We present a case of lower lid oncocytoma, a rare cause of a lesion on the eyelid.

A 73-year-old man was referred with a 3-month history of a slowly enlarging lesion at the medial end of the right lower lid. There was no discomfort and no other relevant medical history.

On examination, the subject was found to have a 10 × 7 mm smooth, round lesion, with central umbilication and a purple hue (Fig. 1). Initial differential diagnosis included cystic basal cell carcinoma, pyogenic granuloma and meibomian carcinoma.


Figure 1. Photograph of the patient's right eye, showing the pre-operative clinical appearance of the right lower lid lesion.

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The lesion was completely excised and the lid reconstructed under local anaesthetic.

Histology examination revealed the lesion to have a tubulo-papillary architecture in which the constituent cells had regular vesicular nuclei and intensely eosinophilic cytoplasm.

These are the features of a benign oncocytoma (Fig. 2).


Figure 2. Photomicrograph of the excised lesion, demonstrating regular vesicular nuclei and richly eosinophilic cytoplasm. Haematoxylin-eosin stain; original magnification × 20.

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Two years later, the patient has had no recurrence of the tumour.

Oncocytomas, or oxyphil adenomas, are rare tumours of transformed epithelial cells, with eosinophilic granular cytoplasm containing densely packed abnormal mitochondria.

Oncocytomas have been found in various organs, including the thyroid, adrenal gland, kidney, breast and liver.

Ocular oncocytomas are generally benign tumours, but occasionally become malignant, with both local and distant spread. This is often dependent on the exact site, as oncocytomas of lacrimal or caruncle origin are generally benign, and those with orbital involvement may be malignant. They occur most commonly in elderly women. The first reported case was in 1941.

The commonest site of ocular oncocytoma is the caruncle (more than half of reported cases.) Oncocytomas of the eyelid margin are rare, with only six cases previously reported (Biggs & Font 1977; Thaller et al. 1987; Rodgers et al. 1988; Pe'er et al. 1993; Fukuo et al. 1994; Morand et al. 1998). In a peri-punctal tumour such as this, it is thought that the oncocytes may arise from the epithelium of the lacrimal canaliculus. Surgical excision is the treatment of choice.


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