Case Study: May 2017

History

A 55-year-old female presents with a few months history of an enlarging lump on the right eyelid.

There was no history of trauma or previous surgical procedures. She was otherwise fit and well.

The lump was biopsied and sent for histopathological analysis.

Fig 1-H&E of the upper lid skin.

Fig 2-higher power on an area of interest.

Fig 3-Alcian Blue stain.

Questions

1. What ar ethe key histopathological features demonstrated in the Figures?

2. what is the differential diagnosis?

3. The patient admitted to have a procedure performed after the second clinic visit. What is the likeliest diagnosis now?

 

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Answers

1. The key features are the presence of spiculate, Alcian Blue positive dermal deposits of bluish, acellular material, present in the dermis. There is associated oedema. No inflammation is identified.

2. The differential diagnosis includes: Primary or secondary mucinosis, cosmetic filler, metastatic mucinous tumours.

3. Cosmetic dermal filler (hyaluronic acid). Hyaluronic acid can lead to chronic eyelid oedema and other complications such as migration and granuloma formation.

References

Yu JTS, Peng L, Ataullah S.Chronic Eyelid Edema Following Periocular Hyaluronic Acid Filler Treatment. Ophthal Plast Reconstr Surg. 2017 Nov/Dec;33(6):

Jordan DR, Stoica B.Filler Migration: A Number of Mechanisms to Consider. Ophthal Plast Reconstr Surg. 2015 Jul-Aug;31(4):257-62

Morley AM, Taban M, Malhotra R, Goldberg RA.Use of hyaluronic Acid gel for upper eyelid filling and contouring.Ophthal Plast Reconstr Surg. 2009 Nov-Dec;25(6):440-4