Trichilemmal Cyst of the Bulbar Conjunctiva: A Rare Presentation - PDF document

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/259337135 Trichilemmal Cyst of the Bulbar Conjunctiva: A Rare Presentation Article in Middle East African journal of ophthalmology · October 2013 DOI: 10.4103/0974-9233.119999 · Source: PubMed CITATIONS READS 2 38 4 authors , including: Rajani Kadri Devika Parameshwar A.J. Institute of Medical Sciences A.J. Institute of Medical Sciences 14 PUBLICATIONS 42 CITATIONS 18 PUBLICATIONS 22 CITATIONS SEE PROFILE SEE PROFILE All content following this page was uploaded by Devika Parameshwar on 09 May 2016. The user has requested enhancement of the downloaded file.

[Downloaded free from http://www.meajo.org on Monday, March 31, 2014, IP: 41.237.236.15] || Click here to download free Android application for this journal Case Report Trichilemmal Cyst of the Bulbar Conjunctiva: A Rare Presentation Rajani Kadri, Devika Parameshwar, Sandhya Ilanthodi 1 , Sudhir Hegde ABSTRACT Access this article online Website: We report a rare case of trichilemmal cyst involving the bulbar conjunctiva. A 55‑year‑old www.meajo.org female presented with a history of a painless, progressive swelling in the left bulbar conjunctiva DOI: adjacent to the nasal limbus of 3 years duration. Wide excision biopsy was performed. 10.4103/0974-9233.119999 Histopathologic examination fjndings were consistent with those of trichilemmal cyst. Quick Response Code: Trichilemmal cyst should be considered as differential diagnosis in a case of limbal nodule. Key words: Conjunctiva, Limbal Nodule, Trichilemmal Cyst INTRODUCTION and posterior segment was unremarkable. The right eye was unremarkable. A fold of subconjunctival tissue extending from A trichilemmal cyst also known as pilar cyst is a common cyst the swelling to the caruncle was observed during wide excision that forms from a hair follicle. 1 The cysts are smooth filled biopsy of the lesion. The specimen was sent for histopathological with keratin, a protein component found in hair, nails, and skin. examination. Occasionally, trichilemmal cysts can become malignant. Histopathology indicated the presence of sebaceous material. To the best of our knowledge, trichilemmal cysts involving the bulbar conjunctiva have not been reported so far. We report a Microscopic examination showed a cyst lined by stratified rare case of trichilemmal cyst involving the bulbar conjunctiva. squamous epithelium with the absence of granular cell layer, focal basal cell hyperplasia, and flakes of keratin within the CASE REPORT cyst [Figures 2a‑c]. A diagnosis of a conjunctival trichilemmal cyst was made based on the histopathological findings. A 55‑year‑old female from South India of Dravidian race DISCUSSION presented with a history of gradually progressive, painless swelling in the left bulbar conjunctiva adjacent to the nasal limbus of 3 years duration. It was not associated with redness, A limbal nodule often presents a difficult clinical, histopathologic, discharge or blurring of vision. There was no history of trauma and therapeutic challenge. 2 It poses a diagnostic challenge or history of any surgery performed in the past. There was no because most lesions are transitions between inflammation, significant family history. On clinical examination, there was a inflammatory hypertrophies, and true neoplasms. 3 nodular mass adjacent to the nasal limbus of left eye measuring 5 mm × 5 mm, fixed to the underlying tissue, non‑tender, lying A trichilemmal cyst, also known as wen, pilar cyst or within the pterygium [Figures 1a and b]. The transillumination isthmus‑catagen cyst forms from a hair follicle. 4 Though most test was negative. Examination of the rest of the anterior often found on the scalp, they can also occur on other parts of Departments of Ophthalmology, 1 Pathology, A. J. Institute of Medical Sciences, Kuntikana, Mangalore, India Corresponding Author: Dr. Rajani Kadri, Department of Ophthalmology, A. J. Institute of Medical Sciences, Kuntikana, Mangalore ‑ 575 004, India. E‑mail: rajani_kadri@redifgmail.com 366 Middle East African Journal of Ophthalmology, Volume 20, Number 4, October - December 2013

