Jakobiec, Frederick A.; Hanbazazh, Mehenaz; Barrantes, Paula Cortes; Yoon, Michael K.
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.
Clinicopathologic case report with detailed histopathologic and immunohistochemical evaluation for cytokeratins combined with a tabulation of mimicking lesions and relevant literature citations.
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.
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.
Natalie A. Homer, Paul M. Hoesly & Vikram D. Durairaj
Charlotte L. Marous, Mohamed Kahila & Roman Shinder
Sitara H. Hirji, Michelle M. Maeng, Ann Q. Tran, Wen-Hsuan W. Lin & Lora R. Dagi Glass
Cutaneous T-cell lymphoma (CTCL) may pose a diagnostic challenge for physicians, as clinical presentation and histologic analysis may mimic benign dermatologic conditions. The authors present a case of recurrent CTCL in which the recurrence was limited to the eyelid and misdiagnosed as a contact dermatitis. To the best of the authors’ knowledge, this is the first reported case of recurrent CTCL that has presented solely as dermatitis of the eyelid.
Nandini Bothra & Mohammad Javed Ali
A 46-year-old lady presented with progressively growing mass from the inner side of the right upper eyelid. The mass was elevated, pinkish with surface vessels, engulfing the puncta. Careful evaluation revealed a patent punctal opening. Excision biopsy of the mass was carried out. Histopathology showed pseudoepitheliomatous hyperplasia with few inflammatory cells. We describe a case of punctal pseudoepitheliomatous hyperplasia masquerading as a punctal granuloma or papilloma.
Md. Shahid Alam, Vathsalya Vijay, Atanu Barh & Krishnakumar Subramanian
Plasma cell granuloma is a rare non-neoplastic inflammatory condition of unknown etiology commonly involving lung and gastrointestinal tract. Conjunctival disease per se is very rare and usually associated with involvement of other organs. We report a case of conjunctival plasma cell granuloma without any systemic involvement in a 9-year-old girl who presented with bilateral reddish vascularised subconjunctival episcleral mass. An excision biopsy of the mass in the left eye followed by histopathologic examination and Immunohistochemistry confirmed the diagnosis. At 1 year follow-up, the child had no recurrence in the operated eye whereas the lesion remained the same in the other eye despite systemic treatment with immunosuppressants. This case is being reported for its rarity and to insist on the mandatory need for a thorough systemic workup to identify multiorgan involvement as well as to rule out other systemic disorders.
Jiawei Zhao, Harry Quon, Wayne Koch, Lisa M Rooper & Ashley A Campbell
A 78-year-old Caucasian female presented with a painless mass in the right orbit that had progressively enlarged over several months. Computed tomography scan of the orbits showed a right lacrimal gland mass with no bony erosion. Histopathologic analysis of the biopsy specimen revealed invasive squamous cell carcinoma positive via in-situ hybridization for high-risk human papillomavirus. The patient underwent successful removal of the right lacrimal gland tumor en bloc, followed by adjuvant radiotherapy. This is an extremely rare case of primary squamous cell carcinoma of the lacrimal gland and the first report describing human papillomavirus positivity in this tumor location.
Shiao Wei Wong , James Laybourne, Luciane Irion & Anne Cook
A 65-year old woman presented with 3-year history of painless, gradual swelling of the right upper eyelid associated with proptosis. Computed tomography (CT) and magnetic resonance imaging (MRI) of the orbit showed a well circumscribed soft tissue mass in the supero-lateral orbit. An excision biopsy of the lesion was performed via lateral orbitotomy. Histopathology examination and immunochemistry staining confirmed the diagnosis of cavernous angioleiomyoma. The tumour was excised completely. Orbital angioleiomyoma is a rare benign tumour and the lesion can cause visual morbidity, particularly when intraconal. Despite sophisticated imaging modalities, histopathological analysis is essential for diagnosis. Angioleiomyoma should be included in the differential diagnosis of well-defined orbital lesions. Complete surgical excision carries a low risk of recurrence.
Sinha Dimpi, Sharma Sukrity, Kale Sudhir Kumar, Gorur Mohammed Imran & Kaur Tripti
Extra-mammary myofibroblastomas are rare benign mesenchymal neoplasms, histologically and immune-phenotypically identical to mammary myofibroblastomas. Histologically, they are characterized by the abundance of spindle cells in hyalinized collagenous stroma with positive expression of CD 34 and desmin. We present an extremely rare case of extra-mammary myofibroblastoma of the orbit in a 29-year – old male who presented with painless proptosis of the right eye, with a description of clinical, radiological, and histological findings.