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Research Letter |

Congenital Megacaruncle:  A Unique and Innocent Ocular Adnexal Anomaly

Gregory J. Bever, MD1; Frederick A. Jakobiec, MD, DSc2,3; Pia R. Mendoza, MD2,3; Mark P. Hatton, MD3,4
[+] Author Affiliations
1Boston University School of Medicine, Boston, Massachusetts
2David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston
3Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
4Ophthalmic Consultants of Boston, Boston, Massachusetts
JAMA Ophthalmol. 2013;131(12):1641-1643. doi:10.1001/jamaophthalmol.2013.4401.
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Normal caruncular tissue contains a goblet cell–rich nonkeratinizing squamous epithelium, pilosebaceous units, eccrine and/or apocrine sweat glands, acini of lacrimal gland tissue, lobules of fat, and striated orbicularis muscle.1 Acquired lesions of the caruncle have been well categorized.2 The rarest lesions are congenital, including ectopias, dysgeneses (dysplasias), and duplications (supernumerary caruncles).1,3,4 We report a case of a congenitally well-formed massive caruncle that we have designated as a “megacaruncle.”

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Figure 1.
Clinical and Histopathologic Features of Megacaruncle

A, An enlarged, reddish, right caruncle was present since birth with a glistening and opalescent apex. It was 8.5 mm in its greatest diameter compared with a 3-mm left caruncle. B, The megacaruncle is symmetrically globular with proliferation of the surface epithelium at the apex. The surgical margin is present below. Arrow indicates the point of transition between nonkeratinizing squamous epithelium that covers most of the structure and keratinizing epithelium on the left, which is where the mass was fused with the medial lower eyelid margin (hematoxylin-eosin, original magnification ×20). C, Higher-power photomicrograph of the mucocutaneous junction (crossed arrow) depicts the transition to keratinizing epithelium on the left. Arrows indicate sebaceous glands and lanugo hairs (hematoxylin-eosin, original magnification ×40). D, Cytokeratin 7 expressed in nonkeratinizing conjunctival epithelium is identified at the apex and on the right of the lesion. The epidermis on the left is nonstaining due to its keratinizing character (arrow) (immunoperoxidase reaction, diaminobenzidine chromogen, hematoxylin counterstain, original magnification ×20). E, Mild acanthosis with epithelial invaginations into the stroma typify the surface epithelium (hematoxylin-eosin, original magnification ×40). F, The invaginations (arrows) have a tubular structure and contain numerous goblet cells (hematoxylin-eosin, original magnification ×100).

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Figure 2.
Histopathologic Features of Megacaruncle

A, The mucicarmine stain highlights the goblet cells with a magenta coloration (original magnification ×100). B, A cross-section through many of the tubular invaginations of the surface epithelium imparts the false impression of an adenomatous tumor (arrows) (hematoxylin-eosin, original magnification ×100). C, The center of the mass is dominated by adnexal structures, especially hairs cut in cross-section (arrows) and sebaceous glands (S) (periodic acid–Schiff, original magnification ×100). D, The collagen composing the deep portion of the lesion is thickly textured. A sebaceous gland unit (S) is embedded in the collagen (Masson trichrome, original magnification ×200). E, The substantia propria immediately beneath the surface epithelium (EP) with its tubular invaginations (arrows) manifests vertically arranged, blue-staining delicate collagen fibers with interspersed mononuclear chronic inflammatory cells (Masson trichrome, original magnification ×200). F, Bundles of striated orbicularis muscle fibers (arrows) are distributed at the base of the lesion amidst fibroadipose tissue (hematoxylin-eosin, original magnification ×100).

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