Lesions of the caruncle: a description of 42 cases and a review of the literature

Clinicopathologic study of caruncular lesions

PURPOSE

The caruncle is a unique anatomical site in the human body, comprising various structures derived from the surface ectoderm and mesoderm. Caruncular lesions can range from benign to malignant and present challenges in accurate diagnosis and timely management due to their hidden nature and proximity to the lacrimal sac. This study aims to provide a comprehensive description of caruncular lesions, presenting the first Indian case series on this topic.

METHODS

Ethical approval was obtained, and data collection was conducted at a tertiary care center in India. A retrospective analysis was performed on 44 patients with caruncular lesions treated between 2013 and 2020. Detailed patient histories, clinical examinations, slit lamp imaging, and excision biopsies were conducted. Histopathological examination of the specimens was carried out.

RESULTS

The study included 42 cases of caruncular lesions, with a mean age of 31.09 years. The majority of cases were male (54.54%). Benign lesions accounted for 84.09% of the cases, while premalignant and malignant lesions accounted for 11.36% and 4.54%, respectively. Papilloma and nevus were the most common lesions, with 11 cases each. All caruncular lesions were successfully and completely excised without complications. Histopathological examination confirmed the accuracy of the diagnoses, with an 84.09% concordance rate between clinical assessment and pathological diagnosis.

CONCLUSION

This case series reveals a predominance of benign lesions among individuals in their early thirties. The successful excision of all lesions with a high concordance rate between clinical assessment and histopathological diagnosis underscores the importance of timely and accurate management.

Sebaceous Gland Hyperplasia of the Caruncle in a 6-Year-Old Child: A Case Report with Summary of Prior Published Cases

Background: Caruncular sebaceous gland hyperplasia (SGH) is an uncommon, benign lesion. Its cause is still unclear. It has not been reported in the pediatric population, with few cases diagnosed in the fourth to eighth decades of life. Case Report: A 6-year-old boy presented with a slowly growing caruncular mass in the right eye. A diagnosis of caruncular SGH was made by histopathology. The clinical, histopathology, treatment, and prognosis are reviewed. Conclusion: This is the first described pediatric case of caruncular SGH that occurs since birth. There are many similarities between adult and pediatric caruncular SGH. Surgical excision is the recommended treatment.

A giant lobular capillary haemangioma of the caruncle

Key Clinical Message

Caruncle lesions are uncommon, though it may be involved by a wide variety of lesions including tumors and cysts of the conjunctiva, skin, or lacrimal gland. Lobular capillary haemangioma of the caruncle is a rare occurrence but may mimic some primary or secondary malignant neoplasms. Excision and histopathological examination confirm the diagnosis.

Abstract

The caruncle lesions are uncommon. Lobular capillary haemangioma involving caruncle is a rare occurrence. We present a case of large lobular capillary haemangioma of caruncle in a 10-year-old boy, was treated successfully by surgical excision.

Frozen Section Histoanatomy of the Peritarsal Eyelid

BACKGROUND

Mohs surgery of eyelid skin cancers requires detailed knowledge of anatomy for precise surgery and accurate evaluation of histology.

OBJECTIVE

To review the histology of the peritarsal eyelid using frozen sections as encountered intraoperatively by Mohs surgeons.

METHODS

The authors review the literature describing the anatomy and histology of the peritarsal eyelid from the lens of a Mohs surgeon. Histology from select Mohs cases is used to frame the discussion of the microanatomy of this region.

RESULTS

The peritarsal eyelids contain a unique mixture of skin, muscle, tarsus, glandular tissue, and conjunctiva. The histologic appearance of many of these structures differs from skin found outside of this anatomic region. Tumors of the eyelid and periocular region may mimic normal histologic structures found within the peritarsal eyelid.

CONCLUSION

The peritarsal eyelids have unique anatomy and associated histologic structures. Knowledge of the detailed histoanatomy is required for confident execution of Mohs surgery in this anatomic region.

