Epibulbar osseous choristoma: Two case reports

INTRODUCTION

1.6 療效標(biāo)準(zhǔn) 臨床癥候觀察項(xiàng)目為：氣促、發(fā)熱、咳嗽。參照衛(wèi)生部制定的《中藥新藥臨床研究指導(dǎo)原則》和國(guó)家中醫(yī)藥管理局制定的《中醫(yī)病證診斷療效標(biāo)準(zhǔn)》及相關(guān)文獻(xiàn)進(jìn)行檢索［5-6］，將主要癥狀按輕重程度分為4級(jí)，以3分制積分：正常為0分，輕度為1分，中度為2分，重度為3分。

CASE PRESENTATION

Chief complaints

Case 1: A 23-year-old woman with no obvious predisposing cause was found to have a soybean-sized mass above the outer sphere of her left eye and visited our hospital for more than 6 mo.

這里將工序也分為質(zhì)檢類和非質(zhì)檢類，分別用QualityProcedure和UnQualityProcedure表示為

Case 2: A 31-year-old man presented with a mass in the right upper eyelid persisting for 1 mo.

History of present illness

Case 1: The patient was asymptomatic with no ocular pain or diplopia as well as no history of eye trauma or surgery.

我先不知道對(duì)你稱呼什么好些?一個(gè)青年可以在他敬愛的姑娘前面叫名字么?我想,你有少年人底理性和勇敢,你還是做我底弟弟罷。

History of past illness

Case 1 and Case 2: The patients had no past illness.

Personal and family history

Case 1 and Case 2: The patients had no history of familial diseases.

Physical examination

Case 1: Pre-procedure examination of the patient showed a pale-white nodule with a 5 mm diameter on the superior temporal bulbar conjunctiva of the left eye. It presented with a hard texture, mild hyperemia, poorly defined boundary, irregular shape, and no tenderness. The nodule was closely adhered to the substrate and could not be moved. There was no eye protrusion, and eye movement was normal (Figure 1). No abnormalities were found in the anterior and posterior segments.

Osseous choristomas are usually asymptomatic. Our patients were cured immediately after surgery, suggesting that surgical treatment is an effective strategy.

2.3 “uWS-MI”軟件應(yīng)用滿意度 兩名醫(yī)師對(duì)“uWS-MI”界面友好性、時(shí)效性及操作便捷性，系統(tǒng)的穩(wěn)定性和可靠性，系統(tǒng)數(shù)據(jù)管理的滿意率均為100%。

加強(qiáng)對(duì)河道的清淤疏浚施工工作，讓河道充分發(fā)揮其重要功能。重要作用。因此要加強(qiáng)對(duì)清淤疏浚技術(shù)的研究，對(duì)有關(guān)問題進(jìn)行有效控制，保證各項(xiàng)生產(chǎn)活動(dòng)順利完成。在具體的工作中，應(yīng)做好準(zhǔn)備工作，掌握現(xiàn)場(chǎng)的實(shí)際情況，落實(shí)施工準(zhǔn)備工作。還應(yīng)做好安全生產(chǎn)工作，建立健全安全生產(chǎn)責(zé)任制，采取有效的安全防范措施，嚴(yán)格執(zhí)行各項(xiàng)安全管理制度。有關(guān)部門負(fù)責(zé)人按照相關(guān)規(guī)定，組織人員進(jìn)行河道清淤疏浚工作，保證河道順通無(wú)阻，發(fā)揮河道在生產(chǎn)生活活動(dòng)中的積極作用，促進(jìn)經(jīng)濟(jì)建設(shè)事業(yè)不斷發(fā)展壯大，提高人們的生活水平。

Choristoma is a rare, benign, congenital proliferative tumor[1], which is defined as normal tissue that stops migrating during embryonic development and is located in an abnormal position. Epibulbar choristoma normally occurs sporadically and develops alone, or it may be associated with a variety of syndromes[2], such as Goldenhar syndrome, epidermal nevus syndrome, and encephalo-cranio cutaneous lipomatosis.Ocular choristomas can be classified as dermoid, dermolipoma, complex choristoma(choristomas with more than one tissue type), and single-tissue choristoma, among which osseous and complex choristomas are the rarest. The prevalence of epibulbar choristoma ranges from 1/10000 to 3/10000[2] and can occur at multiple sites,predominantly in the cornea, rectus muscle, and conjunctiva. In this study, we reviewed myoblastoma cases treated at our hospital since 2010 and provided reports and detailed preoperative, intraoperative, and postoperative lesion images, including gross and pathological images, of two patients with osseous choristoma.

