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Kumari S. Benign eyelid lesions and its histopathological picture: A case-series. J Family Med Prim Care 2024; 13:5903-5907. [PMID: 39790812 PMCID: PMC11709021 DOI: 10.4103/jfmpc.jfmpc_760_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 05/26/2024] [Accepted: 06/14/2024] [Indexed: 01/12/2025] Open
Abstract
Our prospective case series evaluates the clinical feature, histopathological picture, and treatment of benign eyelid lesions in a tertiary referral setting. Participants were first nine patients referred to the author with unilateral eyelid swelling. Main outcome measures were clinical features, histopathological picture, and response to surgical intervention. Benign eyelid lesions in our case series were epidermal inclusion cyst, giant conjunctival inclusion cyst, epidermoid cyst, dermoid cyst, intradermal nevus, dermal nevus, apocrine hidrocystoma, capillary hemangioma, and lobular capillary hemangioma. The histopathological diagnosis of eight lesions were consistent with their respective clinical diagnosis, while one lesion was misdiagnosed. Surgical excision was done in all cases. One case underwent revision surgery for complication. This series highlights the importance of achieving higher diagnostic accuracy with thorough knowledge of clinical features and subsequent confirmation with histopathological analysis.
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Affiliation(s)
- Shalini Kumari
- Department of Ophthalmology, AL-Falah Medical College, Faridabad, Haryana, India
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2
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Shih B, Joseph M, Zhang Q, Gray MT. A Rare Hybrid Skin Cyst of the Scalp With Pilar and Apocrine Features. Cureus 2024; 16:e62071. [PMID: 38989380 PMCID: PMC11235387 DOI: 10.7759/cureus.62071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/12/2024] Open
Abstract
Benign epithelial skin cysts containing multiple components of the folliculo-sebaceous apocrine unit are only rarely reported in the literature. Here, we describe a 12-year-old girl who presented with a cystic mass on the vertex of her scalp. Upon resection, it showed a hybrid benign skin cyst with interesting histological features of both pilar and apocrine differentiation. The clinicopathological and imaging findings of this unusual skin cyst, successfully managed by a plastic surgeon and neurosurgeon, are described. Pathologists and clinicians should be aware of this type of skin cyst rarely encountered in their clinical practice.
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Affiliation(s)
- Brian Shih
- Medicine, Western University, London, CAN
| | - Mariamma Joseph
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, CAN
| | - Qi Zhang
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, CAN
| | - Madison T Gray
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, CAN
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Di Marino M, Quaranta Leoni F, Ranazzi G, Quaranta Leoni FM. Orbital apocrine hidrocystoma. Report of two cases. Eur J Ophthalmol 2024; 34:NP42-NP45. [PMID: 38073082 DOI: 10.1177/11206721231219720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
INTRODUCTION We report the clinical features and the management of two cases of orbital hidrocystoma in the setting of an enlarging orbital mass. CASES DESCRIPTION A 48-year-old man presented with a mass in the right upper medial orbital quadrant, firmly attached to the supraorbital incisure. A 70-year-old man had a well demarcated lesion in the upper lateral orbital quadrant adherent to the lacrimal gland. There was no history of previous orbital trauma. In both cases histopathology confirmed a diagnosis of apocrine hidrocystoma. Following surgery, the first patient complained of mild hypoesthesia in the territory of the supraorbital nerve that resolved spontaneously within 3 weeks. Surgery was uneventful in the other patient. No recurrence was seen during the follow up. CONCLUSIONS Apocrine hidrocystomas have been rarely described in the orbit, but should be considered in the differential diagnosis of orbital cystic masses. Recurrence is rare following complete surgical excision.
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Affiliation(s)
- Matteo Di Marino
- Orbital and Adnexal Service, Tiberia Hospital - GVM Care & Research, Rome, Italy
| | - Flavia Quaranta Leoni
- Faculty of Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulio Ranazzi
- Department of Pathology, Tiberia Hospital - GVM Care & Research, Rome, Italy
| | - Francesco M Quaranta Leoni
- Orbital and Adnexal Service, Tiberia Hospital - GVM Care & Research, Rome, Italy
- Oftalmoplastica Roma, Rome, Italy
- Faculty of Medicine and Surgery, University of Pavia, Pavia, Italy
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4
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Connolly DM, McGeehin EL, Lee JB. Apocrine cystadenoma: A long-standing apocrine hidrocystoma with an adenomatous proliferation. J Cutan Pathol 2024; 51:251-257. [PMID: 38084825 DOI: 10.1111/cup.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/13/2023] [Accepted: 11/25/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Apocrine cystadenoma is a rare, benign adenomatous cystic neoplasm, the pathogenesis of which is not fully understood. We sought to characterize the clinical, dermatoscopic, and histopathologic features of apocrine cystadenoma and its relationship to hidrocystoma. METHODS We retrospectively analyzed cases of apocrine cystadenoma and hidrocystoma retrieved from the dermatopathology laboratory information system. RESULTS Of the 350 cases apocrine cystic lesions, 13 cases of apocrine cystadenomas met the inclusion criteria. The age ranged from 20 to 84 years with an average of 64 years. They were long-standing (duration 3-15 years), slow-growing, large tumors usually found on the scalp. Dermatoscopy accentuated translucent light to dark blue color and prominent vessels that were present more at the periphery. All lesions were multilocular with columnar to cuboidal lining and decapitation secretion. A large portion of the lesion consisted of a simple nonproliferative epithelial lining, identical to that observed in apocrine hidrocystomas, while the proliferative adenomatous component made up a smaller portion with two patterns: (1) tubular proliferation, which either protruded into the cystic cavity or expanded outward peripherally, or (2) papillary projections, which were multiple layers thick with fibrovascular core, sometimes accompanied by tubular proliferation. Immunohistochemical stains showed strong staining for p40 and a sparse number of cells stained for Ki-67 and p53. CONCLUSIONS The long duration of the lesion and the large areas of simple apocrine epithelial lining suggest that apocrine cystadenomas arise from long-standing apocrine hidrocystomas. However, the retrospective nature of the study from a single institution is a limitation.
