Solitary mastocytoma of the eyelid

Ocular and palpebral manifestations of mastocytosis: A prospective single-center study

BACKGROUND

Ocular discomfort has been described as a frequent symptom in patients with mastocytosis, a rare disease resulting from accumulation of mast cells in organs.

OBJECTIVES

This study aims to assess the frequency and describe the nature of ocular and palpebral abnormalities in mastocytosis patients.

PATIENTS AND METHODS

We conducted a prospective, single-center study in adult mastocytosis patients, who were systematically examined by a dermatologist and an ophthalmologist with determination of tear cytokine levels.

RESULTS

Twenty-one patients with a mean age of 60.7 ± 16.4 years were included. Nine patients presented with isolated cutaneous mastocytosis and 12 with indolent systemic mastocytosis. Seventeen patients (81.0%) presented with one or more eye symptoms. The most frequently reported symptoms were ocular itching (n = 12), dryness (n = 12), and excessive tearing (n = 9). Based on their Ocular Surface Disease Index scores, 11 patients (52.4%) were classified as having moderate orsevere ocular surface disease. Eye examination revealed dry eye disease in 11 patients (52.4%), associated with superficial punctate keratitis in two patients and posterior blepharitis in 10 patients (47.6%). Tear cytokine levels of interleukin (IL)-1RA and IL-6 were not significantly different in mastocytosis patients compared to controls and did not vary according to ocular symptoms.

CONCLUSION

Dry eye disease and blepharitis were frequently found in this cohort of mastocytosis patients. Ocular consultation may be considered in this population to initiate eye hydration measures.

Large Congenital Cutaneous Mastocytoma Presenting With Recurrent Persistent Blistering: A Case Report

Congenital cutaneous mastocytoma is an uncommon disorder characterized by abnormal proliferation of mast cells. It typically presents as a single, small, yellowish-brown plaque, and its diagnosis is generally facilitated by distinctive clinical features, including a positive Darrier's sign. This report presents a case of an unusually large, solitary congenital mastocytoma encompassing nearly the entire circumference of the calf, observed in a newborn boy of Bangladeshi origin. Measuring 13x6 cm, the lesion formed large bullae and subsequent erosions. The perplexing clinical appearance prompted a skin biopsy, revealing monomorphic CD117 (c-KIT) positive infiltration without significant cell pleomorphism, confirming the diagnosis of cutaneous mastocytoma. The patient underwent management with potent and very potent topical steroids, oral antihistamines, and non-adhesive dressings, remaining under long-term follow-up with secondary care dermatology. In reporting this case, our objective is to augment the existing scientific literature by providing additional evidence that cutaneous mastocytomas can display a spectrum of clinical presentations, as illustrated in this case.

Solitary mastocytoma in the eyelid of an adult

Purpose

To describe the ophthalmic symptoms and histopathological findings in a rare case of an eyelid mastocytoma in an adult.

Observations

A man in his early 60s developed a painless, non-tender, non-pruritic, mobile nodule on the right lower eyelid beneath the inferior orbital rim. The lesion grew to 15 × 9 mm over eleven months. Biopsy revealed a diffuse infiltrate of histiocytoid and spindle-shaped mast cells forming cords and small nests between collagen fibers in the superficial and deep dermis. Mast cell lineage was confirmed by immunohistochemistry. Physical examination revealed no other cutaneous lesions and no evidence of systemic disease. Serum tryptase level was normal. Annual full-body examination by a dermatologist for 4.5 years has revealed neither recurrence in the eyelid nor cutaneous involvement at other sites.

Conclusions and importance

Mast cell tumors limited to the human eyelid are extremely uncommon with only four previously reported cases, including one in an adult. This case highlights the rare possibility of a solitary mastocytoma presenting in the eyelid of an adult.

