Oxyphil cell adenomas. Three case reports

Eccrine acrospiroma of the eyelid with oncocytic, apocrine and sebaceous differentiation

A wide variety of sweat gland tumors occur in the eyelids. We used light and electron microscopy to investigate an eccrine acrospiroma showing areas of oncocytic, apocrine and sebaceous differentiation. To our knowledge this is the first report of an oncocytic lesion arising from an eccrine sweat gland, and only the second report of such a lesion arising from the skin. Furthermore, apocrine and sebaceous differentiation are atypical in lesions originating from sweat glands. The wide spectrum of differentiation in this adenoma lends further support to the concept of pluripotentiality of the adnexal glandular epithelia.

Oncocytic lesions (oncocytoma) of the ocular adnexa: report of 15 cases and review of literature

PURPOSE

To describe the clinical, imaging, and pathology features of oncocytic lesions in the ocular adnexa.

METHODS

Retrospective, noncomparative, interventional case series.

RESULTS

Fifteen oncocytic neoplasms (n = 15 patients) were classified as oncocytoma in 14 (93%) and oncocytic hyperplasia in 1 (7%). The mean patient age was 66 years (median = 66, range = 44-82), and 9 (60%) were male. The tumor involved the caruncle (n = 13, 86%), bulbar conjunctiva (n = 1, 7%), and plica semilunaris (n = 1, 7%). All cases were unifocal and most often presented as a painless mass (n = 12, 80%), evolving over a median 6 months (mean = 12, range = 1-48 months). The mean tumor base was 4.1 mm (median = 4.0, range = 1-10), and the tumor was well-circumscribed (n = 14), dark blue (n = 7), and cystic (n = 10). Ultrasound biomicroscopy and anterior segment optical coherence tomography disclosed mixed solid and cystic components. Complete surgical excision was curative without recurrence after a mean follow up of 39 months. Histopathology disclosed columnar cells with copious quantities of intensely eosinophilic cytoplasm in the lining epithelium (oncocytic hyperplasia) and in some cases with cystadenomatous proliferation (oncocytoma).

CONCLUSION

Oncocytic lesions of the ocular adnexae are typically well-circumscribed, cystic lesions that most often involve the caruncle. Surgical excision can be curative. Epithelial cells with copious quantities of intensely eosinophilic cytoplasm characterize oncocytic transformation histopathologically.

Oculocutaneous Oncocytic Tumors: Clinicopathologic and Immunohistochemical Study of 2 Cases With Literature Review

Oculocutaneous oncocytic tumors (OCOTs) are uncommon neoplasms that have been reported only rarely in the dermatopathology literature and whose immunophenotypic profile has not been well characterized. The clinical, histologic, and immunophenotypic features of 2 cases seen by the authors were assessed, and relevant publications in the literature were reviewed. Both patients with OCOTs were adult women with gradually enlarging, asymptomatic lesions involving the caruncle; they were locally excised. Histologically, the tumors were well-circumscribed nodules comprised of large oxyphilic cells arranged in confluent sheets and forming glandular spaces with secretory material. Microcystic areas and sparse intermingled goblet-cells were also apparent. Nuclear atypia and infiltrative growth were absent. Mitotic activity was absent in one case; a single mitotic figure was identified in the other. Immunostains demonstrated uniform expression of pankeratin and mitochondrial antigens. Both neoplasms were also labeled for markers associated with cutaneous adnexal, lacrimal, and minor salivary glandular tissue, including alpha-1-antitrypsin, gross cystic disease fluid protein-15, carcinoembryonic antigen, lysozyme and MUC1; each case expressed 4 of the 5 substances. Some cells expressed cytokeratins 5/6 and p63 consistent with the presence of basal-type differentiation in a subset of cells. No definite evidence of myoepithelial differentiation was demonstrated, as stains for smooth muscle actin, muscle-specific actin, and S100 protein were negative. Estrogen and progesterone receptor proteins were absent; strong cytoplasmic immunoreactivity for androgen receptor protein was evident, but nuclear staining was absent. The authors conclude that OCOTs show glandular differentiation. A review of the literature disclosed that none of these lesions arising in the caruncle behaved aggressively, in contrast to occasional tumors in other oculocutaneous sites.

Oncocytoma of the peripunctum

BACKGROUND

Oncocytoma is rarely found around the lacrimal punctum. We describe a case of oncocytoma of the peripunctum.

METHODS

Case report.

RESULTS

An 88-year-old patient presented with a upper peripunctal mass in the left eye. The tumor was completely excised including the lacrimal punctum and part of the canaliculus. The upper eyelid was reconstructed with a skin flap from the residual skin of the lid, and the lacrimal canaliclus was replaced by a silicone rubber tube. Histologically, the tumor had tubulo-papillary architecture and was composed of two layers of cuboidal cells. The cytoplasm of the tumor cells was rich in eosinophilic granules. The diagnosis was oncocytoma arising from the canaliculus.

CONCLUSION

Oncocytoma should be considered in differential diagnosis of a peripunctal mass in elderly patients. In this patient it probably originated from the epithelium of the lacrimal canaliculus.

Oncocytoma of the eyelid: an aggressive benign tumor

OBJECTIVE

The authors report the case of an 83-year-old patient with a benign oncocytoma of the inferior eyelid.