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Affiliation(s)
- Deirdre M Connolly
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Eleni L McGeehin
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jason B Lee
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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5
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Charles NC, McGee RP, Kim ET. Apocrine Cystadenoma of the Eyelid, a Rare Neoplasm: Expanded Immunohistologic Profile. Ophthalmic Plast Reconstr Surg 2023; 39:e142-e145. [PMID: 37010052 DOI: 10.1097/iop.0000000000002396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
An 83-year-old woman experienced the slow enlargement of a right lower eyelid mass. Histopathologic examination of the excised tissue showed a mucin-filled cystic tumor emanating from an apocrine bilayer that displayed bleb-like apocrine decapitation secretion. The outer flattened myoepithelial layer of the bilayer reacted with immunohistochemical stains for smooth muscle actin and calponin. In foci, the tumor exhibited a cribriform architecture with small pockets of mucin. Tumor cells were reactive for cytokeratin 7, Gross Cystic Disease Fluid Protein 15 (BRST-2), estrogen and progesterone receptors, androgen receptors, mammaglobin, epithelial membrane antigen, and GATA3. Ki67 showed a very low proliferation fraction. The lesion exemplifies the fourth instance of an eyelid apocrine cystadenoma in the literature.
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Affiliation(s)
- Norman C Charles
- Pathology, New York University Langone Medical Center, New York, U.S.A
| | - Rebecca P McGee
- Pathology, New York University Langone Medical Center, New York, U.S.A
| | - Eleanore T Kim
- Pathology, New York University Langone Medical Center, New York, U.S.A
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Charles NC, Kim ET. Eccrine Cyst (Hidrocystoma) of the Inner Canthus: A Rare Entity With Immunohistologic Confirmation. Ophthalmic Plast Reconstr Surg 2023; 39:e96-e97. [PMID: 36806128 DOI: 10.1097/iop.0000000000002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A small ruptured cyst was excised from the left inner canthus of a 68-year-old woman. Histopathology displayed a cyst lined by a double layer of cuboidal epithelium and filled with amorphous material. The lining cells were strongly positive for cytokeratins 5/6 and 14, with weak reactivity with cytokeratin 7. These findings were identical to those in a single previous report of an eccrine cyst of the eyelid, making this the second example of a bona fide eccrine hidrocystoma of the eyelid.
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Affiliation(s)
- Norman C Charles
- Department of Ophthalmology
- Department of Pathology, New York University Langone Medical Center, New York, New York, U.S.A
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Kim JH, Uh JA, Lee JH, Kim HY, Lee SK, Kim MS, Lee UH. Unusual Complex Apocrine Tumor Consisting of Syringocystadenoma Papilliferum and Apocrine Hidrocystoma within a Single Lesion: A Case Report. Ann Dermatol 2023; 35:66-70. [PMID: 36750461 PMCID: PMC9905859 DOI: 10.5021/ad.21.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/23/2021] [Accepted: 04/06/2021] [Indexed: 02/03/2023] Open
Abstract
Syringocystadenoma papilliferum (SCAP) and apocrine hidrocystoma (AH) are benign apocrine neoplasms that usually occur separately. SCAP arises predominantly in head and neck, while AH typically develop in periorbital area. We report a case of a 68-year-old male with an asymptomatic erythematous papulonodule that occurred on his back 3 years ago. Histologic examination showed cystic invagination extending from the epidermis into the dermis with some papillary projections. The invaginated portion was lined by epithelial bilayer composed of cuboidal and columnar cells, and decapitation secretion was observed in the inner epithelial layer. In the deep dermis, multiple cystic spaces with variable sizes were observed, and these cysts also presented double layers of the epithelium and decapitation secretion. According to such histologic features, the coexistence of SCAP and AH within a single lesion was demonstrated. The patient was recommended to completely remove the remaining lesion after punch biopsy, but he refused further surgical management. Herein, we report an unusual case of complex apocrine tumor with a rare composition in an atypical site.
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Affiliation(s)
- Joong Ho Kim
- Department of Dermatology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Ji An Uh
- Department of Dermatology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jae Ho Lee
- Department of Dermatology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Ho Young Kim
- Department of Dermatology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Soo Kyung Lee
- Department of Dermatology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Myoung Shin Kim
- Department of Dermatology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Un Ha Lee
- Department of Dermatology, Inje University Sanggye Paik Hospital, Seoul, Korea.
