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Cunha JLS, Andrade CES, da Cunha Filho FAP, da Paz AR, Gordón-Núñez MA, Alves PM, Nonaka CFW. Intratarsal Keratinous Cyst Clinically Misdiagnosed as a Chalazion. Dermatopathology (Basel) 2024; 11:142-146. [PMID: 38651459 PMCID: PMC11036242 DOI: 10.3390/dermatopathology11020014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
The intratarsal keratinous cyst (IKC) is a recently described entity, often clinically misdiagnosed as a chalazion. We report a case of a 61-year-old male patient with a chief complaint of a small lesion on the upper eyelid that evolved over six months. On physical examination, an asymptomatic, firm nodule was identified on the left upper eyelid. The patient reported no history of trauma. A provisional diagnosis of chalazion was established, and an excisional biopsy was performed. Histopathologically, the lesion was lined with a stratified squamous epithelium, with a corrugated epithelial surface showing abrupt keratinization without keratohyalin granules, and compact keratinous-appearing material in the cystic lumen. The diagnosis was IKC. No signs of recurrence were observed after one year of follow-up. It is essential to accurately diagnose IKC and distinguish it from chalazion and epidermal inclusion cysts, because IKC requires complete surgical excision and can exhibit multiple recurrences if not properly removed.
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Affiliation(s)
- John Lennon Silva Cunha
- Postgraduate Program in Dentistry, Department of Dentistry, State University of Paraíba (UEPB), Campina Grande 58429-600, PB, Brazil; (M.A.G.-N.); (C.F.W.N.)
| | - Clenia E. S. Andrade
- Residency Program in Oral and Maxillofacial Surgery, School of Public Health of Paraíba, João Pessoa 58040-440, PB, Brazil
| | - Fernando A. P. da Cunha Filho
- Residency Program in Oral and Maxillofacial Surgery, School of Public Health of Paraíba, João Pessoa 58040-440, PB, Brazil
| | - Alexandre R. da Paz
- Department of Physiology and Pathology, Federal University of Paraíba (UFPB), João Pessoa 58051-900, PB, Brazil
| | - Manuel A. Gordón-Núñez
- Postgraduate Program in Dentistry, Department of Dentistry, State University of Paraíba (UEPB), Campina Grande 58429-600, PB, Brazil; (M.A.G.-N.); (C.F.W.N.)
| | - Pollianna M. Alves
- Postgraduate Program in Dentistry, Department of Dentistry, State University of Paraíba (UEPB), Campina Grande 58429-600, PB, Brazil; (M.A.G.-N.); (C.F.W.N.)
| | - Cassiano F. W. Nonaka
- Postgraduate Program in Dentistry, Department of Dentistry, State University of Paraíba (UEPB), Campina Grande 58429-600, PB, Brazil; (M.A.G.-N.); (C.F.W.N.)
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Sarubbi C, Simonin M, Gauthier AS, Solecki L. [An unusual cause of an eyelid mass]. J Fr Ophtalmol 2024; 47:104038. [PMID: 38212205 DOI: 10.1016/j.jfo.2023.104038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/09/2023] [Indexed: 01/13/2024]
Affiliation(s)
- C Sarubbi
- Département d'ophtalmologie, hôpital universitaire régional Jean-Minjoz, 25000 Besançon, France.
