A 6-year-old child presented with a painless swelling in the right upper eyelid, first noticed 7 months prior Fig. 1. It grew in size in the first month and then remained stable thereafter. There was no history of any antecedent trauma. The swelling was hard in consistency, oval-shaped, non-tender, adherent to the skin, but mobile from the underlying tissue. Adjacent meibomian gland orifices along the eyelid margin were healthy. The rest of the ocular and systemic examination was normal. Excision biopsy of the lesion was performed under general anesthesia. Intra-operatively, a hard mass measuring 7 × 3 × 2 mm in size was noted Fig. 2a-c. Histopathological examination revealed a cyst wall lined by stratified squamous epithelium with dense laminated keratin and an absent granular layer with dystrophic calcification, suggestive of trichilemmal cyst Fig. 3.Figure 1: Small mass, oval shaped, non tender away from the lid marginFigure 2: The intra-operative findings showing a small mass measuring 7mm x 3mm x 2mm in size seen in (a-c)Figure 3: H and E image (200x) showing a cyst wall lined by stratified squamous epithelium (green arrow) without granular layer and dense laminated keratin (black arrow)Discussion Trichilemmal cyst or pilar cyst is a benign tumor of the skin, which forms from the outer root sheath of the hair follicle with a distinct pattern of keratinization without keratohyalin granules and may contain amorphous eosinophilic keratin.1 They are commonly found in the hairy regions, namely scalp and face.2 Involvement of the eyelid is rare, wherein the upper eyelid being the most common site. Elsewhere in the body, they usually present as a smooth, firm to hard, round, mobile nodule without a visible punctum. In the eyelid, they can be immobile and fixed to the tarsus. Literature search showed nine cases to date, none of which were in the pediatric age group.1–5 Most of these cases reported in adults were misdiagnosed as chalazion with a tendency to recur after incision and curettage.3 In our case, the growth was away from the lid margin, thus ruling out chalazion. While uncommon among the differentials for swellings in the eyelids in children, trichilemmal cysts should also be considered in atypical lesions. Authors contributions Lanalyn Thangkhiew: Concepts, Design, Definition of intellectual content; Literature search, Data acquisition, Manuscript preparation, Manuscript editing, Manuscript review, Guarantor; Subhankar Paul: Concepts, Design, Definition of intellectual content; Literature search, Data acquisition, Manuscript preparation, Manuscript editing, Manuscript review; Benjamin Nongrum: Concepts, Design, Definition of intellectual content; Literature search, Data acquisition, Manuscript preparation, Manuscript editing, Manuscript review, Guarantor; Sumanto Das: Definition of intellectual content, Data acquisition, Data analysis, Manuscript review. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/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.
Thangkhiew et al. (Thu,) studied this question.