Abstract
PurposeThe lacrimal caruncle is composed of numerous structures including different glands as well as hair follicles. Accordingly, the spectrum of benign and malignant lesions is broad, and the clinical diagnosis is often challenging. Here we systematically analyzed excised caruncular tumors over the past 22 years with special emphasis on the clinico-pathological correlation to provide a guidance for clinicians.MethodsRetrospective evaluation with clinico-pathologic correlation of surgically removed caruncular tumors between 1998 and 2020 at a tertiary referral center.ResultsEighty-two caruncular tumors were identified in the respective period. The patients were between 11 and 85 years of age (mean, 46.8 years; median, 49 years). Nevi (n = 35), cystic lesions (n = 14), oncocytoma (n = 9), papilloma (n = 8), sebaceous gland hyperplasia (n = 8), and reactive lymphoid hyperplasia (n = 4) were observed most frequently. Besides, we are the first reporting herniated orbital fat accompanied by a pyogenic granuloma. 2.4% (n = 2) were malignant tumors (sebaceous gland carcinoma, conjunctival intraepithelial neoplasia with pyogenic granuloma).ConclusionCaruncular tumors show a broad spectrum of mostly benign tumors. They can occur in patients of any age. However, 8/9 oncocytomas and both malignant lesions were detected in patients older than 60 years. Although the clinical diagnosis was confirmed in only 68.3% by the histopathological analysis, the two malignant lesions were identified as such already clinically. Caruncular lesions with a history of growth or other signs of malignancy should be excised followed by detailed histopathological examination to allow a final diagnosis and exclude rare malignant tumors with lethal potential.
Highlights
The lacrimal caruncle is located in the medial angle of the eyelids
The histological evaluation was performed by light microscopy using routine hematoxylin–eosin staining (HE) and periodic acid-Schiff reaction (PAS) as well as immunohistochemical stains where necessary
The diameter of the lesions ranged from 1 × 1 × 0.5 mm to 11 × 10 × 8 mm
Summary
The lacrimal caruncle ( referred to as caruncle) is located in the medial angle of the eyelids. It is covered partly by non-keratinized squamous epithelium with numerous goblet cells and partly by keratinized stratified squamous epithelium. The caruncle is composed of loose connective tissue rich in fibroblasts and may contain adipose tissue. It contains numerous skin appendages such as hair follicles, sebaceous and sweat glands as well as occasionally accessory lacrimal glands (accessory lacrimal glands of Popoff), and striated muscle fibers. Melanocytes are present in the basal layer of the surface epithelium. The composition of the caruncle with its various structures is responsible for the variety of benign and malignant tumors arising in this specific location
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