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Photo Essay |

Subepidermal Calcified Nodule

Claus Cursiefen, MD; Anselm Jünemann, MD
Arch Ophthalmol. 1998;116(9):1254-1255. doi:10.1001/archopht.116.9.1254.
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A 7-year-old girl was seen for evaluation of a small tumor on her left upper eyelid (Figure 1). She first noted the lesion 7 months earlier. Suspecting a retention cyst at that time, 2 punctures of the tumor were performed by an ophthalmologist. Examination findings disclosed a firm, well-circumscribed, slightly elevated yellow-white tumor. Findings from her general medical history and ophthalmic and physical examinations that included standard laboratory tests were unremarkable. An excisional biopsy of the tumor was performed. Results of histopathologic examination disclosed focal subepithelial calcification beneath a multilayered cornifying squamous epithelium with acanthosis and hyperkeratosis (Figure 2). Findings from von Kossa staining for calcium were positive in this area (Figure 3). Adjacent to the calcium deposits a foreign body granulomatous inflammatory reaction with giant cells was observed (Figure 4). Results of Feulgen staining for DNA and Gram staining were negative within the calcified masses. No recurrence occurred in the last year.

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Figure 1.

Well-circumscribed, firm, prominent yellow-white tumor on the left upper eyelid of a 7-year-old girl. The tumor was first noted 7 months earlier by the patient and punctured twice by an ophthalmologist suspecting a retention cyst.

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Figure 2.

Subepidermal calcified nodule of the eyelid. Calcium deposits are located subepithelially (asterisk) with acanthotic thickening and hyperkeratosis of overlying squamous epithelium (hematoxylin-eosin, original magnification ×50).

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Figure 3.

Positive von Kossa staining for calcium in the subepidermal calcified nodule of the eyelid (original magnification ×50).

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Figure 4.

Foreign body granulomatous reaction adjacent to focal calcium deposits (asterisk) with a foreign body giant cell (arrow) (hematoxylin-eosin, original magnification ×160).

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