A retrospective study of conjunctival lesions in the Paediatric Eye Clinic over 12 years

BACKGROUND

Paediatric conjunctival lesions are rare and diverse. Though often indolent and asymptomatic, they can in some cases be sight or life-threatening. Awareness of concerning features of conjunctival lesions is key to optimal management. We aim to provide insight into management of paediatric conjunctival lesions though a review of cases in our service in last 12 years.

METHODS

We present a retrospective analysis of our population-based cohort of children with conjunctival lesions presenting to our regional service in Belfast between 2011 and 2022 inclusive. We detail three rare cases of paediatric conjunctival lesions; a congenital intrascleral cyst leading to astigmatic amblyopia, a rapidly changing salmon-pink lesion confirmed as an embryonal rhabdomyosarcoma and an unusual presentation of a chronic granuloma arising from the caruncle.

RESULTS

85 conjunctival lesions were identified in <16 year olds giving a cumulative incidence of 27 cases per 100,000 population over 12 years. Mean age at presentation was 7 years old. Most common lesions were naevi (40%), limbal dermoids (21%), conjunctival melanosis (14%), conjunctival cysts (7%) and phlycten (6%). When seen at presentation 8% of cases were immediately listed for surgery, 28% were discharged and 64% entered a phase of observation.

CONCLUSION

Paediatric conjunctival lesions have potential to cause visual manifestations, whilst some may undergo malignant transformation. Anterior segment photography is crucial in monitoring change and facilitating early discharge in the absence of sinister features. Malignant transformation must be considered in changing lesions which ought to have histological diagnosis obtained to prevent potentially sight and life-threatening conditions.

Lymphoproliferative disorders in the lacrimal caruncle: report of three cases and review of literature

This report included three cases of lymphoproliferative disorders developing from the lacrimal caruncle. The first case was an 11-year-old boy with reactive lymphoid hyperplasia in the left lacrimal caruncle. The second case was an 80-year-old woman with reactive lymphoid hyperplasia in the right lacrimal caruncle. The third case was a 77-year-old man with follicular lymphoma in the left lacrimal caruncle. Our literature review of cases with lacrimal caruncular lesions showed 11 reported cases with reactive lymphoid hyperplasia and 17 with malignant lymphoma. There had been no previous report on follicular lymphoma in the lacrimal caruncle.

Malignant lesions of the caruncle

Caruncle malignancy is rare, but signs of disease can be easily missed by both patients and clinicians. There is significant potential for significant morbidity and even mortality from delayed diagnosis and treatment. Clinical features of primary malignant cancer include rapid growth, pigment deposition, ulcerated surface and bleeding. Malignant diagnoses include lymphoproliferative disease, basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma and malignant melanoma. Increased pigmentation is associated with melanoma, yellow coloured deposition with sebaceous carcinoma and a salmon-pink hue with lymphoproliferative disease. Treatment involves excision with margin control which may necessitate exenteration. Metastases to cervical and preauricular lymph nodes has been reported.

Caruncular lesions: A 16-year single centre review in the United Kingdom

BACKGROUND/AIMS

To review the clinicopathological features of caruncle biopsies carried out at a district general hospital in the United Kingdom (UK), and compare with other centres where data has been published.

METHODS

Retrospective, single-centre, observational case series between 2004-2020.

RESULTS

A total of 31 lesions from 31 patients were analysed. 18 of 31 patients were men (58%), and the age ranged from 12 to 91 years. 13 different histopathological types of lesions were identified in our case series, including 9 melanocytic nevi (29%), 7 benign squamous papillomas (23%), 5 skin adnexal lesions (16%), 3 chronic inflammation (10%), 3 epithelial cysts (10%), 1 basal cell carcinoma (3%), 2 malignant melanomas (6%) and l lymphoproliferative disorder (3%). Pre-operative suspected diagnoses were often vague but correct in 12 of 18 cases (67%), where data was available.

CONCLUSION

The uncommon nature and variety of caruncular lesions make the diagnostic process difficult. Our case series is the first reported in the UK, showing a slightly higher proportion of malignant melanomas, in keeping with the population demographics. Excisional biopsies would, therefore, be prudent in the majority of cases to rule out any possible malignancy.