DESIGN

INTERVENTIONal case report.

INTERVENTION

Treatment consisted of a large orbital exenteration followed by reconstruction with a pedicled temporalis muscle flap.

MAIN OUTCOME MEASURES

Histologic evaluation and clinical follow-up were measured.

RESULTS

After a year of follow-up, there was no sign of local recurrence.

CONCLUSIONS

Oncocytomas, even if benign, must be considered as very aggressive tumors and treated accordingly.

Ocular adnexal oncocytoma: a case series and clinicopathologic review of the literature

The authors report the clinical, microscopic, and ultrastructural features of four oncocytic lesions involving the ocular adnexa. Three of the lesions originated in the ocular caruncle of elderly women, and a single case was encountered from the medial eyelid of an elderly man. Each lesion clinically presented as a slow-growing, painless, red mass. The histopathologic features were distinctive, with polyhedral cells containing granular eosinophilic cytoplasm found to consist of large numbers of mitochondria on ultrastructural examination. Of the 40 cases previously reported primarily in the ophthalmologic literature, the cases reported here similarly involved the eyelid and associated ocular adnexa with a predilection for elderly women. Oncocytomas probably represent an age-associated metaplastic and neoplastic transformation of the glandular epithelium comprising the ducts of salivary glands.

Glandular tumors of the lacrimal sac. Their histopathologic patterns and possible origins

PURPOSE

To describe and characterize the primary lacrimal sac epithelial tumors of glandular origin, and to describe their possible source from glands in the lacrimal sac and nasolacrimal duct walls.

METHODS

The authors conducted a clinicopathologic study on 14 patients with epithelial lacrimal sac tumors of possible glandular origin. In addition, they reviewed 35 surgical specimens of the lacrimal sac and nasolacrimal duct region and 13 cadaver specimens of the lacrimal sac region.

RESULTS

Six of the tumors were benign: four were oncocytomas and two were pleomorphic adenomas. Eight of the tumors were malignant: three were oncocytic adenocarcinomas, three were adenoid cystic carcinomas, and two were adenocarcinomas. All tumors were from adults, ranging in age from 38 to 87 years. Twenty-eight of the 47 specimens of lacrimal sac and nasolacrimal duct region showed mixed glands of serous and mucous elements.

CONCLUSIONS

Although rare, benign and malignant glandular lacrimal sac tumors should be considered in the differential diagnosis of lacrimal sac obstruction. Their possible origin is from the normal glands that exist under the lacrimal sac and nasolacrimal duct epithelium.

Oxyphil cell adenoma (oncocytoma) of the lacrimal sac. Review of the literature

A case of oncocytoma of the lacrimal sac is presented. An 84-year-old woman with a mass in the lacrimal sac area and epiphora was operated with excision. Histological and electron microscopic examination revealed it to be an oncocytic adenoma. Oncocytic tumours of the lacrimal sac are very rare and to our knowledge this is the 14th case to be reported. Oncocytomas are composed of polyhedric cells with abundant oxyphil cytoplasm which is granular and contains large numbers of abnormal mitochondria. Non-neoplastic oncocytes may arise from the secretory epithelium of the sac in various chronic inflammatory states. They may also occur at an old age, as a result of the normal aging process.

Papillary oncocytoma of the eyelid. A previously undescribed tumor of apocrine gland origin

Oncocytomas are uncommon tumors arising within the ductular cell lining of glandular structures. The oncocytic cells are characteristically large and rich in eosinophilic cytoplasm. Electron microscopic studies show densely packed mitochondria with irregular, whorled, or fragmented cristae. Ocular adnexal oncocytomas have been reported to arise in the caruncle, lacrimal gland, and lacrimal sac. The authors recently encountered an oncocytic tumor occurring in a most unusual location, the skin of the medial lid margin and commissure. Microscopically, the lesion was papillary and cystic in architecture, and arose from an adjacent apocrine gland of the eyelid margin (gland of Moll). Electron microscopic studies showed that the tumor cells were packed with malformed mitochondria to the exclusion of other organelles. This is the first report documenting an oncocytic lesion arising in the skin from an adnexal gland.

Types and frequency of lesions of the caruncle

We reviewed 57 consecutive biopsies of lesions of the caruncle seen in the Wills Eye Hospital Pathology Department from 1977 through 1985. The types and relative frequency of excised caruncular lesions were recorded and correlation of pathologic diagnosis with preoperative clinical diagnosis, age, and sex was made. Squamous papillomas accounted for 18 (32%) and nevi for 14 (24%) of all caruncular masses. Pyogenic granulomas accounted for five (9%), epithelial inclusion cysts for four (7%), chronic inflammation for four (7%), and oncocytomas for two (4%) of all caruncular masses. Of the 57 cases only three (5%) were malignant tumors.

Oncocytoma of the caruncle

The oncocytoma (oxyphil adenoma) is an uncommon tumor composed of transformed epithelial cells of the ducts of salivary glands and other organs. In two men, 66 and 75 years old, oncocytomas originated in the caruncle where they assumed rather characteristic features. The caruncular oncocytomas clinically appeared to be cystic. Light microscopy showed that the tumor cells (oncocytes) had eosinophilic granular cytoplasm; electron microscopy demonstrated that the cytoplasm contained densely packed abnormal mitochondria.