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Alsarhani WK, Al-Sharif EM, Al-Faky YH, Alkatan HM, Maktabi AM, Alsuhaibani AH. Dacryops and clinical diagnostic challenges. CANADIAN JOURNAL OF OPHTHALMOLOGY 2022; 57:388-393. [PMID: 34324876 DOI: 10.1016/j.jcjo.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/23/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The study aims to describe the clinical and histopathologic features of different types of dacryops and their clinical diagnostic challenges. METHODS This is a retrospective cohort study of all surgically excised cases of dacryops in 2 tertiary eye hospitals in Riyadh, Saudi Arabia. RESULTS The study included 58 dacryops specimens from 55 patients with an average age of 41.2 years (range, 4-78 years). The most common location was the upper lid (60.3%), whereas the least expected location was the caruncle (6.9%). The most common site of dacryops occurrence was in the accessory lacrimal gland (55.2%), the main lacrimal gland (32.8%), and then ectopic dacryops (12%). All patients presented with lid swelling alone except for 3 patients who experienced secondary mechanical ptosis. On physical examination, conjunctival scarring existed in 4 patients (6.9%). Preoperative diagnosis of dacryops was accurate in 44.8% of the cases. Dacryops of the main lacrimal gland was accurately diagnosed clinically in all cases compared with other locations, which was statistically significant (p < 0.001). The causes of inaccurate clinical diagnoses were hidrocystoma (26.9%), inclusion cyst (11.5%), and dermoid cyst (7.7%), whereas the remaining cases were diagnosed as cysts without a specific subtype (53.9%). Recurrence of the lesion was observed in 2 cases (3.5%). No clinical or histopathologic factors were associated with a risk of recurrence. CONCLUSION Dacryops can represent a diagnostic challenge to ophthalmologists. Familiarity with clinical presentations and findings is required to diagnose dacryops outside the main lacrimal gland.
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Affiliation(s)
- Waleed K Alsarhani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Eman M Al-Sharif
- Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Department of Ophthalmology, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, Riyadh, Saudi Arabia; Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Azza M Maktabi
- Department of Pathology and Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Adel H Alsuhaibani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, Riyadh, Saudi Arabia
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9
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Huang V, Lee V, Briceño CA. Orbital apocrine hidrocystoma with ptosis. Am J Ophthalmol Case Rep 2022; 28:101747. [DOI: 10.1016/j.ajoc.2022.101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/15/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022] Open
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What could this dark lesion on a woman’s eyelid be? Int J Womens Dermatol 2022; 8:e037. [PMID: 36035862 PMCID: PMC9400936 DOI: 10.1097/jw9.0000000000000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 06/02/2022] [Indexed: 11/26/2022] Open
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Episcleral Apocrine Hidrocystoma Following Strabismus Surgery. Ophthalmic Plast Reconstr Surg 2022; 38:e112-e113. [DOI: 10.1097/iop.0000000000002153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Karachrysafi S, Fadel G, Kapourani V, Akritidou F, Anastasiadou P, Papamitsou T, Sioga A, Fadel E. Histological study of eyelid hidrocystoma: A clinical case. SAGE Open Med Case Rep 2022; 10:2050313X221097770. [PMID: 35573100 PMCID: PMC9102149 DOI: 10.1177/2050313x221097770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
Hidrocystomas are benign lesions with frequent localization on the eyelids and common appearance as isolated translucent cystic lesions. The multiple and bilateral localization has been associated with systemic diseases or epidermodysplasia. The histological and ultrastructural study contributes to the distinction in eccrine or apocrine. In this clinical case, multiple bilateral skin lesions of the eyelids were removed surgically from a 55-year-old male patient with free medical history. The lesions were fully removed surgically without rupture of the cysts. The obtained tissues were fixed and prepared for an anatomical pathology study as well as observation under the electron microscope. The histological study revealed cystic lesions with low cuboid epithelium and presence of cells and collagen fibrils, while the ultrastructural study also revealed the presence of apoptotic and secretory cells as well as vacuolization of the cytoplasm. No relapse of the lesions was obtained. In conclusion, the histological and ultrastructural study of multiple hidrocystomas can highlight special features that help to better classify and diagnose eccrine or apocrine hidrocystomas, while surgical removal without rupture of the cyst can prevent reappearance.
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Affiliation(s)
- Sofia Karachrysafi
- Department of Ophthalmology, General Hospital G. Papanikolaou, Thessaloniki, Greece.,Laboratory of Histology-Embryology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Fadel
- Department of Ophthalmology, General Hospital G. Papanikolaou, Thessaloniki, Greece
| | - Viktoria Kapourani
- Department of Ophthalmology, General Hospital G. Papanikolaou, Thessaloniki, Greece
| | - Fani Akritidou
- Laboratory of Histology-Embryology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pinelopi Anastasiadou
- Department of Oral Medicine/Pathology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Papamitsou
- Laboratory of Histology-Embryology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonia Sioga
- Laboratory of Histology-Embryology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elie Fadel
- Department of Ophthalmology, General Hospital G. Papanikolaou, Thessaloniki, Greece
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Abstract
Apocrine hidrocystomas are benign cystic tumors derived from apocrine sweat glands; they are most commonly located in the skin of the head and neck regions. Ophthalmic occurrences characteristically appear at the lash line and canthi of the eyelid, although rare instances have been described in the conjunctiva, caruncle, and orbit. The authors describe an exceptional instance of a mobile epibulbar subconjunctival apocrine hidrocystoma in a 57-year-old woman without a history of previous ocular injury or surgery. Histopathology of the excised specimen displayed an empty cyst lined by a double layer of cuboidal epithelium with the inner layer exhibiting periodic acid-Schiff-positive apical decapitation secretion. Confirmatory immunohistochemistry included reactivity with cytokeratin-7, smooth muscle actin, D2-40, and CDGFP-15.