Clinical and histopathological profile of primary caruncular lesions

Purpose

To provide a retrospective analysis of lesions of the caruncle which have been very rarely reported in the literature.

Methods

A retrospective review of all the caruncular lesions between January 2000 and January 2020 was done at a single tertiary eye care hospital. The lesions were classified as benign and malignant lesions. Clinicopathological correlation was done for the excised lesions.

Results

A total of 87 caruncular lesions were included in the study. Males (59%) were affected more than females (41%). The mean age at presentation was 44 ± 20 years. The mean duration of complaint was 36 ± 62 months. A total of 36 patients underwent surgical excision whereas the rest opted for conservative management. Recurrence was noted in five patients. Fifteen different types of lesions were identified histopathologically. Benign lesions (78%) were far more common than malignant ones (22%). Epithelial inclusion cyst was the most common benign lesion and sebaceous gland carcinoma was the most common malignant lesion. Correct clinicopathological correlation was seen in 52.7% of the cases. Caruncular tuberculosis, oncocytoma, and basosquamous cell carcinoma were some of the rare lesions.

Conclusion

Caruncular lesions are uncommon and very diverse, which makes clinical diagnosis challenging. Epithelial inclusion cyst and sebaceous gland carcinoma were the most common benign and malignant lesions respectively. Correct clinicopathological correlation was seen in more than half of the cases.

Conjunctival Lesions: A 5-Year Basic Demographic Data and Clinicopathological Review in a Tertiary Eye Care Hospital

Background

Conjunctival lesions are common with a wide spectrum of benign, premalignant, and malignant lesions. Few histopathological studies have been conducted on conjunctival lesions with variable designs and results. Our aim in this study is to provide information on common conjunctival lesions seen in an ophthalmology tertiary care center in Saudi Arabia.

Methods

A retrospective, observational study of all consecutive conjunctival tissue specimens sent for histopathological assessment to the pathology department from 2015 to 2019 were analyzed. Clinical data were collected from medical records, and the histopathological slides were reviewed by a single pathologist.

Results

A total of 110 conjunctival specimens from 108 patients were included (mean age: 53 years, 67 males and 43 females). Bilateral involvement was mostly found in inflammatory lesions (40%). Most lesions were benign (91%), with a significantly longer duration of symptoms in malignant lesions (p = 0.036*). The clinical diagnosis matched the final histopathological diagnosis in 75.5% of the total specimens. The most frequent category of benign lesions was fibrodegenerative and proliferative lesions (53.6%), with a significantly higher prevalence among adult males (p < 0.001). Melanocytic lesions were more common in children (33.3%) than adults (9.8%), and the mean age of children was significantly lower (p = 0.013). The most frequent malignant lesion was ocular surface squamous neoplasia (50%), with equal prevalence among males and females. The overall outcome was favorable in 89.4% and unfavorable in 10.6%, mostly due to surgical complications, further progression of the lesion, or recurrence.

Conclusion

This study shows variability in the frequency of conjunctival lesions based on gender, age, geographical, racial, and environmental factors. There has been a shift in the gender-based prevalence of ocular squamous neoplasia over the last three decades, probably due to a change in lifestyle.

Clinico-pathological correlation of lacrimal caruncle tumors: a retrospective analysis over 22 years at the University Eye Hospital Bonn

Purpose

The lacrimal caruncle is composed of numerous structures including different glands as well as hair follicles. Accordingly, the spectrum of benign and malignant lesions is broad, and the clinical diagnosis is often challenging. Here we systematically analyzed excised caruncular tumors over the past 22 years with special emphasis on the clinico-pathological correlation to provide a guidance for clinicians.

Methods

Retrospective evaluation with clinico-pathologic correlation of surgically removed caruncular tumors between 1998 and 2020 at a tertiary referral center.