| | - M Simonin
- Centre hospitalier de Vesoul, GH70, 2, rue René Heymes, 70000 Vesoul, France
| | - A-S Gauthier
- Département d'ophtalmologie, hôpital universitaire régional Jean-Minjoz, 25000 Besançon, France
| | - L Solecki
- Département d'ophtalmologie, hôpital universitaire régional Jean-Minjoz, 25000 Besançon, France; Université de Franche-Comté, LNIT, 25000 Besançon, France
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Alexa AI, Leferman CE, Ciubotaru AD, Sandu IA, Sandu CA, Bogdănici CM. Therapeutic challenges in epidermal inclusion cysts with periocular localization: case reports. J Med Life 2023; 16:1575-1578. [PMID: 38313165 PMCID: PMC10835546 DOI: 10.25122/jml-2023-0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 02/06/2024] Open
Abstract
Epidermal inclusion cysts in the periocular region are distinctive pathologies exhibiting varied clinical and radiological features, and they should be taken into consideration in the differential diagnosis of cystic lesions near the orbit. This article discusses the clinical and radiological details, along with the surgical results, of two individual cases of epidermal inclusion cysts, with different localization and without any preceding trauma, surgical history, or eyelid inflammation. In the first case, a substantial spherical structure closely connected to the tarsal plate was identified via excisional biopsy, whereas the second case involved a soft, oval tumor located at the outer right orbital corner, as determined clinically and validated through computed tomography. The histological examination showed cysts lined with a keratinized squamous layer, confirming an epidermoid cyst. The surgical removal of the cysts led to esthetically satisfactory outcomes in both cases. The particularity of the presented cases lies in the locations and considerable sizes of the tumors, which have complicated their surgical management. Such instances of epidermal inclusion cysts attached to the tarsus are rarely reported in the literature.
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Affiliation(s)
- Anisia-Iuliana Alexa
- Department of Ophthalmology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
| | | | - Alin Dumitru Ciubotaru
- Department of Neurology, "Grigore T. Popa" University of Medicine and Pharmacy Iași, Romania
| | - Ioana Alexandra Sandu
- Department of Medical Specialties II, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Calina Anda Sandu
- Department of Ophthalmology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
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Alsarhani WK, Al-Sharif EM, Al-Faky YH, Alkatan HM, Maktabi AM, Alsuhaibani AH. Dacryops and clinical diagnostic challenges. CANADIAN JOURNAL OF OPHTHALMOLOGY 2022; 57:388-393. [PMID: 34324876 DOI: 10.1016/j.jcjo.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/23/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The study aims to describe the clinical and histopathologic features of different types of dacryops and their clinical diagnostic challenges. METHODS This is a retrospective cohort study of all surgically excised cases of dacryops in 2 tertiary eye hospitals in Riyadh, Saudi Arabia. RESULTS The study included 58 dacryops specimens from 55 patients with an average age of 41.2 years (range, 4-78 years). The most common location was the upper lid (60.3%), whereas the least expected location was the caruncle (6.9%). The most common site of dacryops occurrence was in the accessory lacrimal gland (55.2%), the main lacrimal gland (32.8%), and then ectopic dacryops (12%). All patients presented with lid swelling alone except for 3 patients who experienced secondary mechanical ptosis. On physical examination, conjunctival scarring existed in 4 patients (6.9%). Preoperative diagnosis of dacryops was accurate in 44.8% of the cases. Dacryops of the main lacrimal gland was accurately diagnosed clinically in all cases compared with other locations, which was statistically significant (p < 0.001). The causes of inaccurate clinical diagnoses were hidrocystoma (26.9%), inclusion cyst (11.5%), and dermoid cyst (7.7%), whereas the remaining cases were diagnosed as cysts without a specific subtype (53.9%). Recurrence of the lesion was observed in 2 cases (3.5%). No clinical or histopathologic factors were associated with a risk of recurrence. CONCLUSION Dacryops can represent a diagnostic challenge to ophthalmologists. Familiarity with clinical presentations and findings is required to diagnose dacryops outside the main lacrimal gland.