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Affiliation(s)
- Norman C Charles
- Department of Ophthalmology
- Department of Pathology, New York University Langone Medical Center, New York, U.S.A
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Koumaki D, Papadakis M, Lagoudaki E, Manios GA, Kassotakis D, Doxastaki A, Krasagakis K, Manios A. Apocrine and eccrine hidrocystomas: a clinicopathological study. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2021. [DOI: 10.15570/actaapa.2021.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Current Diagnosis and Treatment Options for Cutaneous Adnexal Neoplasms with Apocrine and Eccrine Differentiation. Int J Mol Sci 2021; 22:ijms22105077. [PMID: 34064849 PMCID: PMC8151110 DOI: 10.3390/ijms22105077] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/15/2021] [Accepted: 05/02/2021] [Indexed: 12/16/2022] Open
Abstract
Adnexal tumors of the skin are a rare group of benign and malignant neoplasms that exhibit morphological differentiation toward one or more of the adnexal epithelium types present in normal skin. Tumors deriving from apocrine or eccrine glands are highly heterogeneous and represent various histological entities. Macroscopic and dermatoscopic features of these tumors are unspecific; therefore, a specialized pathological examination is required to correctly diagnose patients. Limited treatment guidelines of adnexal tumor cases are available; thus, therapy is still challenging. Patients should be referred to high-volume skin cancer centers to receive an appropriate multidisciplinary treatment, affecting their outcome. The purpose of this review is to summarize currently available data on pathogenesis, diagnosis, and treatment approach for apocrine and eccrine tumors.
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Conjunctival Implantation Cyst in the Orbicularis Oculi Muscle: Review of a Possible Origin From Displaced Stem Cells With a Differential Diagnosis. Ophthalmic Plast Reconstr Surg 2021; 37:1-11. [PMID: 32304506 DOI: 10.1097/iop.0000000000001631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To document a unique case of a corneal/conjunctival epithelial inclusion cyst located in the orbicularis oculi muscle with a comprehensive review of variant conjunctival cysts and simulating conditions. METHODS Clinicopathologic case report with detailed histopathologic and immunohistochemical evaluation for cytokeratins combined with a tabulation of mimicking lesions and relevant literature citations. RESULTS A 59-year-old man experienced severe blunt left periorbital trauma that resulted in a limbal partial-thickness corneal wound with an associated epithelial abrasion and a full-thickness eyelid laceration extending from the superior fornix to the margin. Several months after surgical repair of the eyelid a cyst appeared in the superior pretarsal skin. Histopathologic and immunohistochemical investigations supplied data suggesting that the cyst had a high probability of a corneoscleral limbal stem cell origin. Distinctive features of the lesion are contrasted with those of allied or simulating cysts. CONCLUSIONS Stem cells are now believed to be located at the corneoscleral limbus, in the inferior fornix, in the medial canthal region, and at the eyelid margin where transitions from conjunctival epithelium to epidermal epithelium occur. Due to their replicative, hardy and robust nature, stem cells displaced to alien environments are most likely to survive and produce cysts. The cyst's corneal-type cytologic characteristics, the absence of goblet cells, and the expression of a broad spectrum of cytokeratin biomarkers in the current case give support to the proposal that limbal stem cells in the region of the corneal laceration were displaced to the eyelid orbicularis muscle and were responsible for this most extraordinary cyst. Comparison with other epithelial cystic linings lends further evidence for this conclusion.
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Stagner A. In memoriam: Frederick A. Jakobiec, M.D., D.Sc., the “king of cysts,” and so much more. Saudi J Ophthalmol 2021. [DOI: 10.4103/sjopt.sjop_105_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Matsueda K, Otani T, Fujioka Y, Mizuno M. A giant apocrine hidrocystoma associated with elevated serum carcinoembryonic antigen levels: a case report. J Med Case Rep 2019; 13:237. [PMID: 31366404 PMCID: PMC6670128 DOI: 10.1186/s13256-019-2175-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/26/2019] [Indexed: 11/19/2022] Open
Abstract
Background Serum carcinoembryonic antigen levels are often elevated in patients with malignant diseases. However, the etiology of elevated serum carcinoembryonic antigen levels may be extremely difficult to determine considering that this finding may occasionally occur in patients with benign diseases. Apocrine hidrocystomas, which are typically small and found on the face, are benign cystic lesions of apocrine sweat glands. Case presentation A 58-year-old Japanese man was referred to us because of high serum carcinoembryonic antigen levels (15.9 ng/mL) found incidentally during a routine medical checkup. A physical examination revealed a hemispherical mass approximately 5 cm in diameter on his left thigh. Magnetic resonance imaging of the region showed a multilocular cystic mass with clear margins and a smooth surface, suggesting a cystic tumor. He underwent local mass resection. Pathological examination of the resected mass revealed an apocrine hidrocystoma with luminal cells, which tested immunohistochemically positive for carcinoembryonic antigen. Postoperatively, serum carcinoembryonic antigen levels returned to normal. This report is the first to describe an apocrine hidrocystoma associated with high serum carcinoembryonic antigen levels. Conclusions An apocrine hidrocystoma can cause elevation of serum carcinoembryonic antigen levels. Despite its rarity, apocrine hidrocystoma should be considered in the differential diagnosis of conditions causing high serum carcinoembryonic antigen levels. In addition, skin diseases deserve more careful attention for patients with high serum carcinoembryonic antigen levels.
