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The White Caruncle: Sign of a Keratinous Cyst Arising From a Sebaceous Gland Duct

Jakobiec, Frederick A MD, DSc; Mehta, Manisha MD; Greenstein, Scott H MD; Colby, Kathryn MD, PhD

doi: 10.1097/ICO.0b013e3181b55b5c
Case Report

Purpose: To describe an acquired, smooth white lesion of the caruncle and to underscore the role of subsurface keratinizing squamous epithelium in its formation.

Methods: Clinical photographic documentation, histopathologic evaluation, and immunohistochemical staining of an excised specimen from a 25-year-old woman.

Results: A cyst was found that was lined by keratinizing squamous epithelium without a keratohyaline layer (trichilemmal keratinization), typical of lesions of the pilosebaceous unit. A portion of the cyst's lining was replaced by granulomatous inflammation resulting from an earlier spontaneous partial rupture. Ki-67 immunolabeling demonstrated relatively few nuclei in S-phase (DNA synthesis) in comparison with the overlying epithelium, thereby suggesting an obstructive, nonproliferative cause for the cyst.

Conclusion: A white caruncular lesion is a very rare finding according to the literature. It is most likely caused by a cyst lined by squamous epithelium elaborating trichilemmal-type keratin. A sebaceous gland duct was established as the source for the current lesion.

From the *Department of Ophthalmology; †David G. Cogan Laboratory of Ophthalmic Pathology; ‡Comprehensive Ophthalmology Service; and §Cornea Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.

Received for publication May 29, 2009; accepted June 17, 2009.

Reprints: Frederick A. Jakobiec, MD, DSc, Director, David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114 (e-mail:

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