Lesions of the Lacrimal Caruncle With an Emphasis on Oncocytoma

Abstract

Lesions of the lacrimal caruncle vary widely due to its unique composition. Rarely, dermatologists and dermatopathologists encounter biopsies taken from this location. The aims of this study were to (1) retrospectively review caruncular lesions of the eye examined at Duke University Medical Center and (2) review the literature associated with caruncle pathology with emphasis on oncocytoma. A retrospective search of all lesions of the caruncle examined at Duke University Medical Center from 1991 to 2009 was performed. Fifty-nine lesions of the caruncle were identified. Nevi (40.7%) were the most common lesions observed, although squamous papillomas were the second most common entity (8.5%). Three oncocytomas were identified (5.1%), and were the next most common lesion present at this body site. These 3 entities represented 54.3% of the lesions found in the caruncle. Fifteen percent of the caruncular biopsies contained malignant or borderline malignant lesions, whereas the remaining 85% were benign entities. Most lesions present in the caruncle are benign. Although relatively rare, oncocytomas may be encountered by the dermatopathologist and may be confused for other neoplasms. Oncocytomas should be considered in the differential diagnosis based on this location in addition to histopathologic features.

Caruncular Dacryops

“…8 Oncocytomas are composed of swollen, granular, ductal cells containing myriad malformed mitochondria, reflective of a senescent change. 9 They may be cystic to a substantial degree. Clinically, these lesions can have an orange-rust discoloration due to the iron content within the mitochondria associated with the cytochrome oxidase energyproducing mitochondrial pathway.…”

Atypical Presentation of a Pigmented Oncocytoma of the Caruncle: A Case Report

“…The lesion is usually composed of large oval cells with eosinophilic granular cytoplasm filled with malformed mitochondria, most likely representing an age-associated metaplastic and neoplastic transformation of the glandular epithelium [8]. Clinically, caruncular oncocyto-mas occur more frequently in female elderly patients [1, 4, 6] and usually present as a mass or lump that rarely shows a tendency to grow [4]. They are commonly red-blue or orange–tan in color, sometimes with a lobulated, fleshy, or cystic appearance [6].…”

“…In the vast majority of cases [3], oncocytic lesions of the ocular adnexa occur in the caruncle; other locations rarely include the conjunctiva, plica semilunaris, lacrimal sac, eyelid, and lacrimal gland [1, 4, 6]. Oncocytic lesions occur more commonly in elderly patients, usually in their seventh decade of life, with a 2:1 female:male ratio, especially for those occurring in the caruncle [1, 5, 6].…”

“…Oncocytic lesions occur more commonly in elderly patients, usually in their seventh decade of life, with a 2:1 female:male ratio, especially for those occurring in the caruncle [1, 5, 6]. The most common presenting symptom is a mass or lump, although patients are usually asymptomatic [4, 5].…”

Caruncular Oncocytoma Mimicking Malignant Melanoma

“…Immunohistochemistry usually is not necessary to make the diagnosis but can be helpful in differentiating oncocytoma from melanoma. Melanoma typically is immunoreactive for S-100 protein and HMB-45, but oncocytoma is not [12,25]. Treatment outcomes following complete excision of the oncocytoma are usually excellent.…”