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Affiliation(s)
- Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan.
| | - Toshio Otani
- Department of Dermatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Yusuke Fujioka
- Department of Plastic and Reconstructive Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
| | - Motowo Mizuno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan
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Ishikawa E, Sabundayo MS, Kono S, Kakizaki H, Takahashi Y. Patency of the lacrimal drainage system in patients with a peripunctal tumour. Orbit 2019; 39:102-106. [PMID: 31169438 DOI: 10.1080/01676830.2019.1626446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To examine the patency or secondary obstruction of the lacrimal drainage system in patients with a peripunctal tumour.Methods: This retrospective, observational, and comparative study included 10 patients with a peripunctal tumour. Lacrimal probing and syringing in all patients and dacryoendoscopic examinations in 5 patients were performed to check for patency of the lacrimal drainage system. Tear meniscus height (TMH) was measured bilaterally in the upper and lower eyelids using anterior segment optical coherence tomography and compared in relation to the affected side using one-way ANOVA.Results: All patients did not complain of epiphora. Probing gave a hard stop and irrigation fluid passed into the nose. A patent punctum/canaliculus was also confirmed by dacryoendoscopy in all of the 5 patients. TMH was not significantly different among the sides (P = .900).Conclusions: This study shows patency of the lacrimal drainage system in patients with a peripunctal tumour and no significant difference in TMH among the sides, resulting in absence of epiphora in all patients.
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Affiliation(s)
- Eri Ishikawa
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Maria Suzanne Sabundayo
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Shinjiro Kono
- Department of Ophthalmology, Fukui Kosei Hospital, Fukui, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
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Abstract
A cystic lesion of the eyelid margin in a 37-year-old man was diagnosed clinically as an apocrine hidrocystoma, a common lesion in that location. Histopathologic examination confirmed the presence of a hidrocystoma but also disclosed an extensive proliferation of bland epithelial cells arising from the inner layer of the cyst. The authors further characterized this unique occurrence on the spectrum of Moll gland eyelid tumors by immunohistochemical analysis.
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Abbeel L, Van Ginderdeuren R. Ectopic Tubular Papillary Apocrine Adenoma on the Eyelid: A Case Report of Misleading Clinical Presentation and Location. Ocul Oncol Pathol 2018; 4:267-271. [PMID: 30320096 DOI: 10.1159/000485426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/15/2017] [Indexed: 11/19/2022] Open
Abstract
We report the case of a 38-year-old patient with a tubular apocrine adenoma with papillary differentiation. The clinician was challenged in her diagnosis by the initially misleading appearance and ectopic location. Histopathological findings and immunohistochemistry delivered conclusive proof for the correct diagnosis. Therefore, it is important for the ophthalmologist to request histopathological analysis to diagnose and differentiate from malignancy. A complete local excision is recommended to prevent recurrence.
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Affiliation(s)
- Laura Abbeel
- Department of Ophthalmology and Pathology, University Hospital Leuven, Leuven, Belgium
| | - Rita Van Ginderdeuren
- Department of Ophthalmology and Pathology, University Hospital Leuven, Leuven, Belgium
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Multiple Eyelid Cysts (Apocrine and Eccrine Hidrocystomas, Trichilemmal Cyst, and Hybrid Cyst) in a Patient With a Prolactinoma. Ophthalmic Plast Reconstr Surg 2018; 34:e83-e85. [PMID: 29351118 DOI: 10.1097/iop.0000000000001069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 53-year-old man presented with smooth-domed, variegated cysts (polycystic disease) of all 4 eyelids, worse on the left side. Some of the cysts were clear, while others were creamy-white colored. In addition, multiple, very fine vesicopapules were noted along the eyelid margins. Histopathologic examination revealed a trichilemmal cyst, several pure apocrine hidrocystomas displaying multiple chambers, a hybrid cyst, and many small eccrine cysts of the deep dermis. The apocrine lesions, including the small ones at the eyelid margins, predominated. Smooth muscle actin sometimes positively stained outer myoepithelial cells in some of the apocrine cysts, which helped to distinguish them from eccrine cysts. Most noteworthy was the fact that the patient had been diagnosed with a prolactinoma 20 years earlier. There is only 1 previous report of multiple apocrine cysts and an antecedent prolactinoma in the dermatologic literature. This syndrome should be separated from that of Schöpf-Schulz-Passarge, which manifests multiple small eyelid apocrine cysts and other ectodermal dysplasias without any association with neoplasia, and from that of focal dermal hypoplasia (Goltz-Gorlin) syndrome with apocrine cysts but again without neoplasia.
