A 60-year-old male patient came with gradual progressive swelling on the outer corner of his left lower eyelid for the past 1 year. Examination revealed 3.5 mm × 3 mm, round, translucent cystic lesion with overlying vessels, Figs. 1 and 2. Routine investigations were normal. The cystic lesion was excised in its entirety from its base without rupturing its walls. Histopathological examination confirmed a diagnosis of apocrine hidrocystoma Figs. 3 and 4.Figure 1: Preoperative clinical photograph showing swelling in the left lateral canthal regionFigure 2: Preoperative clinical photograph showing cystic surface of the lesionFigure 3: A histopathological image (at 10X magnification) of an apocrine hidrocystoma showing double-walled cyst (white arrow) and decapitation secretions (black arrow) (Hematoxylin and Eosin stain)Figure 4: A histopathological image (at 40X magnification) showing decapitation secretions (green arrow), a hallmark of apocrine differentiationDiscussion Apocrine hidrocystoma is a benign cystic lesion originating from the apocrine sweat glands, commonly occurring in the periorbital region.1 Its small size and asymptomatic nature are consistent with the typical presentation.2 Histologically, they are characterized by a cystic structure lined by a double layer of epithelial cells; the inner layer consists of columnar cells exhibiting decapitation secretion, a hallmark feature of apocrine differentiation, while the outer layer is composed of myoepithelial cells.3 Cystic eyelid lesions mimicking apocrine hidrocystoma are eccrine hidrocystoma, epidermoid (epidermal inclusion cyst), sebaceous cyst, and basal cell carcinoma. Histopathological differentials also include syringocystadenoma papilliferum and mucocele. Dermoscopy revealed a homogeneous, translucent appearance with overlying vessels.4 Surgical excision is the treatment of choice as it provides both therapeutic and diagnostic benefits yielding excellent cosmetic results. Minimal follow-up is needed post excision, with reviews at 1–2 weeks and 6–8 weeks. Conservative cases require review in 4–6 weeks for size and appearance changes. The patient must report rapid growth, pain, ulceration, or color changes. Alternative treatment modalities include laser ablation and electrodessication, yielding good cosmetic outcomes with minimal scarring. Contrasting Khullar et al.’s5 unusual upper-lid case, our report documents typical lower-lid involvement in South India, emphasizing apocrine hidrocystoma’s diagnostic importance and contributing valuable regional insight to the existing literature. Authors’ contributions’ Padmavathi V designed, developed, and prepared the manuscript. Neena T provided key information, reported the case, and assisted in revising the manuscript. Both authors read and approved the final version. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
Padmavathi et al. (Thu,) studied this question.