The clinicopathological spectrum of benign peripunctal tumours

Purpose: Because of the rarity of peripunctal tumours and their clinical classification as conjunctival or eyelid tumours, they have gained little attention in the literature. We conducted a retrospective study to illustrate the different clinical and histopathological spectrum of peripunctal tumours seen at two oculoplastics clinics. Methods: In a retrospective interventional clinicopathologic case series study, all the charts of patients with peripunctal tumours presented at an ophthalmic oncology clinic in Jerusalem, Israel and an oculoplastics clinic in Boston, USA were reviewed. The tumours were classified as epithelial and non-epithelial tumours. The symptoms caused by these tumours, their pattern of growth and their management were evaluated. Results: Fourteen peripunctal tumours were identified. Eleven out of 175 (6.3%) peripunctal disorders and out of approximately 4, 000 (0.27%) surgical oculoplastics patients were seen at Massachusetts Eye & Ear Infirmary, Boston. Three were seen at Hadassah University Hospital, Jerusalem. Seven histopathological types of peripunctal tumours of epithelial, subepithelial or melanocytic origin causing punctal occlusion or displacement were identified. The tumours included compound and junctional naevi, non-pigmented compound naevus, epithelial, subepithelial inclusion cysts, verrucous and squamous papilloma, pyogenic granuloma and oncocytoma. All the tumours were benign. They involved the peripunctal or canalicular epithelium, the adjacent skin, the glandular epithelium or the subepithelium. They presented as a peripunctal mass or were accidentally disclosed but none of them resulted in epiphora. Conclusions: Peripunctal tumours are rare. They exhibit different clinical types of growth and may be difficult to diagnose based on their clinical appearance alone. The location of peripunctal tumours potentially allows their extension from the conjunctival sac into the canaliculus and vice versa. Therefore, it is best to ascertain free margins when the tumour is excised.