Track: Case Reports

Abstract:

A 38-year-old white male presented for Mohs Surgery consultation with a biopsy proven keratotic basal cell carcinoma (BCC) on the right cheek encroaching upon the lower eyelid and conjunctiva. During Mohs micrographic surgery (MMS), glandular proliferation and goblet cell hyperplasia were visualized on histologic sections, raising concern for an adnexal or mucinous carcinoma. Following referral for expert dermatopathological consultation, a final diagnosis of reactive pseudoglandular hyperplasia of the conjunctiva (PHC) in the setting of chronic conjunctivitis was made, likely having developed in response to longstanding irritation from the nearby carcinoma. This case represents only the sixth reported case of PHC and the first identified incidentally during MMS of an adjacent cutaneous neoplasm. PHC is a rare, benign reactive proliferation characterized by invagination of the conjunctival epithelium into the stroma, forming gland-like structures. Due to its histological resemblance to invasive neoplasms, such as mucoepidermoid carcinoma, PHC poses a significant diagnostic and clinical challenge. Only a handful of cases of PHC have been described and a diagnostic framework for this pathologic entity has not yet been sufficiently established. This report highlights the importance of increasing the awareness of this benign phenomenon and defining its histologic features to distinguish it from resemblant malignancies and avoid unnecessary surgery.

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Samantha Spence