1
|
Mirzania D, Jacobson A, McHugh J, Demirci H. Conjunctival Apocrine Hidrocystoma: A Case Report and Review of Literature. Cornea 2024; 43:1431-1435. [PMID: 38900714 DOI: 10.1097/ico.0000000000003598] [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: 12/01/2023] [Accepted: 05/07/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To describe the clinical features of a conjunctival apocrine hidrocystoma that developed 6 decades after a strabismus surgery and review existing literature on apocrine hidrocystomas of the conjunctiva and caruncle. METHODS Case report and review of literature on conjunctival apocrine hidrocystomas. RESULTS A 71-year-old man with a history of strabismus surgery as a child presented with a cystic lesion on the nasal conjunctiva and caruncle for 1 year. Excision of the lesion showed a unilocular cavity lined by a double layer of cells with the hallmark finding of apical decapitations, confirming a diagnosis of apocrine hidrocystoma. Seven additional cases of conjunctival and caruncular apocrine hidrocystomas were reviewed. All cases presented after 50 year of age. Most cases presented nasally or within the caruncle and had a pigmented appearance. No other reported cases had a history of trauma or surgery. All cases were treated with surgical excision without recurrence. CONCLUSIONS History of strabismus surgery or conjunctival trauma may lead to ectopic deposition of apocrine glands that may contribute to the formation of an apocrine hidrocystoma.
Collapse
Affiliation(s)
- Delaram Mirzania
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI; and
| | - Adam Jacobson
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI; and
| | - Jonathan McHugh
- Department of Pathology, University of Michigan Health, Ann Arbor, MI
| | - Hakan Demirci
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI; and
| |
Collapse
|
2
|
Ludzik J, Lee C, Mengden S, Nguyen H, Pleshakov D, Witkowski A. Dermoscopy and Reflectance Confocal Microscopy of Apocrine Hidrocystoma. Dermatol Pract Concept 2023; 13:dpc.1301a39. [PMID: 36892387 PMCID: PMC9946129 DOI: 10.5826/dpc.1301a39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Joanna Ludzik
- Department of Telemedicine and Bioinformatics, Jagiellonian University Medical College, Krakow, Poland.,Department of Dermatology, Oregon Health and Sciences University, Portland, Oregon
| | - Claudia Lee
- Department of Dermatology, Oregon Health and Sciences University, Portland, Oregon.,School of Medicine, University of California Riverside, Riverside, California
| | - Stephanie Mengden
- Department of Dermatology, Oregon Health and Sciences University, Portland, Oregon
| | - Huong Nguyen
- Department of Dermatology, Oregon Health and Sciences University, Portland, Oregon
| | - Dennis Pleshakov
- Department of Dermatology, Oregon Health and Sciences University, Portland, Oregon
| | - Alexander Witkowski
- Department of Dermatology, Oregon Health and Sciences University, Portland, Oregon
| |
Collapse
|
3
|
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]
|
4
|
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.
Collapse
Affiliation(s)
- Norman C Charles
- Department of Ophthalmology
- Department of Pathology, New York University Langone Medical Center, New York, U.S.A
| | | | | |
Collapse
|
5
|
Kenny B, Zhao Y, Banerjee T, Osmond A. Pigmented apocrine hamartoma: A distinct and uncommon pigmented lesion with dendritic melanocytes and appraisal of terminology. J Cutan Pathol 2021; 49:172-175. [PMID: 34590346 DOI: 10.1111/cup.14139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/18/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
A 20-year-old female presented to a gynecologist with an irregular, darkly pigmented, vulvar lesion. Histopathologic sections of a biopsy specimen showed cystically dilated glands with apical snouts, pigmented secretion, and numerous dendritic melanocytes. The lesion was diagnosed as a pigmented apocrine hamartoma of the vulva. We report the fifth case of this uncommonly encountered entity and discuss the conflicting terminology in the literature of this rare, pigmented lesion.
Collapse
Affiliation(s)
- Bret Kenny
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Yayuan Zhao
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Canada
| | - Tamalina Banerjee
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Canada
| | - Allison Osmond
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Canada
| |
Collapse
|
6
|
Trischman T, Scott JF. Comparative Efficacy of Hidrocystoma Treatments: A Systematic Review. J Cutan Med Surg 2020; 24:474-480. [PMID: 32253923 DOI: 10.1177/1203475420915453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Although various treatment options for hidrocystomas have been described, the comparative efficacy of these treatments is poorly understood. METHODS We conducted a systematic review of all articles describing the treatment of hidrocystomas. Treatment modalities were categorized as destructive surgical procedures, skin-directed therapies, systemic medical therapies, general measures, or combined. Patient and tumor characteristics, as well as response rate, recurrence rate, and adverse effects, were extracted from each article. RESULTS A total of 94 articles involving 192 patients and 255 unique treatment events were included in the final analysis. Destructive surgical procedures had an overall response rate and recurrence rate of 92.9% and 10.8%, respectively. Skin-directed therapies had an overall response rate of 72.6%. The overall response rate to systemic medical therapies was 71.4%. Solitary hidrocystomas were primarily treated with destructive surgical procedures, including excision, which was associated with a 4.7% recurrence rate. Multiple hidrocystomas were successfully treated with a variety of therapies, including destructive surgical procedures and skin-directed therapies requiring ongoing or repeated therapy. CONCLUSIONS Excision has the highest efficacy for solitary hidrocystomas. A number of therapies have shown efficacy for multiple hidrocystomas, including lasers, intracystic trichloroacetic acid, intracystic hypertonic glucose, topical and oral anticholinergics, and botulinum toxin. Aluminum chloride is associated with a low response rate. Larger comparative studies are needed to further evaluate the optimal treatments for solitary and multiple hidrocystomas.