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Affiliation(s)
- Waleed K Alsarhani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Eman M Al-Sharif
- Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Department of Ophthalmology, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, Riyadh, Saudi Arabia; Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Azza M Maktabi
- Department of Pathology and Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Adel H Alsuhaibani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, Riyadh, Saudi Arabia
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Tarsal Epithelial Cysts: Prevalence, Case Series, and Synthesis of Existing Literature. Ophthalmic Plast Reconstr Surg 2021; 37:255-261. [PMID: 32826823 DOI: 10.1097/iop.0000000000001795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Tarsal epithelial cysts (TECs) are squamous epithelial-lined lesions of the eyelid that are often mistaken for chalazia or epidermal inclusion cysts. They remain poorly described in the literature. This study is designed to characterize the prevalence and clinical features of TEC. METHODS We conducted a single-center retrospective review of adult patients with a diagnosis of eyelid neoplasm, eyelid cyst, hordeolum, stye, or chalazion between January 1, 2011 and July 1, 2017. Among this cohort, we identified patients with a histopathologic diagnosis of TEC. We also conducted a PubMed literature review and synthesis of existing clinical data of patients reported to have TEC, noting common clinical and histopathological features. RESULTS Of 7,516 patients, we identified 6 patients with a histopathological diagnosis of TEC, amounting to a prevalence of 0.08% amongst patients with eyelid lesions. Average age was 49.7 years (range 18-76 years), with a 1:1 male to female ratio. The most common presenting symptom was a painless eyelid mass, and the majority (66.6%) had a preoperative diagnosis of chalazion. All but 1 patient had surgical excision from the posterior approach and there was 1 recurrence in the follow-up period. On review of the literature, we identified 68 prior cases of TEC from 18 clinical studies, with clinical features mirroring our case series. CONCLUSIONS TEC has stereotypical clinical and histologic features that distinguish it from other tarsal lesions. Our review identified TEC as a relatively rare cause of eyelid lesions.
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AlRubaian A, Alkatan HM, Al-Faky YH, Alsuhaibani AH. Clinical features differentiating intratarsal keratinous cyst from chalazion. Int Ophthalmol 2020; 40:2041-2045. [PMID: 32367161 DOI: 10.1007/s10792-020-01380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/10/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To present the differentiating clinical findings between intratarsal keratinous cyst (IKC) and chalazion. METHOD A retrospective review of medical records of all patients who presented between 2010 and 2018 at King Abdulaziz University Hospital with proven histopathological diagnosis of IKC was done. Complete ophthalmologic evaluation at presentation, surgical procedures performed, complications, histopathological findings, response to treatment and follow-up were recorded. RESULTS Twelve patients were found to have IKC. All patients presented with an eyelid mass with no signs of local inflammation. All lesions were fixed to the tarsus with freely mobile overlying skin, which was found to be slightly pale compared to the surrounding skin in six patients. On palpation, IKC had well-defined boarders. Isolation with clear surgical plane for cyst excision was achieved in nine patients as they were superficially involving the tarsus. When IKC involved the deep part of the tarsus, bluish/ whitish nodules were seen upon eyelid eversion. Six patients were misdiagnosed and surgically treated as a chalazion elsewhere prior to presentation to us with recurrence. CONCLUSION Differentiating IKC from chalazion can be challenging. Careful clinical evaluation helps reaching the right diagnosis and providing the correct treatment, which involves complete excision of IKC to prevent recurrence.
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Affiliation(s)
- Ahmad AlRubaian
- Department of Ophthalmology, King Abdulaziz University Hospital, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Kingdom of Saudi Arabia
- Department of Ophthalmology, College of Medicine, Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia
| | - Hind M Alkatan
- Department of Ophthalmology, King Abdulaziz University Hospital, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Kingdom of Saudi Arabia
- Department of PathologyKing Abdulaziz University HospitalCollege of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Kingdom of Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, King Abdulaziz University Hospital, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Kingdom of Saudi Arabia
| | - Adel H Alsuhaibani
- Department of Ophthalmology, King Abdulaziz University Hospital, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Kingdom of Saudi Arabia.
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Milman T. Unusual Ocular Pathologies. Saudi J Ophthalmol 2019; 33:201-202. [PMID: 31686958 PMCID: PMC6819712 DOI: 10.1016/j.sjopt.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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