Clinical and histopathological profile of primary caruncular lesions

Abstract

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.

Keywords: Caruncle; epidermoid cyst; epithelial inclusion cyst; nevus; sebaceous gland carcinoma.

Figure 1

(a) Slit-lamp photograph showing a yellowish caruncular mass; (b) Microphotograph of the excised lesion showing a cyst wall lined with non-keratinized epithelium and sebaceous glands. The lumen contains sebaceous material. Findings suggestive of epidermoid cyst; (c) Slit-lamp photograph showing a pigmented caruncular mass with hairs protruding from it; (d) Microphotograph of the excised mass shows portions of epithelium and dermis along with matured nevus cells

Figure 2

(a) Slit-lamp photograph showing a papillomatous caruncular mass; (b) Microphotograph showing multilayered thickening with acanthosis. There are scattered clumps of goblet cells with neutrophils showing exocytosis. No atypia is seen, suggestive of mucoepidermoid papilloma; (c) Slit-lamp photograph showing a vascular caruncular mass; (d) Microphotograph showing irregular thickening of the conjunctival epithelium. There is subepithelial lymphocytic infiltrate and multiple vascular channels with degraded collagen, suggestive of pyogenic granuloma

Figure 3

(a) Slit-lamp photograph showing a solid yellowish coloured mass arising from the caruncle; (b) Microphotograph showing multiple tumor cells arranged in lobular pattern. The tumors have high nucleocytoplasmic ration and display mitoses and stained positive for adipophilin, suggestive of sebaceous gland carcinoma; (c) Slit-lamp photograph showing an ill-defined, diffused solid mass arising from the caruncle. The lesion is found extending to medial canthus; (d) Microphotograph showing tumor cells having basaloid and squamous differentiation suggestive of basosquamous cell carcinoma

Figure 4

(a) Slit-lamp photograph showing a greasy yellowish caruncular mass. (b) Microphotograph showing portions of epidermis and dermis. In the dermis lobules of sebaceous glands are seen some of which are draining in to the pilosebaceous unit, suggestive of sebaceous gland hyperplasia; (c) Slit-lamp photograph showing a caruncular mass with patchy pigmentation and hair follicles protruding from it. The findings suggest a caruncular nevus; (d) Slit-lamp photograph showing a smooth yellowish caruncular mass suggesting an epidermoid cyst