Author:Dr. Giri Nilesh Junior Resident Dept Of Ophthalmology, Dr. Pdmmc

1. Author:
Dr. Giri Nilesh
Junior resident
dept of ophthalmology
Dr. PDMMC

2.  Lid masses are commonly encountered cases in ophthalmology
OPD and the diagnosis of the underlying pathology can be easily
made based on detailed history and detailed local examination of the
mass, and the line of management can be decided.
 We report a very interestingly unusual presentation of a single,
solitary, giant, non-umbilicated lesion on R.E. upper eyelid of a
immunocompetent, middle-aged male patient causing mechanical
ptosis, the mass could be easily separated from overlying skin during
complete excision biopsy which showed a never described before
whitish brain like appearance consisting of multiple lobes and gyri,
which histopathologically proved to be molluscum contagiosum
(M.C) lesion.

3.  A 35 y/o male patient, farmer by occupation, was referred from
skin VD OPD to ophthalmology OPD with c/o:
Mass over RE Upper Eyelid since 1 year
for excision of mass ? Wart.

4. Pt was a/a 1 yr back when he started developing mass over RE upper
eyelid which was gradual in onset, painless, and progressively
increasing in size.
Since last 3 to 4 months the size of the mass increased relatively rapidly
to current size.
No h/o trauma
No h/o pain or redness in the mass
No h/o discharge from the mass
No h/o redness in the eye
No h/o similar complaints in LE
No h/o similar compaints elsewhere
No h/o sudden change in the appearance or contour of the mass.
No h/o similar complaints in the past
No h/o HTN/ TB/ DM/ BA or any other major illness in the past
No h/o ocular surgery in the past.
Patient is a tobacco chewer since 15 yrs, denies any other addiction.
d/d on history:
Chalazion, Lipoma, Meibomian
gland adenoma,
Neurofibroma, Meibomian
gland Carcinoma,
Sebaceous cyst, Dermoid
cyst, Foreign body
granuloma.

5. PARAMETER RE (ocular examination) LE
V/A (U/A) 6/18 6/18(P)
(With Pin Hole) 6/9 6/9
Lids :
Upper eyelid Single, well defined Mass ms 1.3 x 1.2x 0.4
cm.
4 mm nasally from lateral canthus , 3 mm
above lid margin.
Rest eyelid: within normal limits.
Normal
Lower lid Normal Normal
PAH Reduced (by 0.2 cm ) due to mechanical
ptosis caused by the U.L. mass.
Normal
Conjunctiva Normal Normal
Cornea clear Clear
Anterior chamber Normal depth Normal depth
Pupil NSRL NSRL
General & systemic examinations: Within normal limits,
physician fitness taken.
ON OCULAR EXAMINATION:

6. On detailedlocalexamination:
 Right eye upper eyelid shows a single, solitary, non-tender, well defined
mass 1.3 x 1.2 x 0.4 cm firm in consistancy, non tender, Smooth, with
well defined margins, with no punctum.
 The overlying skin was tense, shiny.
 Getting under the mass was not possible.
D/D on examination
1)Chalazion (due to tarsal
location of the swelling)
2) lipoma (universal tumor, firm
consistency)
3) Meibomian gland adenoma (tarsal
location)
4) Neurofibroma (appearance, soft to
firm, brown)
We rule out on
examination:
Meibomian gland Ca.(no
extension)
Sebaceous cyst
(no punctum or
inflammation)
Dermoid cyst.(location)
Foreign body granuloma.(no
scar)

7. MANAGEMENT:
•Decision was made to perform an excisional biopsy of the mass.
•Under all aseptic precautions and local anaesthetic infiltration,
excisional biopsy was performed by following steps:
1) A chalazion clamp was applied around the mass for hemostasis.
2) A skin incision was made along the lid crease, the skin was
undermined over the mass which was unexpectedly easy in view of its
adherence to mass on preoperative examination and the mass was
easily separated from the underlying orbicularis muscle.

8. INTRAOPERATIVE
PICTURE
SHOWING
INTERESTINGLY BRAIN
LIKE GYRI AND SULCI.
 The mass was removed in toto.
 primary skin closure was done
using vicryl 4-0
 The excised mass was
white in color and,
interestingly, had brain
like appearance
morphologically. It had
multiple lobes and gyri
like corrugations over its
surface as shown in Fig

9. Histopathological evaluation showed typical epithelial hyperplasia and
intracytoplasmic inclusion bodies and gave us the diagnosis of
molluscum contagiosum.
Courtesy: dept of
pathology Dr
PDMMC

10. A Briefoverview of molluscum contagiosum (M.C.)
•It is a benign, self-limiting, epidermal, contagious viral infection.
•Causative virus: A DNA pox virus , the molluscipox virus and has features intermediate
between the orthopox and parapox groups.
•PCR identified two main types, MCV-1 and MCV-2, with two much rarer types, MCV-3
and MCV-4.
It infects humans, causing characteristic skin papules, more seen in children.
Painless papular eruptions with multiple umbilicated cutaneous lesions of
5 to 8 mm and very rarely >10 mm ( giant M.C. lesion)
Can occour in any body area except palms and soles (atypical, if present).
Rare sites include eyelids, lips and mouth.
•The age of peak incidence is reported as between 2 and 5 years, A later incidence peak in
young adults is attributable to sexual transmission with lesions more common in the
genital area. Higher incidence has been noted in immunocompromised states suggesting
role of cell mediated immunity.
•Cells at the core of the lesion show the greatest distortion and are ultimately destroyed,
and appear as large hyaline bodies (molluscum bodies) some 25 µm in diameter,
containing cytoplasmic masses of virus material {pathognomic}

11. .
 Destroy the infected epidermal cells by Stimulating an immunological
response
 Act directly against the virus (Cidofovir)
 Surgical removal of molluscum contagiosum by curettage has been used for
many years
 Cryotherapy/ Photodynamic therapy
What made this case unique??
 Age ( adult)
 solitary lesion(no crops)
 Unusual ( rare ) location
 Absence of umbilication
 Size of the lesion (>1o mm)
 Immunocompetent status.

12.  Solitary giant MC, although a rare condition in immunocompetent patients, should be suspected
even if central umbilication is not found in the lid tumor.
 Complete excision of the mass is an easy and effective mode of treatment and
 White brain like appearance of the removed tissue may further point towards the diagnosis of MC.
Only one such case with similar brain like appearance has
been published in the Indian Journal of Ophthalmology and
that too was reported in pediatric age group.
References:
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