Syringocystadenoma papilliferum of the eyelid

Two patients presented with slowly developing papillated or hyperkeratotic lesions of their lid margins that began early in the fourth decade. Upon excision, these tumors were discovered to be examples of syringocystadenoma papilliferum, a lesion not previously well documented in the ophthalmic literature. By light microscopy, each tumor displayed surface poral openings where the epidermis underwent a transition into duct-like epithelium, which ramified as luminal channels throughout the tumor. Papillae projected into many of the duct-like spaces and were lined by columnar to multilaminar nonkeratinizing epithelium. A plasma cell-rich infiltrate was present in the connective tissue cores of the papillae. Electron microscopy performed on one of the lesions revealed that the channels were true ducts, with the innermost cells displaying microvilli, small numbers of tonofilaments, and apical junctional complexes composed of a zonula occludens and zonular adherens. These findings, coupled with the location of the tumors at the lid margin and the presence of dilated apocrine glands of Moll deep to one of the tumors, support an apocrine origin. The clinical differential diagnosis of syringocystadenoma papilliferum with respect to other more common lid tumors is discussed.