Trichoblastic fibroma of the eyelid

Trichoblastic fibroma (TBF), also known as trichoblastoma, small nodular type, is a rare benign cutaneous adnexal tumor that shows trichogenic (follicular) differentiation that can be mistaken clinically and histologically for basal cell carcinoma (BCC), a locally aggressive trichogenic carcinoma. As the clinical behaviors of these two follicular neoplasms are opposite from one another and their management is thus different, recognition of TBF is crucial for effective therapy. Although TBF most commonly is first seen on the face, this lesion has not previously been reported in the eyelid. In this report, we document the first case of TBF affecting the ocular adnexa and detail the histologic features that differentiate TBF from BCC.     

Pleomorphic adenoma with extensive myoepithelial component (myoepithelioma) of the lower eyelid

A 58-year-old woman presented with a nodular lesion on the medial part of her left lower eyelid. The lesion had been removed 10 years ago, but showed subsequent recurrence with slow growth. The lesion was again partially removed at another institution prior to presentation. Afterward removal, the persistent lesion had rapid growth. On presentation to us, the lesion showed a clinical appearance that was very similar to a nodular basal cell carcinoma. A pentagonal full-thickness resection biopsy was performed. The pathologic study revealed clusters of tumor cells and some ductal proliferations. Immunohistochemistry demonstrated positive staining for p63, S-100, and smooth muscle actin. No atypia was observed. A diagnosis of pleomorphic adenoma with extensive myoepithelial component (myoepithelioma) was made. The authors conclude that myoepithelioma should be considered in the differential diagnosis of nodular recurrent masses in the eyelids of adults. Definitive diagnosis is possible only after surgical biopsy.     

Pleomorphic adenoma (formerly chondroid syringoma) of the eyelid margin with a pseudocystic appearance

Among the adenomas and adenocarcinomas spawned by the adnexal glands of the eyelids, pleomorphic adenoma (also referred to as benign mixed tumor or chondroid syringoma in dermatopathology) is among the rarest. Pleomorphic adenomas (PAs) can arise from sweat glands in the dermis of the eyelid skin and must be distinguished from those of the accessory lacrimal glands of Krause and Wolfring. We describe an eyelid margin skin PA that appeared clinically to be a cyst and was not associated with an accessory lacrimal gland. Histopathologically, the lesion was circumscribed but nonencapsulated and composed of branching ductular structures with a double layer of epithelial cells set in a myxoid and sclerotic stroma that did not contain cartilage. The outer ductular (myoepithelial) cells delaminated to populate the stroma. Histochemistry disclosed abundant extracellular mucopolysaccharides that conferred the “cystic” character clinically. The inner ductular cells were uniformly positive for cytokeratin 7 and focally for gross cystic fluid disease protein-15, an apocrine marker. The inner and outer ductular cells were negative for alpha-smooth muscle actin. These pathologic findings support an apocrine (gland of Moll) origin for this tumor, which is consistent with the fact that there are no eccrine glands at the eyelid margin.     

Syndrome of the flaccid eyelid (floppy eyelid syndrome

Three patients with increasing swelling of the lateral half of the upper lid associated with chronic papillary conjunctivitis which did not respond to therapy were observed. The history, clinical findings, keratinized epithelial cells in the scrapings and the therapeutic success with a protective shield over night suggested the diagnosis of floppy eyelid syndrome.     

Pleomorphic lipoma of the bulbar conjunctiva

We describe a patient who had most of the histologic features of the pleomorphic lipoma. Floret giant cells and nuclear pyknosis were well demonstrated in this case, and characteristic bubbly nuclear vacuolations were also seen. There was an absence of mitotic activity. The variable size of the adipocytes and nuclear pyknosis and the presence of collagen indicate an atrophying degenerative process in the formation of pleomorphic lipoma.     

Subperiosteal fibroma of the orbit

Fibromas are benign, well-circumscribed tumors that are characterized as spindle-cell lesions with interlacing fibrous stroma. Here, we describe the clinical presentation, management, and outcome of a patient with an orbital fibroma. To our knowledge, this is the second case report of a biopsy-proven subperiosteal orbital fibroma to date.     

