Sebaceous gland hyperplasia of the caruncle: an uncommon diagnosis

Abstract

Dear Editor, We report this interesting case of a 79-year-old black male who presented with a 2-month history of a fleshy growth in his right eye. He had no associated redness, irritation nor discharge, nor history of significant weight loss, loss of appetite, or constitutional symptoms. The vision was count fingers in his right eye due to a mature cataract. The left eye was blind from ocular trauma in childhood. Significant findings were localized to his right conjunctiva, where a smooth, flesh-coloured multinodular lesion (5 mm×8 mm) was arising from the right caruncle (Fig. 1a). There was an associated mucoid discharge. There was no associated pigmentation, ulceration, or telangiectasia. In the right eye, the cornea, anterior chamber, and iris were normal; however, he had a mature cataract. The left cornea was opacified and no fundal view was possible. His intraocular pressures were 15 mmHg and 12 mmHg in the right and left eyes respectively. The differential diagnosis included sebaceous gland hyperplasia, sebaceous adenoma, and to rule out a sebaceous carcinoma of the caruncle. His haemoglobin level was 14.5 g/l, and the VDRL was non-reactive and HIV I-II Ag/Ab was negative. Excisional biopsy of the caruncle was done under local anaesthesia. Histopathology showed well-demarcated sebaceous gland lobules, composed of mature cells with foamy cytoplasm grouped around a central sebaceous duct (Fig. 2a and b). There was no cellular atypia. These features were consistent with sebaceous hyperplasia. Post-operatively, the patient healed well (Fig. 1b). He had no further complaints or symptomology of ocular surface disease. He has had no recurrence after 1 year. Caruncular lesions are uncommon, occurring in 0.003 % of ocular biopsies [1–3]. Sebaceous gland hyperplasia (SGH) of the caruncle is rare. In several clinicopathological series on caruncular lesions, the incidence of SGH varied from 2 to 8 % [1–4]. The commonest caruncular lesions have been papillomas (7.1–32 %) and nevi (24–59.5 %), with the incidence varying widely according to the study [2–4]. SGH have a slow painless growth, a yellow nodular appearance, and associated overlying telangiectatic vessels. Because of the older age of the patient, the long history and yellow nodular appearance our differential diagnosis of SGH was made. This was confirmed with an excisional biopsy. SGH is clinically similar to a sebaceous adenoma This paper has never been presented at a conference