Collapse
Affiliation(s)
- Thomas Trischman
- 2546 Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jeffrey F Scott
- 2546 Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
7
|
AbdullGaffar B. Pilar Cyst Pigmented Epithelial Remnants: A Potential Diagnostic Pitfall. Int J Surg Pathol 2019; 27:639-642. [PMID: 31039667 DOI: 10.1177/1066896919846376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pilar cysts are common cutaneous cysts of follicular origin. They are easy to diagnose clinically and pathologically. Histologic diagnostic difficulties might arise in certain situations, however. Acute inflammation with total destruction of the cyst wall due to rupture with replacement by an abscess formation, foreign body giant cell reaction, and fibrosis could obscure their recognition. Cysts with hybrid lining epithelium could be confused with other cutaneous cysts. Epithelial remnants of the basal layer with loss of the squamous epithelium and shelled out cyst contents might mimic other epithelial cysts and vascular lesions. Few studies focused on the phenomenon of epithelial remnants or epithelial separation of pilar cysts. We report a case of a scalp cyst composed of a single layer of pigmented cuboidal lining epithelium. The initial differential diagnosis was hidrocystoma, solid-cystic hidradenoma, arteriovenous malformation, and lymphangioma. The intraepithelial pigment was melanin. The lining epithelium was positive for cytokeratin cocktail, CK5/6, CK8, CK19, p63, and D2-40 with scattered S-100 protein and melan-A positive melanocytes. Being unaware of the phenomenon of epithelial split in pilar cysts, it was mislabeled as a melanin-pigmented eccrine hidrocystoma. Surgical pathologists should be aware of pilar cysts' epithelial remnants to avoid potential diagnostic pitfalls. An attention to certain histologic hints and knowledge of the immunoprofile of the basal layer should help pathologists avoid this pitfall.
Collapse
|
8
|
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]
|
9
|
Orbital Conjunctival Cyst Associated With the Superior Rectus-Levator Muscles: A Clinicopathologic Study. Ophthalmic Plast Reconstr Surg 2017; 33:e1-e4. [DOI: 10.1097/iop.0000000000000358] [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]
|
10
|
Abstract
PURPOSE To report a case of caruncular dacryops in a 58-year-old man that was excised in its entirety and to offer an immunohistopathologic analysis. METHODS Sections stained with hematoxylin and eosin, periodic acid-Schiff, and Grocott methenamine silver (the latter 2 for identification of mucus) were evaluated, and immunohistochemical investigations were performed using cytokeratin (CK) 7, CK14, CK17, and smooth muscle actin. RESULTS Histopathologic examination revealed a cystic dilation of the lacrimal gland ducts containing secretory globules. The ducts were composed of double-layered cuboidal epithelium with rare scattered goblet cells and interspersed prominent lobules of lacrimal gland tissue, diagnostic of dacryops. Immunohistochemistry of cystic ducts demonstrated a CK profile identical to that of the conjunctiva including the absence of a myoepithelium. CONCLUSIONS This is the first case of an intact caruncular lacrimal ductal cyst (dacryops). A previous report documented a spontaneously collapsed cyst with extrusion of secretory globoid bodies into extracellular space that elicited a foreign body giant cell response.
Collapse
|
11
|
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Christakopoulos C, Prause JU, Heegaard S. Nodular Hidradenoma of the Caruncle. Ophthalmic Plast Reconstr Surg 2014; 30:e37-9. [DOI: 10.1097/iop.0b013e3182937542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Infected Epithelial Inclusion Cyst Simulating Conjunctival Melanoma. Ophthalmic Plast Reconstr Surg 2013; 29:e131-4. [DOI: 10.1097/iop.0b013e31827bdaaa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
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.
Collapse
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.
| | | | | |
Collapse
|
17
|
Kim B, Kang NY. Apocrine hidrocystoma of the conjunctiva. Int J Ophthalmol 2012; 5:247-8. [PMID: 22762060 DOI: 10.3980/j.issn.2222-3959.2012.02.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/12/2012] [Indexed: 11/02/2022] Open
Affiliation(s)
- Boyun Kim
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Kyunggi-do, 420-717, Korea
| | | |
Collapse
|
18
|
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.
Collapse
Affiliation(s)
- Maria Kirzhner
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | | | | |
Collapse
|