A Case of Eyelid Sebaceoma Mimicking Chalazion

PURPOSE: To report a rare case of sebaceoma misdiagnosed as chalazion. CASE SUMMARY: A 42-year-old female presented with a visible mass in her right lower eyelid. An elevated, hard mass was located at the margin of the right lower eyelid, and she had a history of incision and curettage under the clinical impression of chalazion. On eversion of the lower eyelid, the tarsal portion of the mass was visible as a white-yellowish lesion. The mass was excised under local anesthesia. A sebaceoma was diagnosed based on histopathological examinations. Immunohistochemical studies showed positive staining results for mutator L homologue 1 (MLH1), mutator S homologue 2 (MSH2), and mutator S homologue 6 (MSH6), and she had no past medical history or family history of internal malignancy, suggesting a low possibility of Muir-Torre syndrome. CONCLUSIONS: Eyelid sebaceoma should be considered as a differential diagnosis for refractory chalazion.

A Case of Intratarsal Keratinous Cyst of the Meibomian Gland

PURPOSE: To report a patient presenting with an intratarsal keratinous cyst of the Meibomian gland in the upper eyelid and a review of the relevant literature. CASE SUMMARY: A 65-year-old male presented with a right upper eyelid mass which started 5 months prior. The patient reported that the mass recurred several weeks prior even after incision and curettage procedure. The mass was 9 x 5 mm in size and located in the center of the right upper eyelid at the level of lid crease, fixed to the tarsus and a whitish elevated focus was observed at the palpebral conjunctival surface. The mass was excised under local anesthesia and originated from the tarsus. The histopathological examinations revealed an intratarsal keratinous cyst composed of stratified squamous epithelium without keratohyalin granules and filled with keratin. The immunohistochemical studies showed positive staining results for cytokeratin 5/6, epithelial membrane antigen, and carcinoembryonic antigen. CONCLUSIONS: Intratarsal keratinous cyst of the Meibomian gland should be considered as a differential diagnosis of a recurrent tarsal mass.

Surgical Treatment of Extensive Conjunctival Melanocytic Nevus Mimicking Conjunctival Melanoma

PURPOSE: To report a case of diffuse conjunctival melanocytic lesion mimicking conjunctival melanoma and treated by surgical excision and amniotic membrane transplantation. CASE SUMMARY: A 29-year-old man presented with diffuse pigmented lesion on the bulbar conjunctiva in the right eye, which had been present since birth. Circumferential pigmentation was observed in the perilimbal conjunctiva from 4 to 11 o'clock, and slightly elevated, dark brown-colored lesions with multiple small cysts were noted on the superior, inferior, and temporal bulbar conjunctiva. Incisional biopsy was performed from multiple sites to rule out conjunctival melanoma. Histopathologic examination showed small nevus cells and multiple cysts. Under local anesthesia, temporal conjunctival excision and amniotic membrane transplantation were performed. The surgical pathologist confirmed compound nevus. Four weeks after the surgery, full epithelialization was observed over the amniotic membrane. Several lesions were intentionally left during the surgery, and unnoticeable from the frontal view. The patient was satisfied with the surgical result. CONCLUSIONS: In extensive conjunctival pigmented lesion, biopsy should always be performed to rule out melanoma. Temporal conjunctival excision rather than whole lesion excision can be a cosmetically good surgical option for a diffuse conjuntival lesion proven as a benign conjunctival nevus.

A Case of Eyelid Schwannoma

PURPOSE: To report a rare case of solitary eyelid schwannoma. CASE SUMMARY: A 60-year-old female visited our clinic with a small cyst-like mass of the left upper eyelid, which had developed 3 years earlier. A 3x3 mm-sized, nonpigmented, cyst-like mass was located in the lateral area of the left upper eyelid margin. We performed an excisional biopsy under local anesthesia. The tumor was well encapsulated, easily dissected, and could be completely removed. Histopathologic examination showed cellular areas of spindle cells with Verocay bodies forming palisades and less cellular myxoid areas. Immunohistochemical analysis for S-100 protein showed a strongly positive reaction. Based on the histopathologic features, a diagnosis of benign Schwannoma was made. CONCLUSIONS: Schwannoma should be also considered in the differential diagnosis of a well-circumscribed mass lesion in the eyelid.