Histopathological spectrum of ocular masses in a tertiary eye center in Northern China: a 12-year retrospective analysis

To characterize the clinicopathological spectrum of ocular masses diagnosed over 12 years at a tertiary referral center in Northern China and identify demographic and regional patterns relevant to clinical practice.

We retrospectively reviewed 1,345 ocular masses diagnosed at Jinan Second People's Hospital between February 2014 and July 2025. Cases were identified from pathology archives and included patients with surgical excision or biopsy and definitive histopathology. Data on age, sex, anatomic location, and mass type were analyzed. Classification followed AFIP atlas standards and ICD-O coding.

Of the 1,345 masses, 1,146 (85.2%) were non-malignant and 199 (14.8%) malignant. Lesions were located in the eyelid (35.2%), ocular surface (35.7%), intraocular region (1.8%), and orbit (27.3%). For eyelid masses, nevi (20.8%) and cysts (11.2%) were the most common non-malignant lesions, and basal cell carcinoma (55.6%) and sebaceous gland carcinoma (24.2%) dominated malignancies. For ocular surface masses, the top non-malignant lesions included cysts (20.0%) and inflammatory lesions (18.1%), and malignant melanoma (34.6%) and squamous cell carcinoma (26.9%) were the leading malignancies. Most intraocular masses (20/24) were malignant, and the majority was melanoma (16/20). For orbital masses, hemangiomas (21.1%) were the most frequent benign lesions, and lymphoma (51.9%) was the leading malignancy. The majority of malignancies occurred in patients aged > 60 years (132/199, 66.3%). Compared to patients aged 18-60 years, those aged < 18 years had significantly lower odds of malignancy (OR = 0.21, 95% CI 0.08-0.59), whereas those > 60 years had significantly higher odds of malignancy (OR = 3.29, 95% CI 2.37-4.56).

Most ocular masses were non-malignant. The overall risk of malignancy increased significantly after age 60, and this trend was primarily driven by extraocular lesions.