SLIDE 2 Int J Ophthalmol , Vol. 9, No.8 , Aug. 2009 rvwrv. fJO. cn
Tel1029-82245L72 83085628 Emrril : I.Jf). 2000 @ 163. com Case reprirt
Trichilemmal cyst in the eyelid; a rare presentation
Bashkaran Karuppannon I
, Bukiuh Shaharuddinl , Embong Zunainat , Venkatesh Ramaswarny
lVaik2
1I)epartrnent of Ophthalmology, School of lVledical Sciences,
Universiti Sains Nlalaysia, Health Campus, 16150 Kubang Kerian, Kelanlan, Malaysia
2 Depaltment of Pathoiogy, Schno.l o{ Medical Scierrces ,
Universiti Sains Malaysia, Health Carnpus, 16150 Kubang Kerian, Kelantan, Malaysia Correspondence to: Ernborrg Zunaina. Departrnenl of Oph- thalmology, School of Medical Sciences, Universiti Sains
' lVlalaysia, Health Campus, 16150 Kubang Kerian, Kelantan,
.*--'{alaysia. zuneina@ kb. usm, my
- Received r2009-05-13 Accepted .2009-07 -28
Abstract
.,A,42-year=old Malay lady presented with a Z-year history
- f painless and progressive right upper lid swelling. There
was Ro history of trauma or similar lesion elsewhere, An excisional biopsy of the mass was performed and the histopathological findings of the excised lesion were
e onsistent with those for a trichilemmal cyst,
Trichilemmal cyst, although rare should be considered in any case of eye lid lesion, r KEWVOftDS, triehilemmal cyst; eye lid; pilar cyst pOI: 10. 3969/j. issn, 1672-5123. 2009. 08. 006
Karuppannar ts, Shaharuddin Il , Zunaina Il, Naik VR. Trichilernmal cyst in the eyelid;a rare presentation.Int I Ophthalmol (Cuoji Yanke Tazhi ) 2009 i9 (8) l45l -t 452
INTRODUCTION
rp richilemmal cysts &re also known as pilar cysts. They are I
common benigu tumors occurring mainly on the scalp. It presents as smooth , mobile, firm and round nodule without a
visible puncium, containing keratin and its breakdorvn
products I'''1 . 'Tri"lrilemmal cyst arises from the outer root sheath ( tlichilemma) of the hair follicle i'l . Th"." is often an autosomal dominant inhelitance pattern as the lesion is frequently familioi i'''l . To the best of our knowledge, no cases of trichilemmal cysts involving the eyelid have been reported. We report a rare case
- f trichilemrnal cyst iocatecl in the upper eyelid.
CASE REPOITT A 42-year-old Malay lady presented with history of progressive painless srvelling over the right rrpper eyelid over a perir-,d of two years. It rvas not associatecl with redness, discharge or blurring of vision. T'here rvas no history of trautna or similar lesion elsewhere. 'fhere was no family tristory ol sirnilar
- lesion. On clinical examination of the right eye, there n'as a
cystic, fieely rnobile, non tender s'n'elling over the right upper
eye lid measuring about 15mm x l0mrn x 10mrn ( Figure I ). There was no ulceration noted over the skin. Exan'rinati<-rn of
the rest of the anterior and postr:rior segmeuls rvas unremar-
- kable. Left eye was essentially nonnal. Systernic exarnination
revealed normal findings.
An excision biopsy of the mass wirs perlirrnred uncler iocal
- anaesthesia. Unfortunately the srveiling ruptured during
separation releasing clieesy yellorvish iluid. 'fhe cyst was removed and sent for histopathological examitralion. Grossly, the mass measured 10mm x l0rnm x 5trln ancl luas grayish brorvn in colour. 'Ihere rvas presencr) of cysric spaces. Histopathological findings reveaied Iragnrents of fil:rocolla- genous tissue containing a cyst. The cyst was linell i:y
stratified squamous epitheliunt with abrupt keratinizatiorr
( Figure 2 ). Uneven interphase betrveen lteratinized and nonkeratinized cells also noted ( Figule 3 ) . 'I'here was no granuiar celi layer or giandular tissue note;d. The cyst contained keratin material,
A diagnosis of trichilernmal cyst was made based on the
histopathological findings. Patient tr,as reviewed trvo rveeks
- later. The wound heaied well and the eyelid was norrtral
( Figure 4 ). There was no recurrence of the swelling noted
aftel one and a half years of observation. DISCUSSION I'here are many types of benign and malignant turnours that
can occur in the eyelids. Chalazia, epirlennal inclusion cysts, sebon'heic keratoses and apocrine hydrocystomas are the mosl common berrign lesionslo] . Trichilemmal cysts occur most cornmonly on the scalp due io abundance of hair follicle. They can also occur ol1 other paris
- f the body except the palms, soies, ger.ritalia, axillae and
groins t'1. Trichilemmal cysts involving'the skull bases, pulp
- f index firrger and upper lip have also been reporteil [2'3'6].
Trichilemrnal cysts were previously consitlered sebaceons' or epidemroid cysts and were historically referred to by the
common name of ,u",.['] . Trichilemmal cyst needs to he diffe-
rentiated from epidermoid cyst. Trichilemrnal and epiderrnal cysts are both keratinous cysts. Clinically trichilemrnal cysts and epidermal cysts have similar presental.ion. However they differ histopathologically in which trichilemrnal cysts do not
have granular cell Iayer l6l. Approxirnately 20a/o of
epithelial cysts are trichilemnral cysts and the other 804/o are epidermoid i'1. There are reporte(l r:ases r.rf prolilerating trichilemmal cyst and malignant prolifclaling trichilernrnal tumoul of the eyelicl it'el
.
'l'o our knowledge, no cases oi'trichilenrnial cysls involviug the eye lid have been described. 'Ihe unitlueness of this case is due to its rare site of presentation. It is not possil-rle to cotrfitrrr
