Case Study: February 2012

History

  • 50 year old man with cystic swelling occupying proximal tarsal plate of lower lid of left eye.
  • Excised

Questions

  1. The low power confirms an epithelial bound cyst. What are the key features of the lining of the cyst and what is the diagnosis?
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  1. The cyst is within the tarsal plate (fibrous tarsal plate tissue and meibomian glands adjacent), is lined by stratified squamous epithelium without a granular layer and Figure 2 gives the big clue-it is arising from a dilated sebaceous gland duct (most likely from one of the smaller ducts that drain one of the lobules of the meibomian duct into the main duct). The keratin contents are stringy.

    The diagnosis is intra-tarsal keratinous cyst of the Meibomian gland.

References

Intratarsal keratinous cysts of the meibomian gland (a sebaceous duct cyst): report of 2 cases. Patel VS, Meyer DR, Carlson JA. Am J Dermatopathol. 2011 Aug;33(6):624-7.

Intratarsal keratinous cysts of the Meibomian gland: distinctive clinicopathologic and immunohistochemical features in 6 cases. Jakobiec FA, Mehta M, Iwamoto M, Hatton MP, Thakker M, Fay A. Am J Ophthalmol. 2010 Jan;149(1):82-94. Epub 2009 Oct 28.