Case 1: Ultrasound biomicroscopy showed a strong elliptical echo in the superficial scleral layer under the bulbar conjunctiva at the superior temporal side, with a clear boundary, obscured inferior echo, and limited scope exploration (Figure 2). Computed tomography imaging indicated a massive calcification lesion of about 1.0 cm × 0.5 cm in the upper left part of the left eye conjunctiva, and the nodule appeared to be cartilaginous (Figure 3).

由圖4可知，當(dāng)加熱溫度為460 ℃時(shí)，薄壁銅管的延伸率隨著保溫時(shí)間的延長(zhǎng)而變化不大，隨保溫時(shí)間延長(zhǎng)存在輕微波動(dòng)。當(dāng)保溫時(shí)間為30min時(shí)，延伸率為49%；保溫時(shí)間為35min時(shí)，延伸率為51%；當(dāng)保溫時(shí)間增至40min時(shí)，延伸率稍有降低為50%；保溫時(shí)間45min時(shí)，延伸率增至52%。但是，在保溫時(shí)間為30min時(shí)，延伸率波動(dòng)較大，為12%，這可能與該工藝條件下沒有完全發(fā)生再結(jié)晶，存在部分變形組織有關(guān)，見圖1（a）；在保溫時(shí)間為35min、40min和45min時(shí)，銅管的延伸率波動(dòng)仍較大，試樣微觀結(jié)構(gòu)也存在部分變形組織，見圖 1（b）、（c）、（d）。

可見，在上市公司治理中，只要法律對(duì)契約參與各方的欺騙行為的懲罰rx大于欺騙行為獲得的剩余U2-U1,契約參與各方可能會(huì)選擇誠(chéng)信。相反，如果法治環(huán)境不好，對(duì)欺騙行為懲治的力度不夠，對(duì)欺騙行為的懲罰rx小于欺騙獲得的剩余U2-U1，契約參與各方的欺騙行為就可能發(fā)生。假設(shè)法院判決賠償?shù)母怕蕆與法治水平q成正比，即r=a×q。

Histopathological evaluation confirmed osseous choristoma of the superficial sclera(fibrous connective tissue and fat surrounding the oblate neoplasm; hard as bone; and after decalcification, the tumor tissue was found to be mature bone tissue, with multiple Hastelloy tubes and annular bone plates, and no other soft tissue). The patient was diagnosed with epibulbar osseous choristoma and was cured after surgical excision (Figure 4).

Postoperative pathology confirmed osseous choristoma of the right upper eyelid. The tumor tissue was mainly composed of differentiated and mature bone and cartilage surrounded by a large number of proliferative collagen fibers.

We performed surgery to remove the neoplasm from the conjunctiva under local anesthesia; allo-scleral film was prepared to repair sclera. During the operation, the conjunctiva tissue on the surface was separated and the bone lesion with a diameter of 0.5 cm that was adhered to the scleral superficial tissue became visible. The neoplasm had a smooth surface and the sclera beneath was intact without pigment exposure, so it was then separated from the superficial sclera. Therefore, the capsule was sutured intermittently to reinforce the sclera. Postoperative suture removal was normal.

Case 2: The patient was asymptomatic without any ocular pain or diplopia and had no history of eye trauma or surgery.

The patient was cured after the surgery. The patient needs to be followed 1 mo after operation. If there is no discomfort, the patient will be followed every half a year.

OUTCOME AND FOLLOW-UP

Case 1

Treatment involved surgery during which one piece of solid tissue was excised. The resected tissue was red and nodular, with a wide base and no adhesion to the surrounding tissue, and also the neoplasm had a smooth surface. So it was then separated and capsule of the eyelid was sutured intermittently. Postoperative suture removal was normal.

Case 2

Surgery was successful, and the patient was cured. The patient needs to be followed 1 mo after operation. If there are discomfort symptoms, the patient should see a doctor at any time.

