Caruncular Lesions Research Articles

Clinicopathologic study of caruncular lesions.

The caruncle is a unique anatomical site in the human body, comprising various structures derived from the surface ectoderm and mesoderm. Caruncular lesions can range from benign to malignant and present challenges in accurate diagnosis and timely management due to their hidden nature and proximity to the lacrimal sac. This study aims to provide a comprehensive description of caruncular lesions, presenting the first Indian case series on this topic. Ethical approval was obtained, and data collection was conducted at a tertiary care center in India. A retrospective analysis was performed on 44 patients with caruncular lesions treated between 2013 and 2020. Detailed patient histories, clinical examinations, slit lamp imaging, and excision biopsies were conducted. Histopathological examination of the specimens was carried out. The study included 42 cases of caruncular lesions, with a mean age of 31.09 years. The majority of cases were male (54.54%). Benign lesions accounted for 84.09% of the cases, while premalignant and malignant lesions accounted for 11.36% and 4.54%, respectively. Papilloma and nevus were the most common lesions, with 11 cases each. All caruncular lesions were successfully and completely excised without complications. Histopathological examination confirmed the accuracy of the diagnoses, with an 84.09% concordance rate between clinical assessment and pathological diagnosis. This case series reveals a predominance of benign lesions among individuals in their early thirties. The successful excision of all lesions with a high concordance rate between clinical assessment and histopathological diagnosis underscores the importance of timely and accurate management.

Caruncular lesions: A 16-year single centre review in the United Kingdom.

To review the clinicopathological features of caruncle biopsies carried out at a district general hospital in the United Kingdom (UK), and compare with other centres where data has been published. Retrospective, single-centre, observational case series between 2004-2020. A total of 31 lesions from 31 patients were analysed. 18 of 31 patients were men (58%), and the age ranged from 12 to 91 years. 13 different histopathological types of lesions were identified in our case series, including 9 melanocytic nevi (29%), 7 benign squamous papillomas (23%), 5 skin adnexal lesions (16%), 3 chronic inflammation (10%), 3 epithelial cysts (10%), 1 basal cell carcinoma (3%), 2 malignant melanomas (6%) and l lymphoproliferative disorder (3%). Pre-operative suspected diagnoses were often vague but correct in 12 of 18 cases (67%), where data was available. The uncommon nature and variety of caruncular lesions make the diagnostic process difficult. Our case series is the first reported in the UK, showing a slightly higher proportion of malignant melanomas, in keeping with the population demographics. Excisional biopsies would, therefore, be prudent in the majority of cases to rule out any possible malignancy.

Clinical and histopathological profile of primary caruncular lesions.

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.

Clinico-pathological correlation of lacrimal caruncle tumors: a retrospective analysis over 22\xa0years at the University Eye Hospital Bonn

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.

Solitary eccrine spiradenoma of caruncle: A rare occurrence

Eccrine spiradenoma (ES), a sweat gland tumor, is rarely found in the caruncle. Although the occurrence of spiradenoma of carbuncle are rare. On account of the histological composition of the caruncle, which includes, in addition to conjunctiva, hair follicles, sebaceous glands, sweat glands, and accessory lacrimal tissue, the caruncle may develop lesions that may be similar to those found in the skin, conjunctiva, or lacrimal gland. We encountered a 39-year-old female with a nodular growth in her left caruncle, which had developed over the last 10 years. Excision biopsy was carried out under local anesthesia. The histopathology was suggestive for a benign ES. Clinical preoperative diagnosis is very difficult for caruncular lesions and is reached only in about half of the cases. Most lesions of the caruncle are benign, mainly nevi. Reported malignant lesions are very rare, but can be potentially fatal. The possibility of sweat gland tumor should be kept in mind in the diagnosis of caruncle tumors.

ABCDE of a pigmented caruncular lesion.

ABCDE of a pigmented caruncular lesion.

