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A longstanding cystic swelling of the upper eyelid
  1. Kwesi Nyan Amissah-Arthur1,
  2. Hardeep Singh Mudhar2,
  3. Soupramanien Sandramouli1
  1. 1Wolverhampton and Midlands Counties Eye Infirmary, New Cross Hospital, Wolverhampton, UK
  2. 2Department of Histopathology, National Specialist Ophthalmic Pathology Service (NSOPS-Sheffield Lab), Royal Hallamshire Hospital, Sheffield, UK
  1. Correspondence to S Sandramouli, Wolverhampton and Midlands Counties Eye Infirmary, New Cross Hospital, Wolverhampton WV10 0QP, UK; ssandramouli{at}nhs.net

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A 56-year-old man presented to the minor procedures clinic with a referral diagnosis of asymptomatic left upper lid chalazion of a year's duration (figure 1). The patient was fit with no comorbidities and had a normal ocular examination. The lid skin was normal with no history of bleeding. The cyst was immobile and appeared to be attached to the tarsal plate with the prominence being more significant on the cutaneous aspect. Due to the atypical appearance of the cyst, an excision biopsy under local anaesthetic was performed. A skin crease approach was used to gain access to the cyst. The cyst was strongly adherent to the tarsal plate with a mushroom-like configuration and needed to be uprooted. This caused a buttonhole in the upper tarsus that was left to heal. The gentleman made an uneventful recovery.

Figure 1

A photograph of the left upper lid mass lesion.

Questions

1. What are the histopathological findings present in figure 2?

Figure 2

H&E stained section of the cyst (A), surrounded by tarsal plate collagen (B) that contains sebaceous lobules (§). C shows the cyst lining comprising stratified squamous epithelium without a granular layer, covered in lamellate keratin (*) within the cyst (also in A). Image D is a higher power image showing the meibomian gland sebaceous lobules.

2. What is the differential diagnosis for a lesion arising from the tarsal plate?

3. How would you manage this case?

FOR ANSWERS SEE 1360

Answers (FOR QUESTIONS SEE 1352)

What are the histopathological findings present in figure 2?

At scanning power figure 2A shows a cyst filled with keratinous material. The cyst …

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