|Year : 1974 | Volume
| Issue : 2 | Page : 32-33
Solitary trichoepithelioma of the eyelid
Department of Pathology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondichery, India
A L Aurora
Department of Pathology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondichery
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Aurora A L. Solitary trichoepithelioma of the eyelid. Indian J Ophthalmol 1974;22:32-3
Solitary Trichoepithelioma of the eyelids is a rare tumor. Gray and Helwig  and Helwig  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  , 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|| |
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|| |
Trichoepitheliomas are usually multiple lesions except for an occasional solitary case. Most of the solitary lesions reported by Gray and Helwig  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  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  believes that the tumor arises from the outer walls of the hair follicle and hair matrix. Lever  , favours origin from a primary epithelial germ or a pluripotential embryonic cell. Pinkus  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  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|| |
A rare case of a solitary trichoepithelioma of the eyelid is reported in a 50 years old woman.
| References|| |
Aurora, A.L., and Blodi, F.C., 1970, Survey Ophthal, 15,
Gray, H.R., and Helwig, E.B. 1963, Arch. Derm.
Helwig, E.B., 1973, Personal communication.
Lever, W.F., 1967, Histopathology of the skin, 4, 557, J.B. ppincott Company, Philadelphia.
Montgomery, H., Dermatopathology, vol. 2, 887, Hoeber Medical Division, Harper & Row Publishers, New York.
Pinkus, H., 1953, Arch. Derm. and Syphilology,
[Figure - 1], [Figure - 2]