Results

Eighty-two caruncular tumors were identified in the respective period. The patients were between 11 and 85 years of age (mean, 46.8 years; median, 49 years). Nevi (n = 35), cystic lesions (n = 14), oncocytoma (n = 9), papilloma (n = 8), sebaceous gland hyperplasia (n = 8), and reactive lymphoid hyperplasia (n = 4) were observed most frequently. Besides, we are the first reporting herniated orbital fat accompanied by a pyogenic granuloma. 2.4% (n = 2) were malignant tumors (sebaceous gland carcinoma, conjunctival intraepithelial neoplasia with pyogenic granuloma).

Conclusion

Caruncular tumors show a broad spectrum of mostly benign tumors. They can occur in patients of any age. However, 8/9 oncocytomas and both malignant lesions were detected in patients older than 60 years. Although the clinical diagnosis was confirmed in only 68.3% by the histopathological analysis, the two malignant lesions were identified as such already clinically. Caruncular lesions with a history of growth or other signs of malignancy should be excised followed by detailed histopathological examination to allow a final diagnosis and exclude rare malignant tumors with lethal potential.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00417-021-05464-x.

Histopathological and Molecular Features of a Conjunctival Caruncular Deep Penetrating Nevus

We describe the first presentation of a deep penetrating nevus (DPN) on the lacrimal caruncle. This lesion was seen in an 18-year-old woman presenting with hemorrhage of a long-standing pigmented mass on the caruncle. Histology showed a combined melanocytic neoplasm that consisted of two different melanocytic components. The differential diagnosis, based on histological examination, was a conventional melanocytic nevus, a Spitz nevus, or a combined melanocytic nevus. On the molecular level, one of the components revealed a mutation in the CTNNB1 gene encoding the β-catenin protein, while both components harbored a BRAF V600E mutation, without molecular features of a malignant melanocytic lesion. This presentation of a DPN of the lacrimal caruncle emphasizes the similarities of the caruncle with the skin.

[Primary basal cell carcinoma of the caruncle]

BACKGROUND

Primary basal cell carcinoma (BCC) of the caruncle is an extremely rare entity. Overall, only a few cases are described in the literature. With respect to the S2k guidelines on basal cell carcinoma of the skin, the eyelids, eyebrows and periorbital regions are regarded as zones with a high risk of recurrence. Due to its rarity hardly any data are available for primary BCC of the caruncle.

METHODS

This article is based on a comprehensive literature review and a case presentation.

RESULTS

In addition to a literature review this article reports the case of a 58-year-old male who presented at this department with a tumor of the caruncle. The histopathological examination revealed a BCC of the caruncle, which could be completely excised and showed no indications of recurrence in a follow-up period of 6 months.

CONCLUSION

Primary BCC of the caruncle must be considered as a differential diagnosis in the case of unclear caruncular tumors. Moreover, the current data indicate an increased risk of recurrence.

Accessory lacrimal gland tumours of the eye region

PURPOSE

Tumours of the accessory lacrimal glands (ALGs) are rare and need to be differentiated from other tumours involving the eyelids and caruncle. We report on a consecutive series of patients with ALG tumours and describe the clinical characteristics.

METHODS

A retrospective case series including all patients who were operated for ALG tumours at two different centres.

RESULTS

The study included 27 patients diagnosed with ALG tumours. Mean age at presentation was 55.9 years (range, 24-81 years; median, 56 years). Overall, a slight male preponderance was observed (M:F = 1.4:1). Histologically, pleomorphic adenoma was the commonest diagnosis (24 of 27; 88.9%), followed by adenoid cystic carcinoma (2 of 27; 7.4%) and oncocytoma (one of 27; 3.7%). A complete surgical excision was curative in all patients.

CONCLUSION

Accessory lacrimal gland (ALG) tumours are rare and may therefore pose diagnostic difficulties for clinicians. Histopathological examination of these tumours is the cornerstone of the diagnostic evaluation. Complete surgical excision is the treatment of choice in these tumours.

