Case Study: October 2016


A 65 year old man presents with a slowly growing nodular on the left upper lid (Fig 1). Clinically it is arising within the tarsal plate and the skin is mobile over it. The lesion is excised and sent for histopathological assessment. Fig 2 (plates A-D) summarise the pathology findings.


1. What is a cyst?

2. What are the main histological findings?

3. What is the histological differential?

4.  What is the favoured clin-path diagnosis?


Click to show answers


1. A cyst is an epithelial-lined space with or without contents.

2. An intra-tarsal cyst lined by stratified squamius cells without a granular layer and covered in layered keratin.

3. Epidermal cyst, Steatocytoma, Intratarsal keratinous cyst.

4. Intra-tarsal keratinous cyst.


Jakobiec FA, Mehta M, Iwamoto M, et al. Intratarsal keratinous cysts of the meibomian gland: distinctive clinicopathologic and immunohistochemical features in 6 cases. Am J Ophthalmol 2010;149:82.