|Year : 2021 | Volume
| Issue : 1 | Page : 81-82
A rare case of osseous metaplasia of an eyelid in a child
Meenakshi Wadhwani, Shubhangi Kursange, Arti Khatri, Sneha Kumari
Department of Ophthalmology, Chacha Nehru Bal Chikitsalya, New Delhi, India
|Date of Submission||22-May-2020|
|Date of Decision||06-Jun-2020|
|Date of Acceptance||07-Jun-2020|
|Date of Web Publication||19-Apr-2021|
Dr. Shubhangi Kursange
Department of Ophthalmology, Chacha Nehru Bal Chikitsalya, Geeta Colony, New Delhi
Source of Support: None, Conflict of Interest: None
Osseous metaplasia is the formation of bone within a different tissue. It is a rare phenomenon that occurs primarily in breast tissue and abdominopelvic organs. Intraocular osseous metaplasia is also common. Osseous metaplasia in eyelid is rare entity. We present the case of osseous metaplasia of eyelid in a 6-year-old child. This is the first case of osseous metaplasia occurring in the pediatric population. This case also highlights the importance of coordination between ophthalmologist and pediatrician to obtain relevant history, perform imaging, and hematological test to rule out primary and secondary causes of such swellings to reach accurate diagnosis.
Keywords: Calcification, eyelid mass, metaplasia, pilomixotroma
|How to cite this article:|
Wadhwani M, Kursange S, Khatri A, Kumari S. A rare case of osseous metaplasia of an eyelid in a child. Kerala J Ophthalmol 2021;33:81-2
| Introduction|| |
Osseous metaplasia is the formation of benign bone in abnormal location. It is not applicable to the persistence of embryonic or fetal bone, resulting in calcification or ossification. It is also known as heterotopic bone formation, found in variety of tissue types such as prostate, uterus, breast, skin appendages, pulmonary system, and gastrointestinal organs. Osseous metaplasia in the eye has been reported in few cases till date. Following is the case of osseous metaplasia in eyelid in a pediatric age group.
| Case Report|| |
A 6-year-old female child presented to the outpatient department of a pediatric tertiary care hospital with a history of painless swelling in the left eye over lateral canthus for 2 years, gradually increasing in size. It was not associated with any discharge or redness. There was no history of trauma or surgery. Ophthalmic examination of the left eye showed pedunculated mass over lateral canthus of size approximately 0.5 cm, nontender, overlying skin normal, firm in consistency [Figure 1] The rest of the anterior and posterior segment examination of both the eyes was within the normal limits. On cycloplegic refraction, the child was emmetropic. The provisional clinical diagnosis of sebaceous cyst was thought of. Surgical excision of mass under general anaesthesia was planned. Mass was excised in toto, underlying lid margin appeared healthy, and the wound was sutured.
|Figure 1: Clinical picture showing a soft-tissue mass on lateral cantus of the left eye|
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Histopathological examination of the mass revealed ossified bone beneath the stratified squamous epithelium [Figure 2]a and [Figure 2]b. A diagnosis of osseous metaplasia of eyelid was formed. Child was evaluated extensively to rule out metastasis by conducting hematological and endocrinological profile for any systemic associations to rule out rickets and Albright syndrome. Complete blood count showed increase in acute eosinophilic count. Thyroid profile, rickets profile, and serum electrolytes were within the normal limits. Serum Vitamin D level was 13.63 ng/ml (normal range 30–100 ng/ml). X-ray chest ray pelvic bones, computed tomography abdomen and pelvis was normal. Height of child was between third and tenth percentile, weight was between tenth and 25th percentile for age. Similar growth retardation noted in one sibling. Child was advised Vitamin D supplementation and advised for regular follow-up. The child is in regular follow-up with us, and there is no evidence of recurrence at 6 months of follow-up.
|Figure 2: (a) Scanner view of the mass showing ossified bone beneath the epithelium (H and E, ×40). (b) High-power view showing Haversian system in the bone with overlying unremarkable stratified squamous epithelium (H and E, ×400)|
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| Discussion|| |
Osseous metaplasia is the formation of bone at different location. Causes can be primary or secondary. The primary causes being congenital Albright's hereditary osteodystrophy and progressive osseous heteroplasia. The secondary causes include trauma and chronic inflammation. Chronic inflammation triggers local factors to transform cells into osteoblasts leading to bone formation. Abnormal concentration of calcium phosphorus, PH level, and oxygen concentration can be additive factors.,
Osseous metaplasia is frequently reported in breast tissue and abdominopelvic organs. Other locations being thyroid and ocular tissue. Vemuganti GK reported intraocular ossification in 8 out of 151 cases, common location being subretinal or preretinal. Pthisis bulbi due to trauma or retinal detachment, staphyloma, microophthalmos was common causes. Although intraocular ossification is common, osseous metaplasia in ocular adnexa is rare. Till date, only 2 cases of eyelid osseous metaplasia had been reported by Liu et al. both cases were more than 40 years' age with a history of recurrent trauma to skin. The index case is the first case of osseous metaplasia of eyelid in the pediatric age group. The current case lacks a history of trauma or previous excision plus no definite cause for ossification, leading to idiopathic origin of lesion. The lesion differentiated from pilomixotroma of eyelid, which is common in children by the absence of reddish or bluish appearance of skin. Treatment of choice is complete excision. Systemic evaluation for the presence of any malignancy is necessary. Regular follow-up is needed to check any recurrence.
In conclusion, osseous metaplasia of eyelid is a very rare entity with variety of differential diagnosis. Its importance is highlighted by proper coordination between ophthalmologist and pediatrician to obtain relevant history, perform imaging, and hematological test to rule out primary and secondary causes to reach accurate diagnosis. In Index case, complete excision of the mass lead to eradication with no relapse till date.
informed and written consent was obtained from parents.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Ferry AP. Sub epidermal calcified nodules of the eyelid. Am J Ophthalmol 1990;110:316-8.
Burgdorf W, Nasemann T. Cutaneous osteomas: A clinical and histopathologic review. Arch Dermatol Res 1977;260:121-35.
Chun JS, Hong R, Kim JA. Osseous metaplasia with mature bone formation of the thyroid gland: Three case reports. Oncol Lett 2013;6:977-9.
Vemuganti GK, Honavar SG. Intraocular osseous metaplasia. A clinico-pathological study. IJO 2002;50:183-8.
Liu AY, Cole HP, Meldrum Aaberg ML, Hans EG. Osseous metaplasia of the eyelid: Report of two cases. Ophthal Plast Reconstr Surg 2014;30:E9-10.
[Figure 1], [Figure 2]