Caruncular Oncocytoma: Report of Two Cases with Review of Literature

Caruncular lesions are uncommon and could be related to hair follicles, sebaceous glands, sweat glands, and accessory lacrimal gland harbored in caruncle. As the lesions of caruncle are diverse, the clinical diagnosis is difficult. Majority of the caruncular lesions are benign although rare malignant lesions have also been reported. Caruncular oncocytoma (CO) is a rare ocular neoplasm with an incidence of <3%, as per the Western literature. However, only two cases of ocular oncocytoma are reported in the Indian literature. Here, we report two more cases of CO from India with their histochemical and ultrastructural characteristics.

Papilloma and sebaceous gland hyperplasia of the lacrimal caruncle: a case report

Objective

To report a case of coincidence of sebaceous gland hyperplasia and papilloma with detection of human papillomavirus-51 in the apical portion by in situ hybridization.

Case presentation

A 75-year-old man noted discomfort at the inner canthus of his left eye when he blinked. A tumor of the lacrimal caruncle was identified and resected. The base of the tumor had a smooth surface and was whitish. In addition, a “navel-like structure” was seen, and the findings strongly suggested sebaceous gland hyperplasia of the lacrimal caruncle. The apical portion of the tumor was a papillomatous lesion. Histological examination of the resected tumor led to a diagnosis of sebaceous gland hyperplasia. Human papillomavirus-51 was detected in the apical portion by in situ hybridization. Based on these results, the final diagnosis was sebaceous gland hyperplasia with papilloma. No recurrence of either tumor has been observed up to 3 years postoperatively.

Conclusion

This might be the first report of a case of coincidence of sebaceous gland hyperplasia and papilloma, even though the association between these two lesions was unclear, including which developed first.

Lacrimal Caruncle Nevus with Papilloma

Purpose

The aim of this article is to report a case of lacrimal caruncle nevus with papilloma.

Methods

This is a case report of a 39-year-old female with a progressively enlarging pigmented lesion on the left lacrimal caruncle. She had been aware of a raised whitish wart on the top of this pigmented lesion for several months before her initial visit. Slit lamp examination revealed a papillomatous lesion over a well-circumscribed, pigmented lesion on the left lacrimal caruncle.

Results

The histopathological examination of the excised tumor disclosed 2 characteristic findings, which include nests of nevus cells within the dermis and papillomatous structures which had fibrovascular cores overlying squamous cell epithelia with variable levels of acanthosis. The findings were consistent with an intradermal nevus and a papilloma arising from the conjunctival epithelium of the nevus.

Conclusion

This is the first case report of a lacrimal caruncle nevus with papilloma. The clinical history and pathological findings of this case underscore the fact that an intradermal nevus primarily occurred on the lacrimal caruncle, after which a papilloma arose from the epithelium of the nevus as a consequence of human papillomavirus autoinoculation.

Syringocystadenoma Papilliferum of Sweat Gland of Caruncle: A Unique Case Report

Syringocystadenoma papilliferum (SP) is a rare benign hamartomatous malformation of skin which arises from apocrine or eccrine sweat glands. Skin of the head and neck is the usual site for this but rarely involves the eyelids. It is also called as a childhood tumor since it usually appears at birth or during puberty. The diagnosis is confirmed on histopathological examination after surgical excision. We are first to report a case of SP involving the caruncle in an elderly female.

Caruncular Oncocytoma Mimicking Malignant Melanoma

Purpose

To report a case of pigmented caruncular oncocytoma that simulated malignant melanoma and discuss the associated ultrasonographic and pathologic features.

Method

Case report.

Results

An 81-year-old female presented with a painless caruncular mass with a smooth brown surface suspicious for melanoma. Ultrasound biomicroscopy revealed a round mass with a large central cavity, more suggestive of a cystic rather than solid lesion. Following complete surgical resection, histopathology revealed a cystadenomatous lesion composed of bland cells with copious eosinophilic cytoplasm consistent with oncocytoma that had a central blood-filled cavity.

Conclusions

Oncocytoma is a benign tumor that can appear pigmented clinically and resemble melanoma. The definitive diagnosis requires histopathologic evaluation. Oncocytoma should be considered in the differential diagnosis of a pigmented caruncular mass.