Malignant melanoma presenting as amelanotic caruncular lesion in a child

Conjunctival melanoma is a rare malignant neoplasm that can present in childhood in any part of the conjunctiva. The infrequency with which conjunctival melanoma is encountered in childhood caruncular lesions makes it a formidable but important aspect of the differential diagnosis. We report the case of a 10-year-old boy who presented with a left caruncular lesion. On histopathologic analysis, the lesion was determined to be BRAF-negative invasive melanoma arising in association with melanocytic nevus. The melanoma was excised using no-touch technique and double freeze thaw cryotherapy. A full systemic work-up revealed no metastasis or abnormality.

Unilateral caruncular lesion: October consultation #1

Unilateral caruncular lesion: October consultation #1

Sebaceous Carcinoma of Lacrimal Caruncle in a Chinese Patient

To describe a case of sebaceous carcinoma of the caruncle and review relevant literature to raise awareness about this rare disease. A 63-year-old Chinese man presented with a nontender mass that had developed within the right lacrimal caruncle more than 3 years previously and had been growing in size. The patient was admitted to the hospital, and no systemic diseases were noted on physical and instrumental examinations. The mass was removed intact, and 10 small map biopsies of the surrounding conjunctiva and deeper tissues were performed. Thereafter, 0.04% mitomycin C was applied to the surgical defect for 5 minutes before repair by conjunctival autografting. The gross specimen was observed to be firm and yellow. Microscopic examination revealed that the tumor consisted of lobules, composed of pleomorphic vacuolated cells with central necrosis. The pathologic diagnosis was a well-differentiated sebaceous cell carcinoma of the caruncle that did not extend to the deep surgical margins. Moreover, no tumor recurrence was noted 12 months after surgery. The occurrence of sebaceous cell carcinoma in the caruncle is rare. In general, this neoplasm is often both clinically and histopathologically misdiagnosed as a benign condition, resulting in both a delay in correct diagnosis and increased morbidity and mortality. Therefore, this malignancy should be considered in the differential diagnosis of caruncular lesions. The suspected neoplasm should be removed by margins that are as wide as possible; map biopsies are considered to be useful to rule out the subclinical spread of the tumor.

Sebaceous gland hyperplasia of the caruncle: an uncommon diagnosis

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

Lesions of the Lacrimal Caruncle With an Emphasis on Oncocytoma

Lesions of the lacrimal caruncle vary widely due to its unique composition. Rarely, dermatologists and dermatopathologists encounter biopsies taken from this location. The aims of this study were to (1) retrospectively review caruncular lesions of the eye examined at Duke University Medical Center and (2) review the literature associated with caruncle pathology with emphasis on oncocytoma. A retrospective search of all lesions of the caruncle examined at Duke University Medical Center from 1991 to 2009 was performed. Fifty-nine lesions of the caruncle were identified. Nevi (40.7%) were the most common lesions observed, although squamous papillomas were the second most common entity (8.5%). Three oncocytomas were identified (5.1%), and were the next most common lesion present at this body site. These 3 entities represented 54.3% of the lesions found in the caruncle. Fifteen percent of the caruncular biopsies contained malignant or borderline malignant lesions, whereas the remaining 85% were benign entities. Most lesions present in the caruncle are benign. Although relatively rare, oncocytomas may be encountered by the dermatopathologist and may be confused for other neoplasms. Oncocytomas should be considered in the differential diagnosis based on this location in addition to histopathologic features.

