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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.

A 32-year-old black man had a deeply pigmented anterior uveal lesion that was indenting and subluxing the lens. The mass was successfully removed by a sector iridectomy and diagnosed histologically as an adenoma of the iris pigment epithelium. Although this rare tumor is sometimes misdiagnosed clinically as a malignant melanoma or iris cyst, it has distinctive clinical features which should differentiate it from these other entities.

• An otherwise asymptomatic 63-year-old woman with a history of a carcinoid tumor of the ileum and a cutaneous melanoma of the shoulder developed unilateral proptosis. Orbital ultrasonography, computed tomography, and magnetic resonance imaging revealed a large, well-circumscribed orbital mass involving the superior rectus muscle. The surgically excised tumor was studied by light microscopy, histochemistry, and transmission electron microscopy. These studies confirmed the diagnosis of carcinoid tumor. The clinical and pathologic features of this rare type of orbital metastasis are discussed.

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.

A 64-year-old man had slowly progressive thickening of the bulbar and palpebral conjunctiva of the right eye, followed by signs and symptoms of an upper respiratory infection. A biopsy specimen of the conjunctival lesions demonstrated granulomatous inflammation with eosinophils compatible with a diagnosis of Churg-Strauss syndrome (asthma, eosinophilia, vasculitis, and granulomatous inflammation with eosinophils). Subsequently, fever, shortness of breath, moderate renal failure, and anemia developed. Therapy with systemic corticosteroids and cyclophosphamide was instituted, with resolution of the systemic and ocular manifestations.

• A woman was diagnosed as having a benign lacrimal gland mass at age 23 years and no treatment was advised. About 60 years later, the previously stationary proptosis began to increase, and biopsy specimens demonstrated a malignant mixed tumor (pleomorphic adenocarcinoma) of the lacrimal gland. The patient was subsequently treated with orbital exenteration. From the clinical history and histopathologic findings, it appears that the patient harbored a long-standing pleomorphic adenoma (benign mixed tumor) that gave rise to a pleomorphic adenocarcinoma after remaining stationary for 60 years.