式中:F鏈min為驅(qū)動(dòng)鏈輪的最小作用力;T電min為驅(qū)動(dòng)電動(dòng)機(jī)的最小轉(zhuǎn)矩;r為履帶驅(qū)動(dòng)輪的半徑;i為減速齒輪箱的減速比。

The concept of osseous choristoma was first proposed in 1863[5]. Its etiology is unknown and is related to abnormal gene expression and mesenchymal development.Trauma or infection stimulates the bone morphologic proteins, which leads to heterotopic ossification and accelerates the disease progression[3,4]. However, osseous choristoma does not have any malignant metastatic tendency and can be present at birth. It develops rapidly in early childhood and then gradually stabilizes and ceases growth[5], and it may eventually be detected due to symptoms such as foreign body sensation or conjunctival congestion in the later adolescent years.

相信很多人還記得兩年前舉世矚目的“中國(guó)化肥并購(gòu)第一大單”，2016年金正大全資收購(gòu)德國(guó)康樸。德國(guó)康樸公司（COMPO GmbH）有60余年歷史，是植物養(yǎng)護(hù)產(chǎn)品領(lǐng)域應(yīng)用方案的全球供應(yīng)商之一，產(chǎn)品銷往全世界100多個(gè)國(guó)家和地區(qū)，在德國(guó)、奧地利、瑞士、法國(guó)、意大利、西班牙等歐洲多國(guó)市場(chǎng)占有率第一。今年6月19日“德國(guó)康樸公司（COMPO GmbH）回歸特種肥料市場(chǎng)全球啟動(dòng)儀式”在德國(guó)柏林成功舉行，并宣布德國(guó)康樸公司落戶中國(guó)，為包括中國(guó)在內(nèi)的全球市場(chǎng)提供頂級(jí)的高端產(chǎn)品和增效技術(shù)服務(wù)。

At present, there is no unified conclusion on the relationship between the occurrence and development of osseous choristoma and sex. Although it has been reported that young women tend to have a high incidence[4-7], the association with sex was not significant due to the small number of cases[2]. Additionally, osseous choristoma is observed more frequently in the right eye than in the left eye, and its sites are mainly distributed in the conjunctiva, sclera, and ophthalmic muscle, with most of them located in the fascia of the superior temporal quadrant[8-10], However,osseous choristoma occurring in the rectus muscle or eyelid is rare[6], and the frequency of these cases has not yet been statistically analyzed[1].

Since 2010, 296 cases of choristoma have been treated at our hospital, including 183 cases of dermoid cysts, 2 cases of osseous choristomas, 15 cases of osteoid lipomas, and 96 cases of dermoid tumors. The two cases of osseous choristoma, one female and one male patient, presented with a mass in the superficial sclera and eyelid, respectively.The prevalence of osseous choristoma in our hospital was 0.676%. Similar results were observed in a study conducted by Aldossary MM[2], in which among the 120 patients with myoblastoma of the ophthalmic surface, two had osteogenic myoblastoma, with a prevalence of 1.7%. Among the osseous choristoma cases in this study, one case was observed in a young woman, and it presented as a hard mass on the upper left temporal quadrant, which was in accordance with the previous reviews.CT imaging showed a high-density shadow, which was considered to be a dermoid tumor or lipoma, and a low-density focal area. Preoperative CT can be used to determine the properties and adhesion degree of the mass and the depth of the lesion resection. The treatment for osseous choristoma involves observation and surgical resection, with the surgical indications being foreign body sensation, irritative symptoms, and recurrent inflammation. In the study patients, the lesions were closely adhered to the sclera with poor activity, and surgical resection was performed for diagnostic and esthetic purposes[4].

The limitation of this case is that there are only two cases of epibulbar osseous choristoma, and the characteristics of osseous choristoma are not well summarized. In addition, the patients were not followed after surgery, so the postoperative outcome of the disease is unclear. Reviewing the previous literature, there are no large samples or long-term follow-up cases, so we suggest that the future study of osseous choristoma should increase the sample size to make statistical description of the primary sites,pathological features, prognosis and other aspects, so as to provide a clear diagnosis and outcome of the disease. Of course, special cases also deserve our attention.

CONCLUSION

We report two rare cases of osseous choristoma and their successful treatment. This study shows that clarifying the age, location, clinical manifestations, and CT findings of osseous choristoma can facilitate better diagnosis and guide further surgical treatment.