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Clinicopathological Features and Surgical Treatment of Intratarsal Keratinous Cysts

Zhang, Zong-Duan, MD; Li, Xiang, MD; Li, Mei, MD; Zhao, Jing, MD; Zhou, Kai-Jing, MD; Qu, Jia, MD

The American Journal of Dermatopathology: February 2013 - Volume 35 - Issue 1 - p 78–82
doi: 10.1097/DAD.0b013e31825d9d0d
Original Study

Purpose: To explore the clinical and histopathologic features and surgical outcome of intratarsal keratinous cyst (IKC).

Methods: The clinical findings, histopathologic evaluations, and immunohistochemical studies in 15 cases of IKC were investigated, retrospectively.

Results: Fifteen patients with an average age of 44.7 years had noninflamed eyelid cysts sized 1–6 mm in diameter. The cysts appeared as solid, whitish opalescent or yellow-white, mildly elevated lesions beneath the palpebral conjunctiva. The cysts embedded in the tarsus were completely excised with a portion of the adjacent tarsus by a surgical procedure through palpebral conjunctival approach. Histopathologic evaluations revealed stratified squamous epithelium linings and keratin contents, which were not identical to the common epidermal or epidermoid cysts. The results were negative for Alcian blue and periodic acid–Schiff staining and showed positive correlation to the immunoreaction for epithelial membrane antigen. No recurrence occurred in all patients who had their lesions removed completely.

Conclusions: Our study revealed the clinical and pathological characteristics of IKC, including the absence of inflammatory sign, lesion partially embedded in the tarsus and protruding beneath the conjunctiva with the intracystic keratinous contents, stratified squamous epithelium linings, string-like keratin contents from the histopathology sections, and strongly immunoreactivity to antibodies against epithelial membrane antigen. A complete excision of cysts with adjacent tarsectomy by transconjunctival approach was proved to be an effective treatment for prevention of recurrence.

Eye Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China.

Reprints: Jia Qu, MD, Department of Ophthalmology, Eye Hospital of Wenzhou Medical College, 270 Xueyuan Rd, Wenzhou, Zhejiang 325027, China (e-mail:

Supported by the Department of Science and Technology Of Zhejiang Province, Hangzhou, China, grant 2011C33019.

The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.