title: Intratarsal keratinous cysts of the Meibomian gland: distinctive clinicopathologic and immunohistochemical features in 6 cases.
abstract: OBJECTIVE
  To describe 6 patients representing a new entity of Meibomian gland keratinous cysts.
  
  
  METHODS
  Retrospective, interventional, clinicopathologic study.
  
  
  METHODS
  Review of clinical histories and findings, histopathologic evaluations, and immunohistochemical studies of the cysts' linings with monoclonal antibodies directed against cytokeratins and cell surface epithelial markers.
  
  
  RESULTS
  Six patients with an average age of 62.5 years had noninflamed, upper eyelid nodules fixed to the tarsus. Eyelid eversion revealed a white-yellow nodular bulge in 3 cases, a bluish coloration in 2 cases, and a translucent appearance in 1 case. The cysts were lined by undulating squamous epithelium possessing an inner eosinophilic cuticle that produced a peculiar refractile, strand-like intracavitary keratin. Immunostaining for cytokeratin 17 and carcinoembryonic antigen showed strongly positive results in the Meibomian gland cysts and, by comparison, negative results in cutaneous epidermal cysts. Multiple recurrences occurred after incomplete excisions.
  
  
  CONCLUSIONS
  After chalazia and sebaceous cell tumors, Meibomian gland keratinous cysts seem to be the third most common primary intratarsal lesion. Anterior fixation to the tarsus and posterior protrusion beneath the palpebral conjunctiva without inflammation suggest the diagnosis. Histopathologic and immunohistochemical evaluations can distinguish unequivocally the current entity from common epidermal cysts. The optimal treatment consists of an en bloc excision of the cyst with a tarsectomy, or else wide excision with intratarsal cautery of any remnants of the cellular lining.
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA. Fred_Jakobiec@meei.harvard.edu
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Jakobiec
authors.forename: Manisha
authors.initials: M
authors.lastname: Mehta
authors.forename: Mami
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Mark P
authors.initials: MP
authors.lastname: Hatton
authors.forename: Manoj
authors.initials: M
authors.lastname: Thakker
authors.forename: Aaron
authors.initials: A
authors.lastname: Fay
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D017043:Chalazion / Q000378:metabolism / Q000473:pathology*; D004814:Epidermal Cyst / Q000378:metabolism / Q000473:pathology*; D005141:Eyelid Diseases / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008537:Meibomian Glands / Q000378:metabolism / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers