Clinicopathological correlation of caruncular lesions: a 22-year report from the Middle East

Abstract

Introduction: Caruncular lesions are uncommon and diverse, making accurate clinical diagnosis challenging. Discrepancies between clinical and histopathological diagnoses are frequent, and malignant lesions can metastasize early. The lack of substantial regional data necessitates a detailed study of the clinical and histopathological characteristics of these lesions.

Methods: A retrospective study was conducted over a 22-year period, including 52 patients with caruncular lesions. Clinical presentations, demographic data, and histopathological findings were recorded. All lesions underwent biopsy and histological examination to correlate clinical and pathological diagnoses.

Results: A total of 52 patients with caruncular lesions were included, with a mean age of 48 years. The majority presented with unilateral lesions, and six patients had bilateral involvement. The most common presenting complaints were pigmented or enlarging masses. Histopathological examination revealed 13 distinct lesion types, with inflammatory lesions (25%) and melanocytic tumors (23%) being the most common. Malignant lesions were identified in 11.5% of cases. The clinicopathological correlation was accurate in 23% of cases.

Conclusion: Caruncular lesions present significant diagnostic challenges due to their rarity and histopathological diversity. This study underscores the importance of histopathological examination for accurate diagnosis and highlights the need for regional data to better understand the epidemiology of these lesions. The findings also suggest that while most lesions are benign, a high index of suspicion for malignancy should be maintained, particularly in cases of rapid growth or atypical presentation.

Keywords: Benign; Caruncle; Clinicopathologic correlation; Conjunctiva; Lesions; Malignant; Nevus; Tumor.

Fig. 1

Melanocytic Nevus. (A) A clinical photograph depicts a smooth, well-demarcated, brown pigmented lesion overlying the caruncle. (B) The histopathology shows unremarkable epidermis. The dermis is infiltrated by islands of mature nevus cells. [hematoxylin–eosin stain × 100]

Fig. 2

Basal cell carcinoma. The histopathology shows islands of abnormal malignant cells that has a feature of basal cell carcinoma—sclerotic subtypes. [hematoxylin–eosin stain × 200]

Fig. 3

Benign squamous papilloma. The histopathology shows fronds of benign looking conjunctival epithelium with central vascular core. [hematoxylin–eosin stain × 100]

Fig. 4

Benign reactive lymphoid hyperplasia. (A) A clinical photograph shows a pink, smooth-surfaced caruncular lesion in a 41-year-old male. The histopathology shows soft tissue lined by unremarkable epithelium. The underlying substantia propria shows diffuse proliferation of mature lymphocytes with formation of lymphoid follicles with germinal centers (B) hematoxylin–eosin stain × 20, (C) CD 5 × 20, (D) CD 23 × 20,)

Fig. 5

Sebaceous hyperplasia. The histopathology shows soft tissue lined by unremarkable epithelium. Subepithelial tissue shows increased number of sebaceous glands. [hematoxylin–eosin stain × 40]

Fig. 6

Oncocytoma. (A) A clinical photograph shows a caruncular mass with prominent vessels. (B) The histopathology shows cords of benign tall cells with eosinophilic granular cytoplasm. [hematoxylin–eosin stain × 200]

Fig. 7

Pyogenic granuloma. A clinical photograph illustrates a pedunculated, reddish caruncular lesion with a smooth surface in a 49-year-old female