Solitary mastocytoma in the eyelid of an adult

Abstract

PurposeTo describe the ophthalmic symptoms and histopathological findings in a rare case of an eyelid mastocytoma in an adult.ObservationsA man in his early 60s developed a painless, non-tender, non-pruritic, mobile nodule on the right lower eyelid beneath the inferior orbital rim. The lesion grew to 15 × 9 mm over eleven months. Biopsy revealed a diffuse infiltrate of histiocytoid and spindle-shaped mast cells forming cords and small nests between collagen fibers in the superficial and deep dermis. Mast cell lineage was confirmed by immunohistochemistry. Physical examination revealed no other cutaneous lesions and no evidence of systemic disease. Serum tryptase level was normal. Annual full-body examination by a dermatologist for 4.5 years has revealed neither recurrence in the eyelid nor cutaneous involvement at other sites.Conclusions and importanceMast cell tumors limited to the human eyelid are extremely uncommon with only four previously reported cases, including one in an adult. This case highlights the rare possibility of a solitary mastocytoma presenting in the eyelid of an adult.

Childhood Solitary Cutaneous Mastocytoma: Clinical Manifestations, Diagnosis, Evaluation, and Management

“…Congenital cases have been described in approximately 60% of patients [12]. Typically, the age of onset is in infancy, especially in the first 3 months of life [8, 9, 11, 13, 14]. Cases with onset in adulthood have, very rarely, been reported [3, 4, 15].…”

“…Metachromatic intracytoplasmic granules can be easily recognized with the aforementioned stains [21, 23]. Immunohistochemistry requires 15 or more mast cells in aggregates or greater than 20 mast cells per high field for the diagnosis to be confirmed [14].…”

Case report of a clinically indolent but morphologically high‐grade cutaneous mast cell tumor in an adult: Atypical cutaneous mastocytoma or mast cell sarcoma?

“…7,17 Although histomorphology raised concern about a malignant behavior, none of these patients showed systemic involvement or destructive growth, and after excision no recurrence was observed. [4][5][6][7][8][9][10][11][12][13][14][15] Here, we report on an atypical solitary mast cell tumor in a middle-aged patient, which in contrast to the other described cases recurred after excision, showed progressive cytological pleomorphism and an unusually high proliferation rate, but did not show any signs of clinical malignancy after more than 6 years of follow-up.…”

“…3 In the literature, only 14 cases of adult purely cutaneous mastocytomas have been reported. [4][5][6][7][8][9][10][11][12][13][14][15] In cutaneous mastocytosis and indolent systemic mastocytosis, mast cells have round or oval nuclei and abundant metachromatic cytoplasm, 1 or are spindle-shaped hypogranulated cells being referred as atypical mast cells type I. 1,16 A third type of cytomorphology consists of mast cells with nuclear pleomorphism, including bilobation and/or multilobation; these cells are known as atypical mast cell type II or promastocytes.…”

“… 3 In the literature, only 14 cases of adult purely cutaneous mastocytomas have been reported. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 …”