Apocrine hydrocystoma of the bulbar conjunctiva: a case report

The purpose of the study was to demonstrate a clinical case of apocrine hydrocystoma (AH) of the bulbar conjunctiva and the features of clinical and morphological diagnostics of this disease. Clinical observation. A 55-year-old woman complained of a painless lesion in the nasal sector of the bulbar conjunctiva of the left eye that had existed for about 30 years and that had not increased in size and retained a stable shape and color, but in the last year, discomfort appeared when blinking. Slit-lamp biomicroscopy revealed a yellowish-gray cystic lesion up to 3.5 mm in diameter, raised above the surface of the eye at 9 o’clock at a distance of 1.5 mm from the limbus. It was painless on palpation, tightly connected to the conjunctiva, and easily displaced within the underlying tissues. Optical coherence tomography (OCT) of the anterior segment of the eye showed that the lesion consisted of several vesicles filled with medium-reflectivity fluid surrounding a central zone with a fine-mesh structure and areflexive zones. An atypical epithelial inclusion cyst of the bulbar conjunctiva was suspected. Under local anesthesia, the lesion was excised within the intact surrounding tissues. Microscopic examination revealed structural changes characteristic of bulbar conjunctival AH, including PAS-positive staining of the cavity contents. Immunohistochemical (IHC) analysis of the material demonstrated expression of SMA, CK7, CDGFP-15 and p63 by the cells lining the cystic formations. Analysis of the results of the clinical and morphological examination and IHC study of the tissue material made it possible to diagnose multilocular subepithelial AH. During the control examination after 2 weeks, restitution of the epithelium in the projection of the surgical wound with no signs of inflammation was recorded. Conclusion. The modern standard for diagnosing AH of the bulbar conjunctiva is a morphological examination of the removed tumor, indicating the origin of the neoplasm from the epithelial cells of the sweat glands. If a cystic formation is detected in the bulbar conjunctiva, it is advisable to include AH in the differential diagnostic spectrum with subsequent structural analysis of the tissue material.

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