An unusual eyelid swelling – Tarsoconjunctival complex choristoma

A 25-year-old male presented with painless, progressive swelling in the medial aspect of the left upper lid for 2 years which resulted in drooping of the lid [Fig. 1a]. There was no history of trauma and no known systemic disorder. Family and birth history were unremarkable. Best corrected visual acuity in both eyes was 6/6 in both eyes. Examination revealed fullness of the left upper eyelid medially and mechanical ptosis. On lid eversion, there was a well-defined yellowish-pink lobular vascular conjunctival mass with a variegated surface appearance involving medial upper tarsal conjunctiva, extending till fornix with few hair follicles on the surface [Fig. 1b]. It was mobile and soft on palpation. The rest of the ophthalmic examination was within normal limits. Bilateral preauricular skin tags were noted, suggestive of possible Goldenhar syndrome, though systemic evaluation did not reveal any abnormality [Fig. 1c and d]. Orbital CT scan results indicated no orbital extension. He subsequently underwent an excision biopsy of the eyelid mass with reconstruction of the defect with amniotic membrane grafting. Histopathological examination showed adipose tissue, salivary glands with cystic spaces, adnexal structures, and hair follicles within the lesion, suggestive of complex choristoma of the tarsal conjunctiva [Fig. 1e and f]. On follow-up, the excision site had healed with no recurrence.Figure 1: Clinical and histopathological findings in a patient with eyelid tarsal conjunctival complex choristoma. Medial upper eyelid fullness and swelling causing mechanical ptosis (a). Yellowish-pink, soft, tarsal conjunctival mass noted on eyelid eversion, reaching till fornix with a variegated appearance of the conjunctival surface (b). Bilaeral pre auricular skin atags (c, d). Histopathology of the excised mass (H and E, 40×) showed cystic spaces with adipose tissue and salivary gland (e) and adnexal structure and hair follicle within the mass (f) suggestive of complex choristomaDiscussion Complex ocular choristoma is exceedingly rare, with tarsal conjunctival choristoma being even more so. In a literature search, three case reports of tarsal conjunctival choristoma with lacrimal gland tissue and osseous components were found.[1-3] They are characterized by the presence of at least two germ layers and have syndromic associations. Eyelid complex choristoma involving tarsal conjunctiva can mimic chalazion and pyogenic granuloma.[4] Our cases highlight the unusual site and presentation of complex choristoma as an eyelid mass involving tarsal conjunctiva without any other ocular abnormality. This entity should be considered in the differential diagnosis of eyelid mass with a variegated appearance of the conjunctival surface, especially in patients with pre-auricular skin tags or other associated systemic findings. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.