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ARTICLE
Year : 1969  |  Volume : 17  |  Issue : 4  |  Page : 154-155

Cutaneous horn in the lacrimal sac region- a case report


Department of Ophthalmology, Govt. Headquarters Hospital, Anantapur, A. P, India

Date of Web Publication10-Jan-2008

Correspondence Address:
G Radhakrishna Murthy
Department of Ophthalmology, Govt. Headquarters Hospital, Anantapur, A. P
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Murthy G R. Cutaneous horn in the lacrimal sac region- a case report. Indian J Ophthalmol 1969;17:154-5

How to cite this URL:
Murthy G R. Cutaneous horn in the lacrimal sac region- a case report. Indian J Ophthalmol [serial online] 1969 [cited 2021 May 6];17:154-5. Available from: https://www.ijo.in/text.asp?1969/17/4/154/38534

Cutaneous horns or cornu cutaneum are rare and very striking tumours oc­curring on the skin of the lids, parti­cularly near the external canthus or on their margins, other sites of predilec­tion being scalp, forehead, nose and guns penis (Duke-Elder [1] ). They form epidermal growths of corneous material resembling in appearance the horns of animals, being yellowish in colour and conical or cylindrical, straight, twisted or angular in form. They occur usually in old people of both sexes, but have occasionally been seen in young children (Shaw17 ) or adolescents (Natanson [5] ). They are usually small in size and cylindri­cal in shape measuring only a few millimetres in length and breath, but reach considerable dimensions at times. Cor Theodor described a horn 4.5 cm. long on the upper lid of a woman aged 78 years and Schobl [6] reported a horn 5 cms. long and 3 cms. in diameter at the base, situated at the root of the nose and inner canthus in an 82-year-old woman. Multiple horns may occur in the same person (As­cher [1] ). Spietsch [8] described a case with two horns near the outer canthus, one on each lid.

The present case is reported because of the rarity of cornu cutaneum in ophthalmic practice, much more so in the lacrimal sac region. So far, no case of cutaneous horns has been re­ported in the lacrimal sac area, though they were described over either of the lids.


  Discussion Top


Horns spring from wart-like papil­lomata, scars, Sebaceous cysts or cal­cifying carcinomata, but their aetiology is not clear (Bland-Sutton. [3] )

The papilhe at the base are always hypertrophied, rich in vessels and elas­tic tissue and extend into the horn for some distance. The prickle cells proli­ferate exuberantly and become horny instead of being shed, accumulating in columns of concentric lamine to form the main mass of the growth (Bergh, [2] Spietsch, [8] Natanson. 15 ) It is disputed whether the growth is essentially a papillary hyperplasia followed by epi­dermal proliferation and hyperkeratosis (Natanson, 15 ) or a hyperkeratosis fol­lowed by papillary hyperplasia or a precancerous change. As a general rule the horn remains without disturbance or signs of inflammation but every now and signs particularly after trifling trauma, infection of the base occurs. Occasionally it is shed spontaneously and does not recur. Generally recur­rences are the rule and carcinomatous changes develop.


  Case Report Top


Master V. S., a male child aged 10 years was admitted as an in-patient in Govt. Headquarters Hosptal, Ananta­pur on the 6th of April, 1968 for a swelling in the left lacrimal sac region of 6 months duration. He had intense photophobia and lacrimation since two months. He complained of pain and bleeding off and on since about a month.

The most glaring observation was that the child had xeroderma pigmen­tosum and that he was avoiding bright light. On inspection of the lacrimal area, a conical swelling was seen with its base over the lacrimal sac region. It was 4 cms. long and had a diameter of 2 cms. at its base. At its base, it had a softish consistency, grew wider for about 2 cms. and then tapered off once again, being capped by concen­tric horny rings of dminishing sizes. The consistency was firm in the mid­dle and hard at the trip. There was a small ulcerated area on the temporal aspect of the base of the horn, which used to bleed on manipulation or after trivial trauma. The patency of the lacrimal passages showed that the tumour was not connected in any way with the lacrimal sac. The clinical photograph [Figure - 1] clearly illustrates the situation and appearance of the horny change in the growth. In the dif­ferential diagnosis, the possibilities of horny change in a papilloma, sebaceous horn and pre-cancerous change were considered.

Total excision of the horn including the entire base was done on the 18th of April, 1968 with complete healing within a week[9]


  Summary Top


A case of cornu cutaneum in the lacrimal region is reported. The case was one of xeroderma pigmentosum. A brief review of literature is present­ed.

 
  References Top

1.
ASCHER : M. M. Aug., iii, 144 (1914), cited in 4. P. 5033.  Back to cited text no. 1
    
2.
BERGH : Amer. J. Derm. Syph., V. 185 (1873) cited in 4. p. 5033.  Back to cited text no. 2
    
3.
BLAND-SUTTON : Tumours, London, 1902, cited in 4, p. 5033.  Back to cited text no. 3
    
4.
COR THEODOR : Klim. Mona. f. Aug. 30, 310 (1898) cited by Duke-Elder in 4.  Back to cited text no. 4
    
5.
DUKE-ELDER : Text book of Oph­thalmology, Vol. V, p. 5033, Henry Kimpton, London.  Back to cited text no. 5
    
6.
NATANSON : Amer. J. Derm. Syph., 1, 293 (1899) cited in 4, p. 5033.  Back to cited text no. 6
    
7.
SCHOBL : Uber. ciring. Setton. Kera­tome d. Aug., Prague (1892) cited in 4, p. 5033.  Back to cited text no. 7
    
8.
SHAW : Boston med. Surg., III, 17 (1869) cited in 4, p. 5033.  Back to cited text no. 8
    
9.
SPIETSCH : Amer. J. Derm. Syph.. xlii, 395 (1898) cited in 4, p. 5033.  Back to cited text no. 9
    


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