Primary Ocular Caruncular Basal Cell Carcinoma in a Chinese Patient

Although basal cell carcinoma (BCC) is the most common eyelid neoplasm, BCC that originates from the lacrimal caruncle is extremely rare. To the best of our knowledge, only seven cases have been reported and here we report the first documented primary caruncular BCC in an Oriental patient. A 73-year-old Chinese man presented with a telangiectatic, multilobulated, pigmented tumor that measured 5×5 mm, which had arisen from the lacrimal caruncle of the left eye 3 months previously. The patient underwent tumor excision, and histopathological examination revealed BCC. He received adjuvant chemotherapy with intra-arterial methotrexate (30 mg/m(2)). A nodular pigmented BCC recurred in the bulbar conjunctiva close to the original tumor 3 months later, and he underwent a second excision. Bleomycin (8.5 mg/m(2) monthly) was added to the chemotherapy regimen, which was changed to fluorouracil (300 mg/m(2) monthly) 2 months later. The tumor did not recur during follow-up of 22 months. Malignant tumors of the caruncle are infrequent. BCC should be considered in the differential diagnosis of a pigmented caruncular lesion.

The White Caruncle: Sign of a Keratinous Cyst Arising From a Sebaceous Gland Duct

To describe an acquired, smooth white lesion of the caruncle and to underscore the role of subsurface keratinizing squamous epithelium in its formation. Clinical photographic documentation, histopathologic evaluation, and immunohistochemical staining of an excised specimen from a 25-year-old woman. A cyst was found that was lined by keratinizing squamous epithelium without a keratohyaline layer (trichilemmal keratinization), typical of lesions of the pilosebaceous unit. A portion of the cyst's lining was replaced by granulomatous inflammation resulting from an earlier spontaneous partial rupture. Ki-67 immunolabeling demonstrated relatively few nuclei in S-phase (DNA synthesis) in comparison with the overlying epithelium, thereby suggesting an obstructive, nonproliferative cause for the cyst. A white caruncular lesion is a very rare finding according to the literature. It is most likely caused by a cyst lined by squamous epithelium elaborating trichilemmal-type keratin. A sebaceous gland duct was established as the source for the current lesion.

Lesions of the caruncle: a description of 42 cases and a review of the literature

Lesions of the caruncle are uncommon. On account of the histological composition of the caruncle, which includes, in addition to conjunctiva, hair follicles, sebaceous glands, sweat glands, and accessory lacrimal tissue, the caruncle may develop lesions that may be similar to those found in the skin, conjunctiva, or lacrimal gland. Clinical preoperative diagnosis is very difficult and reached only in about half of the cases. The vast majority of lesions of the caruncle are benign, mainly nevi. Reported malignant lesions are very rare but can be potentially fatal. Although malignancy is clinically overestimated, any suspected malignant lesion should be excised and examined histopathologically by an experienced pathologist. This study presents the clinical and histological data of 42 consecutive caruncular lesions processed at our laboratory and reviews previously reported cases of caruncular lesions.

Tumors of the Caruncle: A Clinicopathologic Correlation

To determine the types and incidence of caruncular lesions and to investigate the correlation between clinical and histologic diagnosis. Retrospective, observational case series. Records of patients with a lesion of the caruncle that was excised and submitted to our ocular pathology department between January 1979 and May 2005 were reviewed. Lesions were classified by histologic type and correlated with patient age, gender, and preoperative clinical diagnosis. A total of 195 consecutive caruncular lesions from 191 patients were identified. Twenty-four different types of lesions were identified; the most common were nevi (n = 92, 47%) and papillomas (n = 29, 15%). One keratoacanthoma was identified. One hundred eighty-three lesions (93.8%) were benign, six (3.1%) were premalignant, and five (2.6%) were malignant. Preoperative clinical diagnosis corresponded to postexcision histologic diagnosis in 73 cases (37.4%). Suspected malignancy was a common reason for excision (61 cases, 31.3%), but malignancy was confirmed in only three (4.9%) of 61 cases. Two of the five malignant lesions were clinically thought to be benign. We hereby report the first caruncular keratoacanthoma. The rarity and variety of caruncular lesions make clinical diagnosis difficult. Malignancy is clinically overestimated, and some malignant lesions can take a benign aspect, justifying close photographic follow-up of all lesions. Because caruncular malignant melanoma is associated with poor prognosis, pigmented lesions should be monitored carefully. In the absence of clear criteria for malignancy, any change in color, size, or vascularization of a caruncular lesion should hasten excision.