Steatocystoma simplex of the lacrimal caruncle: a case report

Background

This is the third reported case of a steatocystoma simplex in the lacrimal caruncle.

Case presentation

A 60-year-old male presented with a history of a slowly progressing mass in the right lacrimal caruncle since several years before his initial visit. At the first examination, a yellowish, relatively smooth surface mass was observed in the right lacrimal caruncle. The caruncular mass was completely removed under local anesthesia. The pathological findings of this mass were consistent with a steatocystoma. At the 6-month follow-up, there was no sign of recurrence or development of the steatocystoma or any other masses.

Conclusion

Although steatocystoma simplex rarely occurs in the lacrimal caruncle, it needs to be considered as a possible diagnosis for patients with a mass lesion in the caruncle.

Caruncular and Pericaruncular Sebaceous Gland Hyperplasia: A Report of 2 Cases and Literature Review

PURPOSE

To report the clinical and histopathological features of two patients with caruncular and pericaruncular sebaceous gland hyperplasia (SGH) with a literature review.

METHODS

We performed a retrospective pathology database search of 1195 ophthalmic specimens receiving the clinical diagnosis of SGH for caruncular/pericaruncular lesions during 2004 to 2014 at Tokyo Dental College, Ichikawa General Hospital. Paraffin sections were stained with hematoxylin and eosin. A retrospective patient record and literature review was also performed.

RESULTS

Database search disclosed 2 male patients with SGH of 1195 specimens (0.15%). Pathological specimens revealed neither any cellular/nuclear atypia nor any mitotic figures and invasive features. No recurrences were observed in these 2 cases 12 to 18 months after excision.

CONCLUSIONS

Caruncle and pericaruncular SGH is an uncommon lesion which needs careful histopathological evaluation for differentiation especially from caruncular neoplasias.

Conjunctival malignant melanoma in Denmark: epidemiology, treatment and prognosis with special emphasis on tumorigenesis and genetic profile

Conjunctival malignant melanoma is a rare disease associated with considerable mortality. Most published data have been based on case reports or series of referred patients. In addition, very little is known about the genetic and epigenetic profile of conjunctival melanoma and the resemblance to uveal, cutaneous and mucosal melanoma. The aim was to determine the incidence rate of conjunctival melanoma, and to relate clinicopathological features and treatment to prognosis. A further aim was to determine the prevalence of BRAF mutations in conjunctival melanoma, to determine whether BRAF mutations are early events in pathogenesis, and relate clinicopathological features and prognosis to BRAF-mutation status. Finally, we wanted to identify tumour-specific and prognostic microRNAs in conjunctival melanoma, and to compare these with the microRNA expression of other melanoma subtypes. In order to investigate these rare tumours, we studied all the conjunctival melanomas that had been surgically removed in Denmark over a period of 52 years (1960-2012). Tissue samples, clinical files, pathology reports and follow-up data were collected and re-evaluated. Using droplet digital polymerase chain reaction and immunohistochemistry, we investigated BRAF mutations; and using microRNA expression profiling, we investigated differentially expressed microRNAs. The overall incidence of conjunctival melanoma was 0.5/1 000 000/year, and it increased in Denmark over 52 years. The increase was mainly caused by an increase in older patients (>65 years) and bulbar lesions. Clinicopathological features significantly associated with a poor prognosis were extrabulbar location, involvement of adjacent tissue structures, tumour thickness exceeding 2 mm and local tumour recurrence. Patients undergoing incisional biopsy and/or treatment involving excision without adjuvant therapy fared worse than patients treated with excision and any type of adjuvant treatment. We found that 35% (39/110) of conjunctival melanomas were BRAF-mutated, and the incidence of BRAF mutations was constant over time. BRAF-mutation status corresponded in conjunctival melanoma and paired premalignant lesions. BRAF mutations were more frequent in males, in young patients, and in tumours with a sun-exposed tumour location (bulbar conjunctiva or caruncle), with a mixed or non-pigmented colour, with absence of primary acquired melanosis, and with origin in a nevus. Immunohistochemistry was able to accurately detect BRAF V600E mutations. In univariate analysis, distant metastatic disease was associated with BRAF mutations. No prognostic associations with BRAF mutations were identified in multivariate analyses. MicroRNA expression analysis revealed 25 tumour-specific microRNAs in conjunctival melanoma. Five possibly oncogenic miRNAs (miR-20b-5p, miR-146b-5p, miR-146a-5p, miR-506-3p and miR-509-3p) were up-regulated. Seven microRNAs (miR-30d-5p, miR-138-5p, miR-146a-5p, miR-500a-5p, miR-501-3p, miR-501-5p and miR-502-3p) were significantly and simultaneously up-regulated in both stage T1 and stage T2 tumours, and were associated with increased tumour thickness. The expression of the 25 tumour-specific microRNAs did not differ significantly between conjunctival melanoma and oral or nasal mucosal melanoma. In conclusion, the incidence of conjunctival melanoma increased in the Danish population from 1960 to 2012. From our findings of a distinct pattern of BRAF mutations and differentially expressed microRNAs, it is evident that conjunctival melanoma is closely related to cutaneous and other mucosal melanomas and bears less resemblance to uveal melanomas. This means that conjunctival melanoma patients may benefit from therapies that are effective for cutaneous and mucosal melanoma. Additionally, the identification of several up-regulated microRNAs may prove to be useful as prognostic or therapeutic targets in conjunctival melanoma.