Chondromyxoid fibroma of the orbit

A 51-year-old woman with a history of migraine headaches was found to have an incidental right orbital mass on MRI during neurologic evaluation for headaches. The orbital mass was a well-defined, lobulated, intraosseous soft tissue lesion with circumscribed margins. Clinically, there was noted proptosis, tenderness to palpation, and slight limitation to right abduction. An orbitotomy with incisional biopsy revealed a lesion arising within the lateral orbital rim extending to the subperiosteal space. Intraoperative frozen sections indicated a low grade sarcoma, possibly metastatic. The extraosseous component was excised, and the bone was curetted until all visible tumor was removed. A diagnosis of chondromyxoid fibroma was made. The patient did well until 5 months postoperatively, when right-sided proptosis returned due to recurrent tumor. Repeat surgical resection with removal of the lateral orbital rim was performed. Histopathology was consistent with recurrent chondromyxoid fibroma.     

Malakoplakia of the eyelid

A 35-year-old white man, on immunosuppressive medications for 3 1/2 years following a renal transplant, presented with a whitish-yellow mass at the medial end of the left lower eyelid. An initial incisional biopsy was performed that was misinterpreted as granular cell myoblastoma. The mass was subsequently excised and histopathologic examination revealed malakoplakia. A more extensive recurrent lesion was excised one year later. About two years after the resection of the original lesion the patient died of complications of chronic renal failure. At autopsy there was no evidence of malakoplakia either of the eyelid-or systemically. This is the first case reported of eyelid involvement by malakoplakia, a histiocytic disorder with pathognomonic histopathologic features.     

Osteolipoma of the eyelid

A 50-year-old woman presented with a nodular swelling on her right upper eyelid. The tumour was diagnosed as osteolipoma histologically after resection. Osteolipoma is a very rare variant of lipoma and only a few cases affecting the head and neck are reported in literature. To the best of the author's knowledge this is the first reported case of osteolipoma of the eyelid.     

Poroma of the eyelid

A 71-year-old white woman sought treatment for poroma of the right lower eyelid. Excisional biopsy was performed, and the specimen had histologic features consistent with poroma. One year after excision, there has been no recurrence of the lesion. Clinicians should be aware that poroma can occur in regions other than the hands and feet.     

Trichoblastoma of the eyelid

A 50-year-old woman developed a slow-growing tumor of the right medial canthus. Excisional biopsy and histologic examination showed a trichoblastoma. This nodule was excised using Mohs micrographic and reconstructive surgery. Trichoblastoma is a rare, slow-growing neoplasm derived from the hair follicle. Though rarely undergoing malignant transformation, these nodules histologically resemble basal cell carcinoma and generally require complete excision.     

Anthrax of the eyelid

Anthrax is a rare infection that is transmitted to humans from animals or animal products. In its cutaneous form it may produce lesions of the eyelids which can lead to cicatricization and ectropion. Exophthalmos, optic atrophy and panophthalmitis have also been reported. A case of anthrax affecting the eyelid of a patient seen by the author in Kabul, Afghanistan, is presented.     

Myolipoma of the eyelid

Background: This report describes the pathology of a myolipoma which occurred in the eyelid. Myolipoma is a benign hamartomatous tumour in which smooth muscle cells are interspersed with adipocytes. · Patient details: an irregular yellowish tumour (30×25 mm) with ill-defined borders had been present for 50 years in the medial part of the left lower eyelid of a 67-year-old woman. The tumour was excised and studied by conventional histology, immunohistochemistry and transmission electron microscopy. · Results: The tumour was formed by bundles of spindle-shaped cells with cigar-shaped nuclei intermingled with multiloculated clear cells containing small eccentric nuclei. By immunohistochemistry, positive staining of the spindle cells was restricted to smooth muscle actin and desmin; the clear cells were non-reactive with the immunohistochemical panel, but fat was identified within the cytoplasm. The ultrastructural features of the spindle cells were those of a leiomyoma, while the clear cells were classified as adipocytes. · Conclusion: This tumour was considered to originate from the media of blood vessels within the tumour. Received: 2 June 1997 Revised version received: 6 October 1997 Accepted: 15 October 1997     

Trichoadenoma of the eyelid

PURPOSE: To report the unique occurrence of a trichoadenoma of the eyelid.METHODS: An 80-year-old woman underwent surgical resection of a lesion of the right lower eyelid that was suspected to be a basal cell carcinoma. The lesion was studied with light microscopy.RESULTS: Histopathology showed a lesion in the dermis that contained keratin cysts surrounded by a proliferation of eosinophilic epidermoid cells. The findings were characteristic of a trichoadenoma.CONCLUSION: Trichoadenoma, a rare, benign, cutaneous tumor that usually occurs on the face, can develop on the eyelid and simulate a basal cell carcinoma.