Caruncular lesions in Denmark 1978–2002: a histopathological study with correlation to clinical referral diagnosis

To carry out a retrospective clinicopathological evaluation of caruncular lesions. Data were collected from all surgically removed and histopathologically evaluated caruncular lesions registered by Danish pathology departments during the 25-year period 1978-2002. A total of 574 caruncular lesions were identified. The number of caruncular lesions increased significantly during the 25-year period. This was due to an increase in the number of benign lesions, whereas the number of premalignant and malignant lesions remained constant. A total of 550 (96%) of the lesions were benign. Naevus (n = 248, 43%) and papilloma (n = 131, 23%) were the most common neoplasms. Premalignant lesions (n = 10, 1.7%) were dominated by primary acquired melanosis (PAM) with atypia and epithelial dysplasia. Malignant lesions constituted a total of 14 neoplasms (2.4%), with basal cell carcinoma (n = 4, 0.7%) and lymphoma (n = 4, 0.7%) being the most frequent. The preoperative clinical diagnosis was correct in 286 (50%) of cases. Caruncular lesions are predominately benign but the lesions are rare and diverse, making clinical diagnosis difficult. Referral of excised lesions for pathological examination is recommended.

Surgical treatment of the caruncular lesions

Each lesion which produces a prolong change of the volume of the caruncle necessitates surgical treatment, removal of the caruncle. Caruncular lesions are uncommon. During 15 years on the Institute for eye diseases in Belgrade authors have treated 121 caruncular lesions. Here they present their way of surgical treatment of the caruncle and point out some problems connect with this procedure .

Ocular adnexal granulocytic sarcoma as the first sign of acute myelogenous leukemia relapse

PURPOSE: To report a case of granulocytic sarcoma involving the eyelids and caruncles after bone marrow transplantation. METHODS: Case report. A 30-year-old man with acute myeloid leukemia in remission developed multiple friable eyelid and caruncular lesions in addition to two cutaneous lesions on the chest wall and right axilla approximately 3 months after a successful autologous bone marrow transplant. RESULT: Pathologic examination was consistent with granulocytic sarcoma. CONCLUSION: This condition should be considered in the differential diagnosis of cutaneous or eyelid masses in patients with a history of leukemia.

Clinical aspects and histopathology of caruncular tumors

Histologically the lacrimal caruncle represents a transition zone between the conjunctiva and the skin containing cutaneous, conjunctival and lacrimal elements. This accounts for a variety of histopathological changes. We conducted a retrospective study on the histopathological findings of 65 caruncular lesions which were referred for excisional biopsy between 1974 and 1995 to the Department of Ophthalmology at the University of Heidelberg. The age of the patients ranged from 10-87 years (mean 42 +/- 18.2). Histopathologic diagnoses included 29 (45%) nevi, 15 (23%) papillomas, 7 (11%) chronic inflammatory lesions and 4 (6%) epidermoid cysts. In addition, 4 (6%) semimalignant and malignant tumours were found including one basalioma, one squamous cell carcinoma and two Kaposi-sarcomas. Among the remaining 8% a dermoid cyst, an accessory lacrimal gland with a retention cyst, an epithelial implantation cyst, a teleangiectatic granuloma and an oncocytoma were diagnosed. These findings suggest that malignant caruncular lesions are rare, however excisional biopsy appears prudent in order to establish the histological diagnosis.

Caruncular Malignant Melanoma in a Black Patient

An 84-year-old black woman had a right caruncular lesion that had progressively enlarged over the past 3 months. Surgical excision and cryotherapy were performed. A biopsy confirmed the diagnosis of caruncular malignant melanoma, a rare lesion which, to our knowledge, has not been previously reported in a black patient.