title: Persisting subcutaneous emphysema of eyelids mimicking orbital tumor.
abstract: Eyelids emphysema is a rare condition due to air trapping in subcutaneous tissue of the orbit. It has been clinically and radiologically documented, but histologic evaluation has not been noted. We report a case of a middle-aged woman with periorbital swelling due to self-induced Valsalva maneuver, persisting after decompressive therapy. A fine-needle biopsy was performed and showed a mixed population of osteoclastic-like giant cells and mononuclear epithelioid cells, which were suspected of pathological proliferative disease. Specimens from blepharoplasty indicated pseudocystic empty spaces surrounded by epithelioid cells and giant cell granulomas. Immunohistochemical stains favored diagnosis of benign granulomatous disease, such as subcutis cystic pneumatosis. Histologic examination represented an important tool for differential diagnosis with soft tissue neoplasms of the orbit in subcutis emphysema with unusual clinical presentation and abnormal course.
authors.affiliation: From the Units of *Pathology, †Otorhinolaryngology, ‡Maxillofacial Surgery, Department of Medical Sciences, Faculty of Medicine and Surgery, Amedeo Avogadro University of East Piedmont, Novara, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Bozzola
authors.forename: Andrea
authors.initials: A
authors.lastname: Toso
authors.forename: Gloria
authors.initials: G
authors.lastname: Golinelli
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Benech
authors.forename: Paolo
authors.initials: P
authors.lastname: Aluffi
authors.forename: Renzo
authors.initials: R
authors.lastname: Boldorini
mesh_terms: D003937:Diagnosis, Differential; D005141:Eyelid Diseases / Q000473:pathology*; D005260:Female; D006099:Granuloma / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D009918:Orbital Neoplasms / Q000473:pathology*; D013352:Subcutaneous Emphysema / Q000473:pathology*