done with canthoplasty to close the lateral coloboma. Surgical management of dermolipoma with partial excision aimed at reducing visible tumor produced good cosmetic results, without complications. Microscopic examination of the tumor revealed a mass covered by stratified squamous keratinized epithelium. The mass comprised largely of mature adipose tissue interspersed with bundles of collagen. The presence of pilosebaceous units was also noted. Based on these features, a histopathological diagnosis of a dermolipoma was made. The association between dermolipoma and isolated lateral canthal cleft is much less common than the associations with other distinguishing abnormalities. In summary, these cases illustrate that dermolipomas are also a part of a wide spectrum that characterizes benign growths of the eyelids.

Level of evidence: Level V, therapeutic study.