Subepithelial nevus and papilloma of the lacrimal caruncle: a case report and literature review.

BACKGROUND

Lacrimal caruncular tumors are rare and exhibit a diversity of possible histopathological types. The majority of caruncular tumors are benign, followed by premalignant and malignant lesions, which are associated with a poorer prognosis. Clinical diagnosis is challenging. Therefore, a tissue biopsy is considered and performed based on the presence of features suggesting malignant or undetermined tumors for a definite diagnosis and proper management. The coexistence of different types of benign caruncular tumors is extremely rare and has been rarely described.

CASE PRESENTATION: We herein describe the case of a 63-year-old Thai woman with a history of chronic progressive painless visual loss in her right eye who reported a non-progressive painless hyperpigmented mass without a history of associated contact bleeding on her left lacrimal caruncle. Ophthalmic examination revealed a large hyperpigmented choroidal mass with adjacent exudative retinal detachment in her right eye and a papilliform pinkish lesion over a well-defined, homogeneous, hyperpigmented mass on her left caruncle. Magnetic resonance imaging (MRI) scans of the orbit indicated a malignant choroidal melanoma in her right eye. The regional and distant metastatic work-ups were unremarkable. The patient was treated with a right globe enucleation concurrent with complete tumor removal of the left caruncular mass based on the presence of intratumorally dilated vessels with a feeding vessel to the overlying papilliform lesion, raising suspicion of malignancy, using the no-touch technique, followed by double freeze-thaw cryotherapy. Histopathological examination disclosed a choroidal melanoma in the right eye and a subepithelial caruncular nevus with an overlying conjunctival papilloma emerging from the conjunctival epithelium of the nevus in the left eye. The patient made a complete recovery with no evidence of recurrence at the 12-month follow-up.

CONCLUSION

Coexistence of benign caruncular tumors is extremely rare. We report a rare case of a subepithelial nevus combined with a papilloma at the lacrimal caruncle. Complete tumor resection using the no-touch technique is the primary treatment. Adjunctive double freeze-thaw cryotherapy may be considered to further prevent tumor cell seeding and postoperative recurrences.