Solitary Mastocytoma of the Eyelid in an Adult Patient With Prolidase Deficiency

Prolidase deficiency and solitary mastocytoma of the eyelid are both exceedingly rare. Prolidase deficiency is an inherited connective tissue disorder that has systemic sequelae, such as intractable skin ulceration, poor wound healing, recurrent infections, and intellectual impairment. Cutaneous mastocytoma is an isolated, aberrant cutaneous aggregation of mast cells. A case of an adult with severe prolidase deficiency who developed cutaneous mastocytoma of the eyelid was presented. To the authors' knowledge, adult-onset solitary mastocytoma of the eyelid has never been reported previously.

Exophthalmos, Diplopia, and Bilateral Eyelid Edema: Symptoms of Ocular Mastocytosis

PURPOSE

Mastocytosis is characterized by clonal mast cell proliferation with accumulation within various organs and uncontrolled activation with excessive mast cell mediator release. Ocular manifestations have rarely been published. We describe a 63-year-old man with bilateral exophthalmos that led to the diagnosis of systemic mastocytosis.

CASE REPORT

A patient presented with bilateral eyelid edema with exophthalmos associated with binocular diplopia. Ophthalmologic examination showed bilateral axial, symmetrical, and painless exophthalmos with eyelid edema, and limitation in elevation of the right eye. Visual acuity was normal. Orbital magnetic resonance imaging showed increased volume of both the superior and medial recti muscles and right inferior oblique muscle, and histopathological examination of orbital fat and muscle biopsies revealed an infiltration by mast cells. Serum tryptase was elevated. The patient also complained of a long history of pruritis and diffuse skin erythema that could be elicited with just mild pressure (Darier's sign). A bone marrow biopsy confirmed the infiltration of abnormal mast cells with a D816V mutation in the KIT gene. Treatment with cladribine was initiated and resulted in resolution of both ocular and systemic signs and symptoms that persisted without relapse 18 months after discontinuation. Ocular mastocytosis is a rare condition, which was previously reported to involve the conjunctiva, cornea, uvea, eyelid, orbit, and choroid. Cases of ocular mastocytosis can be classified into two main groups: mast cells tumors (mastocytomas) and ocular manifestations associated with systemic mastocytosis. Histological examination of ocular samples is rarely performed, and there are no standard criteria for the diagnosis of ocular mastocytosis. Our case emphasizes cladribine could represent an alternative treatment.

CONCLUSIONS

Our case is the first published case of exophthalmos and eyelid edema associated with systemic mastocytosis confirmed by pathologic examination of periocular biopsies that was treated effectively with cladribine.

Presumed ocular juvenile xanthogranuloma and biopsy-proven cutaneous mastocytosis occurring sequentially in a young boy

Juvenile xanthogranuloma is a benign non-Langerhans cell histiocytosis characterized by skin lesions that tend to be self-limited. Ocular lesions can occur in juvenile xanthogranuloma, most commonly presenting as an iris granuloma. Skin lesions of juvenile xanthogranuloma may appear similar to lesions of mastocytosis. Mastocytosis includes a heterogeneous group of diseases characterized by the proliferation and abnormal infiltration of mast cells. Rubbing of cutaneous lesions leads to the release of histamine, causing the lesions to urticate. Juvenile xanthogranuloma and mastocytosis skin lesions occurring concurrently is extremely rare, with only four cases reported. Ocular juvenile xanthogranuloma and cutaneous lesions of mastocytosis have never been described in the same patient in the literature. The authors describe a patient with an ocular juvenile xanthogranuloma presenting at birth with cutaneous mastocytosis developing several years later.

Orbital involvement in systemic mastocytosis

A 61-year-old female presented with a 3-day history of painful and reddened right eye with painful ocular movements. She had been diagnosed as having systemic mastocytosis 4 years earlier. Ocular examination showed Best Corrected Visual acuity of 6/6 right eye and 6/6 left eye. There was marked conjunctival injection and chemosis. The posterior segment was normal. The left eye was normal. Exophthalmometry showed 2 mm of right proptosis relative to the left eye. Computed tomography (CT) scans showed an ill-defined intra-conal lesion and enlargement of the lacrimal gland in the right orbit. A diagnostic biopsy was performed; the histopathology findings were of orbital mastocytosis. We present what our literature search suggests is the first biopsy-proven case of orbital mastocytosis.