Encephalocraniocutaneous lipomatosis associated with orbital cyst: is this a variant or a new entity?

Introduction: Encephalocraniocutaneous lipomatosis (ECCL), also known as Haberland or Fishman syndrome, is an extremely rare congenital neurocutaneous disorder that characteristically involves ectomesodermal tissues, such as the central nervous system, eyes, and skin. Aetiology of the disease remains unknown.
Case report: We present a case of a 3-year-old boy who presented with cystic right eye swelling since birth. Physical examination showed alopecia on right side of the scalp, ipsilateral ocular cyst and micropththalmia with a contralateral limbal dermoid. The computed tomography scan of the brain revealed severe atrophy of the right cerebral hemisphere with an expansion of the cerebrospinal fluid space and dilatation of the lateral ventricle suggesting ex-vacuo hydrocephalus. Right orbital cyst continuous with the globe and calcification of the posterior aspect of both globes were also present. Histopathologic findings of the excised orbital cyst revealed an eyeball covered by fatty tissue, cut surface showed calcification of the cyst wall and presence of corneal opacity. Microscopy showed cornea-sclera wall composed of normal cartilage communicating with sandwich bony trabeculae with a focus of marrow cells, consistent with choristoma. The constellation of these findings conforms to Moog’s revised diagnostic criteria for ECCL proposed in 2009.
Conclusion: We present a rare case of ECCL associated with bilateral eye involvement and orbital cyst from Sub-Saharan Africa. The disorder is easily recognizable at birth, however, neuroimaging is essential for appropriate diagnosis and management and to exclude or confirm other unusual associated abnormalities. Parents of a child with this abnormality should be reassured that the syndrome is not transmittable to the offspring and that the risk of recurrence in siblings is virtually absent.