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Eyelid Eccrine Cyst: An Exceptional Lesion Among Dominant Apocrine Cysts. Ophthalmic Plast Reconstr Surg 2017; 33:e128-e131. [DOI: 10.1097/iop.0000000000000855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The eyelids are composed of four layers: skin and subcutaneous tissue including its adnexa, striated muscle, tarsus with the meibomian glands, and the palpebral conjunctiva. Benign and malignant tumors can arise from each of the eyelid layers. Most eyelid tumors are of cutaneous origin, mostly epidermal, which can be divided into epithelial and melanocytic tumors. Benign epithelial lesions, cystic lesions, and benign melanocytic lesions are very common. The most common malignant eyelid tumors are basal cell carcinoma in Caucasians and sebaceous gland carcinoma in Asians. Adnexal and stromal tumors are less frequent. The present review describes the more important eyelid tumors according to the following groups: Benign and malignant epithelial tumors, benign and malignant melanocytic tumors, benign and malignant adnexal tumors, stromal eyelid tumors, lymphoproliferative and metastatic tumors, other rare eyelid tumors, and inflammatory and infections lesions that simulate neoplasms.
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Affiliation(s)
- Jacob Pe'er
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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25
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Clear-Cell (Reticulated) Transformation of Eyelid Eccrine Sweat Glands. Ophthalmic Plast Reconstr Surg 2017; 33:e69-e72. [DOI: 10.1097/iop.0000000000000761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Pigmented Caruncular Apocrine Hidrocystoma With Oncocytic Features. Ophthalmic Plast Reconstr Surg 2017; 33:S42-S45. [DOI: 10.1097/iop.0000000000000441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bordelon J, Tang N, Elston D, Niedt G, Lazic Strugar T. Multiple apocrine hidrocystomas successfully treated with botulinum toxin A. Br J Dermatol 2016; 176:488-490. [DOI: 10.1111/bjd.14753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- J.R. Bordelon
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL U.S.A
| | - N. Tang
- Department of Dermatology Mount Sinai School of Medicine New York NY U.S.A
| | - D. Elston
- Department of Dermatology and Dermatologic Surgery Medical University of South Carolina Charleston SC U.S.A
| | - G. Niedt
- Department of Dermatology Columbia University New York NY U.S.A
| | - T. Lazic Strugar
- Department of Dermatology Mount Sinai School of Medicine New York NY U.S.A
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Ferraz LB, Burroughs JR, Satto LH, Natsuaki KL, Meneguin RLFS, Marques MEA, Schellini SA. Three Adult Cases of Orbital Hidrocystoma Presenting with Blepharoptosis. J Clin Med 2015; 4:150-8. [PMID: 26237024 PMCID: PMC4470245 DOI: 10.3390/jcm4010150] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose: To report adult cases of superior orbital apocrine hidrocystoma. Methods: Retrospective case series of three patients with superior orbital apocrine hidrocystoma and blepharoptosis with review of the clinical aspects of each of the cases. Results: All three cases presented with blepharoptosis. Two of the cases had occult hidrocystoma, and one was visibly subcutaneous at presentation. Conclusions: Although rare and more common along the eyelid margin, apocrine hidrocystomas may occur in the orbit leading to secondary blepharoptosis and should be included within the differential diagnosis of orbital cysts. Physicians should therefore be aware of this possibility.
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Affiliation(s)
- Lucieni B Ferraz
- Ophthalmology Department, Botucatu Medical School, São Paulo Stadual University, São Paulo 18607-370, Brazil.
| | - John R Burroughs
- Private Corporation, 111 East Polk Street, Colorado Springs, CO 80907, USA.
| | - Larissa H Satto
- Ophthalmology Department, Botucatu Medical School, São Paulo Stadual University, São Paulo 18607-370, Brazil.
| | - Kryscia L Natsuaki
- Ophthalmology Department, Botucatu Medical School, São Paulo Stadual University, São Paulo 18607-370, Brazil.
| | - Roberta L F S Meneguin
- Ophthalmology Department, Botucatu Medical School, São Paulo Stadual University, São Paulo 18607-370, Brazil.
| | - Mariangela E A Marques
- Pathology Department, Botucatu Medical School, São Paulo Stadual University, Botucatu, São Paulo 18600-010, Brazil.
| | - Silvana A Schellini
- Ophthalmology Department, Botucatu Medical School, São Paulo Stadual University, São Paulo 18607-370, Brazil.
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Jakobiec FA, Rai R, Lefebvre DR. Papillary hidradenoma of the eyelid margin: clinical and immunohistochemical observations further supporting an apocrine rather than an eccrine origin. Surv Ophthalmol 2014; 59:540-7. [PMID: 24661803 DOI: 10.1016/j.survophthal.2014.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/26/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022]
Abstract
A 46-year-old woman was evaluated for a "recurring papilloma" of the left medial upper eyelid margin. Beneath the papillary lesion medial to the punctum was a 5-mm diameter cutaneous mass thought to be cystic. After excisional biopsy, histopathologic analysis documented the presence of an epidermal keratinizing squamous papilloma surmounting a circumscribed dermal papillary hidradenoma composed of deeply eosinophilic columnar cells. Additionally, there was intraductal proliferation of tumor extending toward a subclinical poral opening through the epidermis. Immunohistochemistry proved the apocrine nature of the benign, non-cystic lesion by virtue of its nuclear androgen receptor and cytoplasmic gross-cystic disease fluid protein-15 positivity, along with its smooth muscle actin-positive myoepithelial layer. This and prior cases establish that apocrine tumors, both benign and malignant, are strictly localized at or near the eyelid margin where only apocrine glands are found. These tumors are more often papillary than solid adenomas, and most exceptionally can be malignant. We review the differential diagnosis of simulating eccrine eyelid tumors. We recommend wide local excision for benign lesions, in view of possible intraductal extension that can be eccentric to the main tumor and the miniscule potential for malignant transformation.
