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Br J Ophthalmol. 2007; 91(12): 1718–1719.
PMCID: PMC2095505

Three oncocytomas in a short space of time

Oncocytomas of the caruncle are rare tumours, found in 3–8% of caruncle excision biopsies.1 They occur most commonly in elderly women. Clinically, these tumours tend to present as a slow‐growing, asymptomatic mass that is often tan red in colour.2 Treatment is by complete surgical excision and recurrence is unusual, although very rare malignant oncocytomas occurring in the ocular adnexae have been reported,3 and there has been a case of persistent rhinorrhea caused by an oncocytoma occurring in the lacrimal sac with extension into the nasolacrimal duct.4

Case reports

A 38‐year‐old woman presented with a two‐year history of a slowly enlarging cystic lesion of the left medial canthus, which was causing increasing irritation. On examination, there was a smooth, pink, fluid‐filled lesion measuring 4 mm in maximum diameter (fig 11).). The cyst was excised under local anaesthesia.

figure bj117317.f1
Figure 1 Smooth, fluid‐filled lesion of medial canthus. Informed consent was obtained for publication of this figure.

An 81‐year‐old man with a history of diabetic retinopathy presented for routine follow‐up and was found to have a cystic lesion on the left lower eyelid, lying just proximal to the medial canthus. On examination, there was a smooth, yellow cystic lesion that was thought clinically to be a cyst of Moll. The lesion was excised with no subsequent recurrence.

An 80‐year‐old man presented to the clinic complaining of a lesion affecting the right eye. On examination, a small cyst was noted adjacent to the caruncle. Excision was performed and one 7/0 Vicryl suture was put in to appose the tissue defect, with a provisional clinical diagnosis of a simple conjunctival cyst.

Comment

All three specimens appeared similar upon histological examination (fig 22).). Each lesion appeared well circumscribed and was composed of nests and trabeculae of uniform, polygonal cells with abundant, finely granular eosinophilic cytoplasm.

figure bj117317.f2
Figure 2 Tumour composed of bland cells with abundant granular, eosinophilic cytoplasm (haematoxylin and eosin, original magnification ×200).

The caruncle is a unique anatomical structure containing elements of both conjunctiva and skin.5 Oncocytomas (oxyphilic adenomas) of the caruncle are rare tumours accounting for only 3–8% of masses of the caruncle.6 These cases are unusual in that, to our knowledge, this is the first series in which three cases presented in the space of eight weeks. This begs the question: are we misdiagnosing or indeed underdiagnosing these tumours, because not all are sent for pathology and how important or relevant is this?

Oncocytomas are benign neoplasms of oncocytic cells, which can occur at a variety of sites. Ocular adnexal oncocytomas are usually situated in the lacrimal drainage apparatus of the caruncle.7 Cases occurring in other sites such as the eyelid8 have also been documented. The differential diagnosis should include melanocytic melanoma at the top of the list; as this carries the worst prognosis, melanocytic naevus, benign epithelial tumours, pyogenic granulomas and haemangiomas, along with several other rarer lesions.9

As already mentioned, oncocytomas are by and large benign in nature and usually only require excision for cosmetic purposes or if they cause irritation to the patient. They do, however, have a real potential to recur in cases of incomplete excision10 and can be locally aggressive and occasionally turn malignant.

Footnotes

Competing interests: None declared.

Informed consent was obtained for publication of figure 1.

References

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3. Cameron J R, Barras C W. Oncocytoma of the eyelid. Acta Opthalmol Scand 2005. 83125
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10. Rennie I G. Oncocytmas (oxyphil adenomas) of the lacrimal caruncle. Br J Ophthalmol 1980. 64935–939.939 [PMC free article] [PubMed]

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