Pilomatrixoma of the Periorbital Region: A Retrospective Review.

PURPOSE: Pilomatrixoma is a benign cutaneous adnexal tumor that differentiates toward hair follicle cells. It infrequently occurs in the periorbital region. In the periorbital area, it is often located in the upper eyelid and eyebrow region. Periorbital pilomatrixoma is often misdiagnosed clinically and is less common than other benign skin tumors. In this retrospective review, we evaluate the demographic, clinical, and histopathological data of patients with periorbital pilomatrixoma, treated from 2010 to 2023. METHODS: A retrospective analysis of periorbital pilomatrixoma cases treated during a period of 13 years was performed. Deidentified data in relation to the age at surgical excision, gender, location, size, histopathological features, treatment, and recurrence were collected. All histological slides were reviewed by an attending histopathologist. RESULTS: A total of 77 cases of periorbital pilomatrixoma were diagnosed by histopathological examination and treated from 2010 to 2023. A slight female preponderance (56%) was noted, and the majority of cases (52%) were presented in the first 2 decades of life. The left periorbital region was involved in 45.5% of cases, and 54.5% in the right. The upper lid was the most affected site. Two cases of recurrence were reported. No malignant transformation was noted. CONCLUSIONS: Pilomatrixoma is an uncommon benign periorbital tumor, commonly misdiagnosed clinically. Ophthalmologists and surgeons should suspect pilomatrixoma in the periorbital region, especially in children or young adults. Complete surgical excision is curative, and recurrence is rare.

Periorbital Myofibroma in a Child: A Case Report and Review of the Literature.

Infantile myofibroma is a rare benign tumor usually diagnosed before the age of 2 and found in the head and neck but much more rarely in the orbital region. There have only been 7 cases of periorbital myofibromas reported in children in the literature to date. The current case is of an 8-year-old boy with a left upper eyelid myofibroma confirmed on histopathological and immunochemical analysis. A literature review of periorbital myofibromas has been performed to bring the reader up-to-date with the current understanding and management of the disease.

The Role of Routine Biopsy of the Lacrimal Sac During Dacryocystorhinostomy Surgery.

PURPOSE: To assess the role of routine histopathological evaluation of the lacrimal sac wall when performing dacryocystorhinostomy (DCR) surgery. METHODS: A retrospective review was conducted of the histology findings in lacrimal sac biopsies, taken routinely, in an external-approach DCR series. This is a single surgeon (RB), single pathologist (AG) consecutive series. The histopathology reports were reviewed and collated. Each patient's medical history and risk factors for malignancy were recorded. The surgeon documented any abnormal lacrimal sac appearance at the time of surgery. RESULTS: No patient in this series of 245, in whom 254 histology specimens were taken, recorded a significant pathological result that was not anticipated from pre-operative assessment, or from the appearance of the lacrimal sac intra-operatively. CONCLUSION: The reported recommendation for routine histopathological evaluation of the lacrimal sac wall when performing DCR surgery is not supported by this consecutive series. The authors recommend histopathological evaluation only in the setting of pre-existing clinical suspicion of malignancy, or an abnormal intra-operative appearance of the lacrimal sac.

The method of en face frozen section in clearing periocular basal cell carcinoma and squamous cell carcinoma.

BACKGROUND: The senior consultants Ross Benger and Andrew Gal have been using en face frozen section histological margin control in removing cancer from the periocular region since 1985. The aim of this study was to determine the percentage of cases in which more than one resection was necessary in order to achieve clear margins. METHODS: This is a retrospective study of patients treated at Drummoyne Eye Surgical Centre in the period 1999-2007, in whom removal of the eyelid cancer was decided to be with en face frozen section histological control. A record was kept of how many resections were necessary to achieve clear margins. Paraffin sections were subsequently examined for a final histopathological diagnosis. RESULTS: Two hundred and fifty people were included in the study, of whom 204 had basal cell carcinoma (BCC) and 32 had squamous cell carcinoma (SCC). One hundred and twenty BCCs had a full-thickness eyelid "wedge" resection, of which 45% needed more than the standard two frozen sections taken to achieve clear margins. Eighty-four BCCs were removed using ring resection, of which 35.7% needed more than the standard initial resections (peripheral annulus and deep disc) to achieve clear margins. CONCLUSIONS: Our study showed that a significant percentage of BCC and SCC lesions needed further resection after the initial frozen section edge checks to achieve clear margins. Intraoperative presence of the histopathologist increased the likelihood of achieving clearance of the cancer at a single operating session.

Mucinous sweat gland adenocarcinoma of the eyelid - current knowledge of a rare tumor.

PURPOSE: To review the medical literature on mucinous sweat gland adenocarcinoma of the eyelid (MSA) and present two new cases. METHODS: Details of published case reports and small series (between 1971-2010) were evaluated and summarized including two patients diagnosed and treated at our institution. Data regarding age, gender, ethnicity, precise location, clinical presentation, treatment and follow up of each patient were collected. RESULTS: 25 reports describing 55 patients were found in the medical literature. The mean age was 61.3 years (30-87), 22(59%) were male and 28(80%) were Caucasian. In 23(44.2%) patients the lesion was in the lower lid, in 20(38.5%) in the upper lid, in 3(5.7%) involving both lids and in 6(11.6%) in a canthus. In 12(21.8%) patients a lesion with a benign diagnosis was previously excised from the same location. In 2 of them histological re-examination resulted in a diagnosis of MSA. Intraorbital involvement was found in 2(3.6%) patients. Regional lymph node metastasis was found in 2(4.4%) patients. Surgical excision was the treatment of choice using Mohs' micrographic-controlled excision technique in recent years. Radiotherapy was applied to 2 patients with clinical resolution in 1. Recurrence of the tumor was reported in 14(30%) patients. CONCLUSIONS: MSA is a rare tumor of the eyelid with no clinically distinguishing features. It should be suspected particularly with recurrent eyelid lesions and must be differentiated from metastatic disease. The tumor may extend into the orbit and metastasize regionally. Surgical removal with continued regular follow-up examination is the treatment of choice.

Paraffin histology sections and delayed repair in recurrent atypical fibroxanthoma of the eyelid.

We present a report of a recurrent atypical fibroxanthoma (AFX), a tumour known rarely to involve the eyelid. A 61 year-old male was referred after reappearance of a lower eyelid AFX within two months of resection. The neoplastic spindle cells at the periphery of an AFX may be difficult to differentiate from dermal fibroblasts in frozen sections. Paraffin sections provide better histological definition and thus greater accuracy in determining completeness of excision. The patient's recurrent tumour was surgically excised and overnight paraffin sections were used to obtain margin clearance, before secondary reconstruction. The tumour required re-excision on three occasions before clearance was achieved. The patient remains tumour free at 12 months' follow-up.