Soft tissue
Adipose tissue
Subconjunctival herniated orbital fat

Author: Ivy John, M.D. (see Authors page)

Revised: 28 November 2016, last major update November 2016

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Subconjunctival herniated orbital fat

Cite this page: Subconjunctival herniated orbital fat. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/softtissueadiposeshof.html. Accessed December 5th, 2016.
Definition / General
  • Rare entity; first described in path literature in 2007 (Am J Surg Pathol 2007;31:193)
  • Prolapsed intraconal fat due to dehiscence of tenon capsule precipitated by age, disease, trauma or surgery
  • Typically occurs in elderly obese men
  • Presents as small (up to 2.5 cm), raised, convex, yellow, compressible mass in the superotemporal quadrant of the eye (Optom Vis Sci 2015;92:1021, Figure 1 & 2)
  • Unilateral or bilateral
  • Low recurrence rate after simple excision
Essential Features
  • Rare entity, caused by forward movement of intraconal fat due to dehiscence of tenon capsule precipitated by age, disease, trauma or surgery
  • Typically presents in elderly obese men as a small, raised, yellow, compressible mass in the superotemporal quadrant of the eye
  • Composed of an admixture of mature adipocytes, delicate fibrovascular septae, Lockhern cells and floret-like giant cells
  • Principal differential diagnosis includes pleomorphic lipoma and atypical lipomatous tumor
Case Reports
Clinical Images
Images hosted on other servers:

Prolapsed orbital fat

Micro Description
  • Composed of uniformly shaped mature adipocytes separated by a delicate fibrovascular septae
  • Scattered Lockhern cells (adipocytes with enlarged nuclei containing intranuclear vacuoles) and floret-like giant cells (multinucleated giant cells with a wreath like arrangement of bland, uniform, often vacuolated nuclei)
  • Varying numbers of inflammatory cells, including lymphocytes, plasma cells, histiocytes and mast cells
Micro Images
Images hosted on PathOut server, contributed by Ivy John, M.D.:

Herniated orbital fat

Positive Stains
Differential Diagnosis
  • Pleomorphic lipoma:
    • Different location; PL often involves soft tissues of back and shoulder of elderly men
    • Areas typical of spindle cell lipomas, including variably myxoid stroma, wire-like collagen and bland spindle cell proliferation are focally present
    • Floret-like giant cells show notable nuclear enlargement and hyperchromasia

  • Well differentiated liposarcoma: