Apocrine Hidrocystoma

INTRODUCTION Also known as a cystadenoma, sudoriferous cyst, or cyst of the gland of Moll, these lesions arise from apocrine glands of Moll and are true cystic adenomas of the secretory cells rather than retention cysts. These lesions are also associated with Schopf-Schulotz-Passarge syndrome, an ectodermal dysplasia in which patients display multiple periocular apocrine hydrocystomas, hypodontias, hypotrichosis, and palmoplantar hyperkeratosis.

CLINICAL PRESENTATION Apocrine hidrocystoma lesions are small (less than 1 cm in diameter) solitary, translucent cysts on the eyelid, usually near the eyelid margin at the canthal angles. The overlying skin is shiny and smooth and the cyst is filled with clear or milky fluid. A layered precipitate of yellow or creamy material may be seen at the base of the cyst representing lipid-rich decapitation secretions. More rarely the cyst may display a bluish coloration. On occasion multiple lesions may occur and long standing lesions may reach several centimeters in size. They often occur bilaterally and symmetrically, and can become confluent and disfiguring.

Inner Eyelid Lesions

HISTOPATHOLOGY Two layers of cells line these cysts, which may be unilocular or multilocular. The inner lining is composed of columnar cells with eosinophilic cytoplasm and decapitation secretion (buds of cytoplasm detaching from the luminal surface). Myoepithelial cells compose the outer layer; the cells are flat to low cuboidal. The epithelium may form papillary projections into the lumen. Cyst contents, when present, are lightly eosinophilic proteinaceous material.

Sudoriferous Cyst Pathology

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes eccrine hidrocystoma, epidermoid cyst, and cystic basal cell carcinoma.

TREATMENT In general, no treatment is necessary. But when removal of the lesion is desired for diagnosis, cosmesis, or to diminish irritation or obstruction of vision, complete surgical excision is appropriate with meticulous removal of the intact cyst wall. In cases of multiple or recurrent lesions adherent to the epithelium, en-bloc excision via a blepharoplasty type incision may be a useful approach. Chemical ablation of the cystic epithelium with trichloroacetic acid has been reported to yield excellent results without scarring. Carbon dioxide laser vaporization has also shown good results.

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