Search

PURPOSE Acne agminata has only been rarely reported in the ocular adnexa. This study was undertaken to identify histopathological, clinical, and management features of this disorder. METHODS A computerized database was utilized to identify cases of ocular adnexal acne agminata. Via chart review and light microscopy, clinical and histopathologic aspects of this dermatosis were collected, and statistical analyses were performed. RESULTS Twelve cases (5 males, 7 females, mean age = 50.5 years) of clinically and histopathologically confirmed ocular adnexal acne agminata were identified. The main variant of granuloma was sarcoidal in 6 cases (50%) and tuberculoid in 5 cases (41.7%), although 9 specimens (75%) displayed greater than 1 variant of granuloma. In addition, specimens demonstrated varying degrees of fibrosis (8 cases, 66.7%), necrosis (6 cases, 50%), spongiosis (5 cases, 41.7%), and perifollicular inflammation (6 cases, 50%). All specimens showed signs of lymphstasis-lymphangiectasis. At a minimum of 6-month postprocedure interval, all patients experienced complete relief of their symptoms and did not experience recurrence. CONCLUSIONS This study represents the largest cohort of ocular adnexal acne agminata, and revealed a spectrum of granulomatous subtypes, including coexistence of different granuloma subtypes within the same specimen. Lymphangiectases is a hallmark of this disorder, and varying features of tissue reaction are typical features of acne agminata. All of these cases were successfully cured by surgical resection of lesions without recurrence at last follow-up, and this modality should be considered the standard of care in the management of this problem.

Purpose To delineate signals by which the vascular abnormalities inherent to ocular rosacea arise and to correlate these signals with elements of the innate immune system. Methods Experimental study. Immunohistochemical staining was performed for a variety of vascular markers and for toll-like receptor-4 on eyelid biopsies taken from patients with ocular rosacea and normal controls. Statistical comparisons were then performed between the 2 groups. Results Immunohistochemical staining for CD31 and integrin-β-3 did not demonstrate any statistically significant differences between eyelids from patients with ocular rosacea and normal controls. Cutaneous biopsies from ocular rosacea patients demonstrated statistically significant enrichments of intercellular adhesion molecule-1 and CD105 among arterioles, whereas there were no statistically significant differences in the venules between normal controls and ocular rosacea patients. The correlation between the number of toll-like receptor-4-positive cells and each vascular marker was statistically significant. Conclusions Cutaneous biopsies of the eyelid did not demonstrate an increase in the total number of blood vessels. However, the vascular abnormalities that are typical of ocular rosacea represent activated, inflamed vessels, and these phenomena may be mediated by intercellular adhesion molecule and CD105. Furthermore, the strong correlations between toll-like receptor-4 and each vascular marker suggest that the innate immune system may govern the cutaneous effects of ocular rosacea. Intercellular adhesion molecule, CD105, and toll-like receptor-4 may represent important therapeutic targets in the management of this disease.

A 71-year-old white woman sought treatment for poroma of the right lower eyelid. Excisional biopsy was performed, and the specimen had histologic features consistent with poroma. One year after excision, there has been no recurrence of the lesion. Clinicians should be aware that poroma can occur in regions other than the hands and feet.

This report details the gross and histopathologic findings of an unusual complex choristoma at the lateral canthus. Although this lesion displays elements of hair follicle nevus, bulbar dermoid, epibulbar osseous choristoma, and accessory tragus, it does not fit neatly in any of these categories. We propose that this lesion is the result of faulty migration of pluripotential cells during embryogenesis.

A healthy 13-year-old female presented with a 5-month history of an enlarging red-brown, firm lower eyelid mass associated with loss of eyelashes. An excisional biopsy revealed a well-circumscribed nodule composed of coalescing nests of epithelioid cells, rare multinucleated cells, and vacuolated macrophages and spindle cells. Additional studies revealed a positive vimentin and alpha(1)-antitrypsin, and negative S100 protein and Factor XIIIa immunophenotype. This constellation of clinicopathologic features is diagnostic of solitary reticulohistiocytoma, but also shows overlap with xanthogranuloma, a common childhood histiocytosis. Reticulohistiocytoma should be considered in the differential diagnosis of eyelid tumors and has the potential for local recurrence. Diffuse cutaneous reticulohistiocytosis or multicentric reticulohistiocytosis should be considered if similar cutaneous lesions with or without symptoms of arthritis are present, respectively.

A 58-year-old man who had his left eye enucleated at the age of 26 after sustaining ocular trauma presented secondary to an inability to tolerate his prosthesis. Examination revealed upper and lower eyelid cicatricial entropion with areas of symblephara and conjunctival scarring causing forniceal shortening. No areas suspicious for malignancy were noted. Surgical correction was performed, and a segment of the conjunctiva sent for pathology revealed squamous cell carcinoma in situ. Map biopsies of the conjunctiva were subsequently performed, with no further areas of malignancy identified. The patient has been followed with close clinical surveillance, with no evidence of any recurrent suspicious areas within the conjunctiva. This case report confirms that squamous cell carcinoma in situ may occur in an anophthalmic socket and be managed conservatively, reserving the need for orbital exenteration for more invasive disease.