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Affiliation(s)
- Frederick A Jakobiec
- Department of Ophthalmology, David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Ruju Rai
- Department of Ophthalmology, David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Daniel R Lefebvre
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Thanos A, Jakobiec FA, Mendoza PR, Hatton MP. Ectopic (choristomatous) orbital respiratory cyst: histopathology and immunohistochemistry. Surv Ophthalmol 2013; 59:328-33. [PMID: 24359804 DOI: 10.1016/j.survophthal.2013.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/26/2013] [Accepted: 07/09/2013] [Indexed: 11/30/2022]
Abstract
A 24-year-old woman underwent excision of a slowly growing mass located in the right superomedial orbit that had histopathologic and immunohistochemical findings consistent with a choristomatous respiratory cyst. This rare condition may either arise primarily from embryologic respiratory epithelium rests in the orbit or develop secondarily as the result of trauma or chronic sinus disease complicated by mucocele formation.
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Affiliation(s)
- Aristomenis Thanos
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Frederick A Jakobiec
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
| | - Pia R Mendoza
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Mark P Hatton
- Harvard Medical School, Boston, Massachusetts, USA; Ophthalmic Consultants of Boston, Boston, Massachusetts, USA
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Pleomorphic adenoma (formerly chondroid syringoma) of the eyelid margin with a pseudocystic appearance. Surv Ophthalmol 2013; 58:486-91. [DOI: 10.1016/j.survophthal.2012.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 09/26/2012] [Accepted: 10/02/2012] [Indexed: 11/23/2022]
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Kikuchi K, Fukunaga S, Inoue H, Miyazaki Y, Ide F, Kusama K. Apocrine hidrocystoma of the lower lip: a case report and literature review. Head Neck Pathol 2013; 8:117-21. [PMID: 23740163 PMCID: PMC3950382 DOI: 10.1007/s12105-013-0451-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/24/2013] [Indexed: 11/28/2022]
Abstract
The hidrocystomas (HCs) are cystic forms of sweat gland resulting from proliferation of the apocrine secretory coil or eccrine duct. Apocrine -HCs are cystic lesions that arise from the apocrine secretory coil, while eccrine -HCs represent retention cysts of the eccrine duct. The commonest site for such lesions is around the eye, and they may also occur on the ears, scalp, chest, shoulders, or feet. However, HCs of the perioral region are uncommon. The differential diagnosis with minor salivary gland cyst or cystic neoplasms often poses a problem in this site. Here we report a rare case of apocrine -HC of the right lower lip for which excisional biopsy of the lesion was performed. Histopathologically, the lesion was a unilocular cyst lined by a double-layered epithelium of the apocrine secretory type. Immunohistochemically, the secretory epithelium was positive for mammaglobin, gross cystic disease fluid protein 15 (GCDFP-15), cytokeratin 7 (CK 7) and CK18, and the myoepithelium was positive for alpha-smooth muscle actin (α-SMA) and weakly positive for S100 protein. Here we present this very rare case of apocrine -HC of the lower lip, and discussed regarding differential diagnosis with minor salivary gland cystic lesion in the lip.
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Affiliation(s)
- Kentaro Kikuchi
- Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama 350-0283 Japan
| | - Shuichi Fukunaga
- Department of Dental and Oral Surgery, Hanyu General Hospital, 511 Kamiiwase, Hanyu, Saitama 348-8505 Japan
| | - Harumi Inoue
- Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama 350-0283 Japan
| | - Yuji Miyazaki
- Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama 350-0283 Japan
| | - Fumio Ide
- Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama 350-0283 Japan
| | - Kaoru Kusama
- Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama 350-0283 Japan
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Jakobiec FA, Zakka FR, Perry LP. The cytologic composition of dacryops: an immunohistochemical investigation of 15 lesions compared to the normal lacrimal gland. Am J Ophthalmol 2013; 155:380-396.e1. [PMID: 23114708 DOI: 10.1016/j.ajo.2012.07.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/25/2012] [Accepted: 07/31/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE To define the cytologic composition of the double-layered epithelial lining of dacryops (lacrimal duct cyst), improve histopathologic diagnosis, and better understand pathogenesis. DESIGN Clinicopathologic retrospective study with immunohistochemical studies of 15 lesions compared with normal lacrimal gland. METHODS Clinical data from 14 patients were reviewed and microscopy was performed with routine stains and immunohistochemical probes for epithelial membrane antigen (EMA), gross cystic disease fluid protein-15 (GCDFP-15), cytokeratin 7 (CK7), and smooth muscle actin (SMA). RESULTS The major lacrimal gland was involved in 13 lesions; 2 lesions arose in an accessory gland of Krause. One case was bilateral; the average age of the patients was 50.7 years. Neither visual acuity nor motility was disturbed. No lesion was discovered to have recurred after excision. Microscopically, in all dacryops specimens goblet cells and luminal pseudoapocrine apical cytoplasmic projections were identified. Lacrimal acinar cells immunoreacted with GCDFP-15 and CK7, whereas the normal ducts and the epithelium of the dacryops lesions reacted diffusely only with CK7. SMA-positive myoepithelial cells were found in the acini but not in the normal ducts or dacryops epithelium. CONCLUSIONS Negative GCDFP-15 staining ruled out apocrine metaplasia in dacryops. Normal ducts and dacryops showed no immunohistochemical evidence for the presence of myoepithelial cells. Pathogenetic theories of dacryops that implicate a failure of ductular "neuromuscular" contractility must therefore be revised. A dysfunction of the rich neural plexus around the ductules may play a role in the development of dacryops in conjunction with periductular inflammation and induced scarring.