Eyelid varix with phlebolith formation, thrombus recanalization, and early intravascular papillary endothelial hyperplasia.
An asymptomatic, bluish-gray, movable, raised, and firm left upper eyelid mass had been present for 8 months in an 82-year-old woman. Histopathologic examination revealed a lesion restricted to the dermis and composed in part of a calcific nodule that was circumscribed by an acellular fibrous capsule. An adjacent nodule exhibited proliferating endothelial cells invading a fresh thrombus. Immunohistochemical staining revealed positivity for CD31, CD34, and CD68; D2-40 was negative, ruling out a lymphatic origin. Masson trichrome and elastic staining of deeper sections revealed recanalization of an earlier thrombus; surviving elastic fibers were discovered in the outer wall, establishing a venous source. This is the first reported case of 3 microscopically discernible events (old phlebolith, fresh intravascular endothelial hyperplasia invading a thrombus, and labyrinthine recanalization of a temporally more remote thrombus) in an eyelid varix. The clinical differential diagnosis is reviewed.
Zakka
Fouad R
FR
David G Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
Jakobiec
Frederick A
FA
Thakker
Manoj M
MM
D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000378:metabolism; D058846:Antibodies, Monoclonal, Murine-Derived; D018952:Antigens, CD34; D014408:Biomarkers, Tumor / Q000378:metabolism; D002114:Calcinosis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D004730:Endothelium, Vascular / Q000473:pathology*; D005142:Eyelid Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D005143:Eyelids / Q000098:blood supply*; D005260:Female; D006390:Hemangioendothelioma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006801:Humans; D006965:Hyperplasia; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000378:metabolism; D013927:Thrombosis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D014648:Varicose Veins / Q000378:metabolism / Q000473:pathology* / Q000601:surgery
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018952:Antigens, CD34; D014408:Biomarkers, Tumor; D019408:Platelet Endothelial Cell Adhesion Molecule-1; C500987:monoclonal antibody D2-40