Conjunctival mucoepithelial hyperplasia of the elderly

The ocular surface is exposed to many chronic inflammatory stimuli, and goblet cell hyperplasia of the conjunctiva occurs in many situations. We report two cases of epithelial goblet cell hyperplasia with nonspecific chronic inflammation which occurred on the internal canthus of elderly people. These cases shared the same clinicopathological features that mimicked neoplastic lesion macroscopically, but are composed of nonspecific inflammatory changes pathologically. Immunostaining of the tissue showed few IgG4+ plasma cells, and no neoplastic changes were observed. Both cases arose in elderly patients over the age of 80 years. Pathogenesis and clinical significance of the lesion is unclear, but it might be age related. Recognition of this diagnosis might help us avoid overdiagnosis of malignancy and to reach the correct diagnosis.

Sebaceous carcinoma of lacrimal caruncle in a Chinese patient

PURPOSE

To describe a case of sebaceous carcinoma of the caruncle and review relevant literature to raise awareness about this rare disease.

CASE REPORT

A 63-year-old Chinese man presented with a nontender mass that had developed within the right lacrimal caruncle more than 3 years previously and had been growing in size. The patient was admitted to the hospital, and no systemic diseases were noted on physical and instrumental examinations. The mass was removed intact, and 10 small map biopsies of the surrounding conjunctiva and deeper tissues were performed. Thereafter, 0.04% mitomycin C was applied to the surgical defect for 5 minutes before repair by conjunctival autografting. The gross specimen was observed to be firm and yellow. Microscopic examination revealed that the tumor consisted of lobules, composed of pleomorphic vacuolated cells with central necrosis. The pathologic diagnosis was a well-differentiated sebaceous cell carcinoma of the caruncle that did not extend to the deep surgical margins. Moreover, no tumor recurrence was noted 12 months after surgery.

CONCLUSIONS

The occurrence of sebaceous cell carcinoma in the caruncle is rare. In general, this neoplasm is often both clinically and histopathologically misdiagnosed as a benign condition, resulting in both a delay in correct diagnosis and increased morbidity and mortality. Therefore, this malignancy should be considered in the differential diagnosis of caruncular lesions. The suspected neoplasm should be removed by margins that are as wide as possible; map biopsies are considered to be useful to rule out the subclinical spread of the tumor.

Squamous cell carcinoma of the lacrimal caruncle: case reports

PURPOSE

To report 2 cases of squamous cell carcinoma of the lacrimal caruncle.

METHODS

Two patients, a 38-year-old man and a 72-year-old woman, presented with a painful mass in the medial angle of the eyelid aperture, with signs of inflammation. Biopsy was performed in both cases.

RESULTS

Pathologic examination revealed a keratinized squamous cell carcinoma of the lacrimal caruncle in both cases.

CONCLUSIONS

We report 2 more cases of the rarely found squamous cell carcinoma of the lacrimal caruncle.

Primary basal cell carcinoma of the caruncle: case report and review of the literature

A case of primary basal cell carcinoma of the caruncle is presented and patients presented in the literature reviewed. Clinical features and outcome of a patient with primary basal cell carcinoma of the caruncle is described. Review of 8 other cases identified through literature search with the keywords of "basal cell carcinoma" and "caruncle" is presented.A 67-year-old male patient presented with a 12 months' history of a lesion over the caruncular region. Incisional biopsy of the lesion revealed primary basal cell carcinoma of nodular type. MRI of the orbit identified extension of the lesion into the medial orbit. The tumor was excised, and reconstructive surgery was performed. The patient declined subsequent radiotherapy. No recurrence was detected during the follow up of 33 months. The current patient and 8 other patients with primary basal cell carcinoma of the caruncle were reviewed.The main therapeutic approach for primary basal cell carcinoma of the caruncle is complete excision with tumor-free surgical margins. Adjuvant radiotherapy or chemotherapy may be administered when deemed necessary.

Oncocytic lesions (oncocytoma) of the ocular adnexa: report of 15 cases and review of literature

PURPOSE

To describe the clinical, imaging, and pathology features of oncocytic lesions in the ocular adnexa.

METHODS

Retrospective, noncomparative, interventional case series.

RESULTS

Fifteen oncocytic neoplasms (n = 15 patients) were classified as oncocytoma in 14 (93%) and oncocytic hyperplasia in 1 (7%). The mean patient age was 66 years (median = 66, range = 44-82), and 9 (60%) were male. The tumor involved the caruncle (n = 13, 86%), bulbar conjunctiva (n = 1, 7%), and plica semilunaris (n = 1, 7%). All cases were unifocal and most often presented as a painless mass (n = 12, 80%), evolving over a median 6 months (mean = 12, range = 1-48 months). The mean tumor base was 4.1 mm (median = 4.0, range = 1-10), and the tumor was well-circumscribed (n = 14), dark blue (n = 7), and cystic (n = 10). Ultrasound biomicroscopy and anterior segment optical coherence tomography disclosed mixed solid and cystic components. Complete surgical excision was curative without recurrence after a mean follow up of 39 months. Histopathology disclosed columnar cells with copious quantities of intensely eosinophilic cytoplasm in the lining epithelium (oncocytic hyperplasia) and in some cases with cystadenomatous proliferation (oncocytoma).

CONCLUSION

Oncocytic lesions of the ocular adnexae are typically well-circumscribed, cystic lesions that most often involve the caruncle. Surgical excision can be curative. Epithelial cells with copious quantities of intensely eosinophilic cytoplasm characterize oncocytic transformation histopathologically.

Subcaruncular approach for the reconstruction of blowout fractures of medial orbital walls

To obtain a wide and clean operative field for anatomic reconstruction of medial orbital blowout fractures, an alternative method called the subcaruncular approach has been performed. Between March 2008 and June 2010, this method was applied to the orbits of 41 patients with isolated pure medial orbital blowout fractures. A medial half conjunctival incision was made and extended meticulously to the subcaruncular area through preseptal plane under direct vision. Pre- and postoperative computed tomographic scans and ophthalmic examinations were performed, and clinical results were assessed. Postoperatively, computed tomographic scans revealed anatomic reduction of orbital soft tissues and the reconstructed medial orbital wall to be in proper position in all cases, and diplopia and eyeball motility limitation were resolved in most patients. There were no complications except severe chemosis in one case. We believe that this method can be a useful alternative option for the anatomic reconstruction of medial orbital blowout fractures.