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Sehgal S, Agarwal R, Singh S, Goyal P. Fine-needle aspiration cytology of eccrine hidrocystoma. Cytojournal 2012; 9:6. [PMID: 22438860 PMCID: PMC3307209 DOI: 10.4103/1742-6413.93283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 01/28/2012] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shelly Sehgal
- Address: Department of Pathology, Swami Dayanand Hospital, Shahdara, New Delhi, India
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Kirzhner M, Jakobiec FA. Clinicopathologic and immunohistochemical features of pigmented Basal cell carcinomas of the eyelids. Am J Ophthalmol 2012; 153:242-252.e2. [PMID: 21982104 DOI: 10.1016/j.ajo.2011.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 07/12/2011] [Accepted: 07/13/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the clinical and microscopic features of pigmented basal cell carcinomas (pBCC) of the eyelid. DESIGN Retrospective observational case series collected at one institution. METHODS An analysis of clinical records, photographs, and histopathologic characteristics of 257 BCCs with a review of the literature. The frequencies of clinically pigmented, and of microscopically pigmented but clinically nonpigmented, BCCs were determined. Cytochemical stains (Fontana-Masson, Prussian blue) and immunohistochemical probes (S-100, microphthalmia-associated transcription factor [MiTF], HMB-45, MART-1, CK20, synaptophysin, chromogranin, CD1a, Ki-67) were then employed and the findings correlated with the degree of clinical pigmentation. RESULTS Histopathologically, 13 of 257 cases (5.06%) were found to have pigment; of these 13, 6 (all white patients) had clinically apparent pigmentation (2.33%), either focal or diffuse. Eight of 13 lesions developed on the lower eyelids. All stained positively for melanin but negatively for iron. MiTF highlighted numerous melanocytic nuclei in the tumor lobules, while MART-1 and HMB-45 revealed the dendritic shapes of the entrapped melanocytes. There was a subtotal blockage of melanin transfer to the surrounding basaloid cells. Intralobular S-100-positive cells included CD1a-positive Langerhans cells, while CK20 did not identify any Merkel cells. CONCLUSIONS Only 1 of 6 lesions was uniformly clinically pigmented, whereas the other 5 were only focally brown-black. The clinical pigmentation was imparted by varying densities and distributions of melanocytes with arborizing dendrites, which were present in all BCCs. Melanophages within the stroma and basaloid cell melanization also contributed to pigmentation. No behavioral or biologic differences in pBCC were documented compared with clinically nonpigmented lesions.
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Affiliation(s)
- Maria Kirzhner
- David G. Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Room 321, 243 Charles St, Boston, MA 02114, USA
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Jakobiec FA, Zakka FR, Townsend DJ. Pleomorphic basal cell carcinoma of the eyelid with true ductular differentiation. Graefes Arch Clin Exp Ophthalmol 2011; 250:451-4. [PMID: 22037988 DOI: 10.1007/s00417-011-1836-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 09/28/2011] [Indexed: 11/30/2022] Open
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Kirzhner M, Jakobiec FA, Kim N. Focal blue nevus of the eyelid margin (mucocutaneous junction): a report of a unique case with a review of the literature. Ophthalmic Plast Reconstr Surg 2011; 27:338-42. [PMID: 21490517 DOI: 10.1097/iop.0b013e318213f743] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the first isolated and focal benign blue nevus of the eyelid margin. METHODS Review of clinical, histopathologic, and immunohistochemical characteristics and relevant literature. RESULTS A 93-year-old Caucasian woman with a flat, irregular, and deeply pigmented black growth of the left upper eyelid margin of unknown duration underwent a full-thickness eyelid excisional biopsy. Microscopically, a population of loosely aggregated, mitotically inactive, heavily pigmented oval-to-elongated spindle dermal cells that paralleled the epithelium was seen. MART-1 and HMB-45 immunostaining of premelanosomes could not distinguish between melanocytes and melanophages. The more specific microphthalmia-associated transcription factor stained the nuclei of the subepithelial melanocytes before and after bleaching of the cytoplasmic melanin. The patient did not have Carney complex. No residual pigmentation or lesional recurrence has been noted during 6 months of follow up. CONCLUSIONS A blue nevus of the preorbicularis eyelid skin is extremely rare, and still more uncommon is such a lesion of the eyelid margin. Careful microscopic and immunohistochemical evaluation is necessary to establish the proper diagnosis. Wide local excision should be performed due to concern about a more common and serious melanomatous nodule. A differential diagnosis of other pigmented lesions in this location is offered.
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Affiliation(s)
- Maria Kirzhner
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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