Subconjunctival orbital fat herniation mimicking lipomatous tumors

概要

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Subconjunctival fat herniation is rarely described in the literature, but it is common in clinical practice. It represents prolapse of the intraconal fat to the subconjunctiva, mainly from aging. It usually occurs in the superotemporal quadrant of the globe, and rarely causes symptoms. Microscopically, multinucleated giant cells that frequently have a floret-like appearance (floretlike cells), and also bizarre adipocytes with nuclear vacuoles (Lochkern cells) are seen. We present a case of a 68-year-old Japanese man with subconjunctival fat herniation that showed floret-like cells and Lochkern cells. The differential diagnosis included lipomatous tumors of the orbit such as pleomorphic lipoma, liposarcoma, as these resemble subconjunctival fat herniation macroscopically. It is important to make a histopathological diagnosis for fat herniation to avoid overlooking malignant tumors and over-treating benign lesions.