Purpose
Subepidermal calcified nodule of the eyelid (SCN) is considered one of the types of Calcinosis cutis.The purpose of this study was to study the clinical features and histopathological findings in patient diagnosis with SCN of the eyelid
Methods
There were 13 patients identified who had been diagnosed with SCN of the eyelid. A chart review was conducted on all patients to identify any salient past medical history, trauma or concurrent systemic disease. Histopathological analysis was performed for each case using hematoxylin-eosin stains. In selected cases, Von Kossa stain was also used to identify and characterize the nature of calcium deposition, as well as immunostains including CD3, CD20 for chronic inflammation and CD68 to recognize granulomatous inflammation.
Results
We have found 13 cases of SCN diagnosis in our ophthalmic pathology archive. Clinical information is summarized in table 1.Two of these patients presented with systemic disease association including hypertension and gout. The other 11 patients were otherwise healthy and most of them presented as white, firm, nodules. All cases from our review received surgical excision of the lesion as treatment under local anesthsia. Microscopically, we described 2 different histopathological patterns according to the age of patients. In younger patients (10 cases, histopathological features were identified as multiple, small, amorphic calcified material within the dermis that was positive for calcium with Von Kossa stain. The spherical calcified deposits were surrounded by foreign body giant cells and lymphoplasmocytic chronic inflammation (image 1). On the other hand, the biopsy findings in elderly patients (3 cases) were characterized by a single, large, well-demarcated amorphous calcified material that also stained positive with Von Kossa, and was surrounded by fibrous tissue without chronic inflammation or foreign body reaction (image 2)
Conclusions
SCN of the eyelid is a rare condition, but should be considered in any patient presenting with a painless white to yellowish<br /> colored nodule of the ocular adnexa. Clinician should be aware that this entity could be associated particularly in elderly patients, with systemic conditions. We have found 2 different histopathological patterns according to patients’ age that are associated with SCN of the eyelid and have not been described yet.