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Bilateral nodular colloidal degeneration of the lower eyelids

Poster Details

First Author: K.Lee MALAYSIA

Co Author(s):    Z. Zainal Abidin   V. Subrayan   W. Muhaizan        

Abstract Details



Purpose:

A case report of bilateral nodular colloidal degeneration of the eyelids

Setting:

University Malaya Medical Centre

Methods:

A 39 year old lady presents with bilateral lower eyelid swellings for a period for 1 month which are progressively increasing in size with mild discomfort. Both the masses are located at the inferior orbital rims, just below the eyelid crease, measuring about 3 centimetre (cm) horizontally and 1 cm vertically. The overlying skin has a purplish-pink hue, no ulceration, mildly tender on palpation, firm and not tethered to the skin. No abnormal vasculature or lymphadenopathy was found. There were no other significant ocular or systemic findings. As it was symptomatic and progressively enlarging, an excision of both the swellings was performed under general anaesthesia. Intraoperatively, a few nodular postseptal solid masses with fairly well delineated borders were found.

Results:

The histopathological sections show nodular tissue with no epithelial lining, with numerous spaces lined by flattened cells. The lumen contain clear eosinophillic, colloid-like material which is pale pinkish on Periodic Acid Schiff staining and negative for Congo Red stain. Scattered foreign body giant cell reaction was seen around the colloid material. No surrounding fibrocollagenous tissue or malignant changes were seen.

Conclusions:

A nodular colloidal generation is in the spectrum of the colloid milium which are rare, degenerative cutaneous deposit conditions characterized by the accumulation of amorphous hyaline-like material in the dermis. The colloid milium is classified into 2 main forms, adult and juvenile variety. It is linked to excessive sun exposure and possibly exposure to petroleum products and hydroquinone. The origin of the colloid deposition in the dermis is not certain, but it is thought to be due to sun induced -degeneration of elastic fibres in the adult form and degeneration of UV-transformed keratinocytes in the juvenile form. Adult colloid milium(ACM) is characterized by multiple translucent small dermal papules 1-2 mm in diameter, yellowish brown and sometimes translucent at the sun-exposed areas of the face, neck, dorsum of hands and back. Differentials include syringomas, retention cysts, sarcoidosis, molluscum contagiosum and senile sebaceous hyperplasia. For a confirmatory diagnosis, a full-thickness skin biopsy is necessary but a patient's history may be helpful. The histological findings in this case were classical in its description in the literature. The histological and clinical findings together are unmistakable, although it may be difficult to differentiate from amyloidosis. FINANCIAL INTEREST: NONE

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