Abstract

Fibrous Papule in the Eyelid: Clinical and Histopathological Features - A Case Series of 13, Including Two Cases of Rare Histologic Variant

Fibrous papule (FP) or angiofibroma is a benign skin lesion that typically presents as a single, small, dome-shaped, skin-colored papule on the nose or central face. However, when located on a rare location like the eyelid, it may be misdiagnosed as other lesions clinically. Here, we report 13 cases of FP in the eyelid to summarize the clinical and histopathological features in this rare location. The majority of our patients were female (11/13) with an average age of 54 years (ranging from 25-68 years). The size of the lesions ranged from 1-6 mm with different colors. None of the patients had tuberous sclerosis complex, and only one case presented with multiple FP on the face with Birt-Hogg-Dube syndrome history. All cases shared common histopathological features of FP, and two cases displayed a unique feature with thin-walled blood vessels showing onion-like concentric perivascular arrangements of loosely arranged collagen and spindled fibroblasts. Trichrome staining reveals red spindled fibroblasts and endothelial cells amidst a background of circumferential light blue collagen and deep blue stroma. Additionally, CD34 immunohistochemistry accentuates perivascular spindled fibrocytes and background stromal fibrocytes. These findings as a distinct histologic variant has been documented in a single case report in the literature. Our study provides insight into the clinical and histopathological characteristics of FP in the eyelid and highlights a rare variant of FP with a perivascular cuff feature.