Cystic Panfolliculoma of the Eyelid

The authors present the second example of a cystic panfolliculoma of the eyelid. A woman in her early 90s presented with a worsening crateriform lesion of the left eyelid and the inferior edge of the eyebrow for approximately 1 year. The lesion fluctuated in size, was painless, and occasionally had a "scab" come off the lesion's surface with drainage of material. Excisional biopsy revealed a well-demarcated cystic panfolliculoma in the dermis, connected to the epidermis. The lumen contained corneocytes (squames) with a basket-weave pattern (infundibular differentiation), blue-gray corneocytes (inner sheath differentiation), and shadow (ghost) cells typical of hair differentiation. The cyst wall showed infundibular, isthmic, inner root sheath, matrical, and germinative cell differentiation. A focus of advanced follicular differentiation had germinative cells enclosing clear cells typical of outer sheath differentiation, surrounding inner sheath cells with eosinophilic trichohyalin granules. Cytological atypia and fully mature hair follicles were not identified. Immunohistochemical stains showed a predominance of cells with outer root sheath and germinative cell immunophenotypes. Panfolliculomas are rare neoplasms with peaks at 50 to 59 and 70 to 79 years, a 1.4:1 male-to-female ratio, and a predominantly scalp- and face-based distribution. There are 3 histological variants, nodular, superficial, and cystic, and all are benign without local recurrence following complete surgical excision.