[Downloaded free from http://www.meajo.org on Monday, March 31, 2014, IP: 41.237.236.15] || Click here to download free Android application for this journal Kadri, et al .: Trichilemmal cyst of the bulbar conjunctiva a b Figure 1: (a and b) Nodular mass at the limbus Figure 2a: Histopathology of the lesion from Figure 1. Cyst cavity filled with keratin Figure 2b: Focal Basal cell hyperplasia in the cyst wall lacking a granular cell layer in its wall (H and E, ×400) cysts are similar to epidermal cysts, both being keratinous cysts. However histologically trichilemmal cysts lack a granular cell layer. 4 Approximately, 20% of the epithelial cysts are trichilemmal cysts and other 80% are epidermoid. 8 Very rarely, trichilemmal cysts can undergo malignant transformation. 9,10 In our case, the cyst showed basal cell hyperplasia without cell atypia or mitosis. There are a few reported cases of trichilemmal cyst and malignant trichilemmal tumor of the eyelid. 11‑13 However to the best of our knowledge, no cases of trichilemmal cysts involving the bulbar conjunctiva have been reported. This case report highlights the need for considering trichilemmal cyst as differential diagnosis of the limbal nodule. ACKNOWLEDGMENTS Figure 2c: Absence of granular cell layer in the cyst wall the body such as the upper lip, palpebral conjunctiva, caruncle, The authors would like to acknowledge the editorial assistance and constant and pulp of the index finger. 5‑7 The rare location of bulbar encouragement of Dr. Asha Achar, Senior Resident, Dr. Ajay Kudva, conjunctiva in this case could be explained as originating from Associate professor, Dr. Vandana Serrao Assistant Professor, Department the caruncle and being pushed toward the nasal limbus. These of Ophthalmology, A. J. Institute of medical sciences, Mangalore, India. Middle East African Journal of Ophthalmology, Volume 20, Number 4, October - December 2013 367

[Downloaded free from http://www.meajo.org on Monday, March 31, 2014, IP: 41.237.236.15] || Click here to download free Android application for this journal Kadri, et al .: Trichilemmal cyst of the bulbar conjunctiva REFERENCES 8. Satyaprakash AK, Sheehan DJ, Sangüeza OP. Proliferating trichilemmal tumors: A review of the literature. Dermatol Surg 2007;33:1102‑8. 1. Meena M, Mittal R, Saha D. Trichilemmal cyst of the eyelid: 9. Rutty GN, Richman PI, Laing JH. Malignant change in Masquerading as recurrent chalazion. Case Rep Ophthalmol trichilemmal cysts: A study of cell proliferation and DNA Med 2012;2012:261414. content. Histopathology 1992;21:465‑8. 2. Farah S, Tad D, Baum, Conlon MR, Alfonso EC, Starck T, 10. Lai TF, Huilgol SC, James CL, Selva D. Trichilemmal carcinoma Albert DM. Tumors of cornea and conjunctiva. In: Albert and, of the upper eyelid. Acta Ophthalmol Scand 2003;81:536‑8. Jakobeic, Azar, Gragoudaseditors. Principles and Practice of 11. Kang SJ, Wojno TH, Grossniklaus HE. Proliferating trichilemmal Ophthalmology. 2 nd ed. Vol. 2. W.B. Saunders Co Philadelphia; cyst of the eyelid. Am J Ophthalmol 2007;143:1065‑7. 2000. p. 1002‑16. 12. Lee SJ, Choi KH, Han JH, Kim YD. Malignant proliferating 3. Duke–Elders S. Tumors. In: System of Ophthalmology. Diseases trichilemmal tumor of the lower eyelid. Ophthal Plast Reconstr of the Outer Eye. Vol. VIII. Part 2. Cornea and Sclera Henry Surg 2005;21:349‑52. Kimpton; St Louis, CV Mosby. 1965. p. 1144‑241. 13. Mendoza PR, Jakobiec FA, Yoon MK. Keratinous cyst of 4. Trichilemmal cyst‑Wikipedia, the free encyclopedia. Accessed the palpebral conjunctiva: New observations. Cornea at htttp://www.en.wikipedia.org/wiki/Trichilemmal cyst. 2013;32:513‑6. 5. Jakobiec FA, Mehta M, Sutula F. Keratinous cyst of the palpebral conjunctiva. Ophthal Plast Reconstr Surg 2009;25:337‑9. 6. Jakobiec FA, Mehta M, Greenstein SH, Colby K. The white caruncle: Sign of a keratinous cyst arising from a sebaceous Cite this article as: Kadri R, Parameshwar D, Ilanthodi S, Hegde S. gland duct. Cornea 2010;29:453‑5. Trichilemmal cyst of the bulbar conjunctiva: A rare presentation. Middle East 7. Ikegami T, Kameyama M, Orikasa H, Yamazaki K. Trichilemmal Afr J Ophthalmol 2013;20:366-8. cyst in the pulp of the index finger: A case report. Hand Surg Source of Support: Nil, Confmict of Interest: None declared. 2003;8:253‑5. 368 Middle East African Journal of Ophthalmology, Volume 20, Number 4, October - December 2013 View publication stats View publication stats