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Year : 1974  |  Volume : 22  |  Issue : 2  |  Page : 32-33

Solitary trichoepithelioma of the eyelid

Department of Pathology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondichery, India

Correspondence Address:
A L Aurora
Department of Pathology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondichery
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Source of Support: None, Conflict of Interest: None

PMID: 4461691

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How to cite this article:
Aurora A L. Solitary trichoepithelioma of the eyelid. Indian J Ophthalmol 1974;22:32-3

How to cite this URL:
Aurora A L. Solitary trichoepithelioma of the eyelid. Indian J Ophthalmol [serial online] 1974 [cited 2021 Jun 21];22:32-3. Available from: https://www.ijo.in/text.asp?1974/22/2/32/31370

Solitary Trichoepithelioma of the eyelids is a rare tumor. Gray and Helwig [2] and Helwig [3] could find only one solitary trichoepithelioma near the inner canthus of the right lower eyelid in their large series of 83 solitary trichoepithe­liomas. No case of solitary trichoepithelioma has so far been reported in the english litera­ture including the one observed by Gray and Helwig [2] , which involved the ciliary border of the eyelids. The author along with Blodil did not find any case of trichoepi­thelioma of the eyelid among the 678 cases of benign lesions of the eyelids received in the state university of Iowa during the 38 year period covering that study.

This paper describes a solitary trichopithe­lioma of the ciliary border of the eyelid in an elderly woman.

  Case Report Top

A 50 year old woman was admitted with a solitary swelling in the middle of the right upper eyelid exten­ding upto and including the ciliary portion of the free margin of the eyelid.-The swelling appeared 2 years ago and attained the present size of 15 x 10 mms. On examination, it was ulcerated over an area of 5 mms, was slightly tender, mobile from side to side, and was not adherent to the underlying structures. The conju­nctiva appeared uninvolved. A clinical diagnosis of Meibomian gland carcinoma was made.

Pathology : On gross examination, the specimen measured 18 x 12 x 10 mms. rt consisted of a portion of the eyelid with the swelling that had ulcerated over 4 to 6 mms. On cut surface, the swelling occupied a well circumscribed area of 15 x 10 x 7 mms and had a creamy appearance. A 3 mm wide compressed tissue separated it from the conjunctiva. A few pre-existing hair shafts were seen within the tumor element. Microscopic examination showed a well circumscribed tumor consisting of sheets of basaloid cells with diffe­rentiation towards hair structures. Several kerationus cysts were present. The basaloid cells were oval with vesicular or slightly hyperchromatic nuclei. A rare normal mitotic figure was seen once in 50 to 60 high power fields. The cysts contained loosely laminated but sometimes dense flakes of keratin. The wall of the cysts was formed by cells which often lead moderate amount of eosinophilic cytoplasm and a large oval pale vesicular nucleus. Trichohyalin granules were noted in the cells lining some of the cysts [Figure - 1],[Figure - 2]. A focus of granulomatous reaction to keratin and pre­existing hair was seen in the deeper parts of the lesion. Thirty semi-serial sections taken through the tumor showed that the tumor had extended through the tar­sal plate to the conjunctiva causing a micro-ulcer. The morphology of the tumor was similar in all the sec­tions. There was no attachment of the tumor to hair follicles. Post-operative follow up for six months was uneventful.

  Comments Top

Trichoepitheliomas are usually multiple lesions except for an occasional solitary case. Most of the solitary lesions reported by Gray and Helwig [2] measured 5 mms except for one on the thigh which was larger than 12 mms. These workers could find ulceration of the lesion in only 5 of their 83 solitary trichopithe­liomas. When ulceration is present a clinical diagnosis of basal cell carcinoma or sebaceous carcinoma is likely to be made. In Gray and Helwig's [2] series 35 percent of the solitary trichoepitheliomas were misdiagnosed as basal cell carcionmas. In the present case, the lesion was 15 mm, had ulcerated and was misdiagnos­ed as Meibomian gland carcinoma.

Brooke demonstrated the histogenesis of the tumor from epidermis and epithelium of hair sacs. Montgomery [5] believes that the tumor arises from the outer walls of the hair follicle and hair matrix. Lever [4] , favours origin from a primary epithelial germ or a pluripotential em­bryonic cell. Pinkus [6] postulates that all epithe­liomas of the skin originate from adult pluri­potential cells rather than from one or the other specific part of the epithelial system or from embryonic rests. Gray and Helwig [2] examined one or several sections from each specimen and observed that about one-third of the lesions of both epithelioma adenoides cysticum and solitary trichoepithelioma had connection with the epidermis. Attachment to hair follicles was noted in two of the epithelioma adenoid cysticum and one solitary epithelioma. These workers suggest that the cells of origin of these tumors are more frequently located in the epidermis rather than in the walls of the hair follicles. In the present case thirty semi-serial sections studied failed to show any attachment to the hair follicles, while attachment to the epidermis was obvious. It is probable that at least some of the solitary trichopitheliomas arise from the epidermis.

  Summary Top

A rare case of a solitary trichoepithelioma of the eyelid is reported in a 50 years old woman.

  References Top

Aurora, A.L., and Blodi, F.C., 1970, Survey Ophthal, 15, 94.  Back to cited text no. 1
Gray, H.R., and Helwig, E.B. 1963, Arch. Derm. 87,142.  Back to cited text no. 2
Helwig, E.B., 1973, Personal communication.  Back to cited text no. 3
Lever, W.F., 1967, Histopathology of the skin, 4, 557, J.B. ppincott Company, Philadelphia.  Back to cited text no. 4
Montgomery, H., Dermatopathology, vol. 2, 887, Hoeber Medical Division, Harper & Row Publishers, New York.  Back to cited text no. 5
Pinkus, H., 1953, Arch. Derm. and Syphilology, 67,598.  Back to cited text no. 6


  [Figure - 1], [Figure - 2]


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