Comments on: Clinicopathologic study of caruncular lesions

Dear Editor, We read with interest the article by Chinmayee J Thrishulamurthy et al.[1] entitled “Clinicopathologic study of caruncular lesions.” We would like to congratulate the authors for sharing their research on such a relatively rare topic. Their findings of novel lesions, such as malakoplakia and steatocytoma, broaden the spectrum of caruncular pathologies, which can otherwise give rise to a wide variety of pathological lesions and will be of great interest to readers. Despite being a well-conducted retrospective study, some of their claims warrant critical scrutiny and clarification. The authors mention this as the first study in the Indian scenario and on the Asian continent. This is incorrect, as we published an original article entitled “Clinical and histopathological profile of primary caruncular lesions” in this very journal in 2022.[2] Unfortunately, in the data presented in their table, they have not included the much larger dataset from our paper. The 42 cases reported in the abstract are listed as 44 in the article. While the abstracts cites the premalignant lesions as 11,36% and malignant ones as 4.54%, both are referred to as 7.5% in the discussion [Table 1]. None of the photographs provided have proper descriptions of either the clinical or histopathological lesions, especially Fig. 1f-h.[1] The authors have reported a case of malakoplakia and claimed it to be the first reported case from India; however, just a few sentences below in the same paragraph, they mention that the lesion was situated over the medial rectus. It is difficult to understand how a lesion situated on the medial rectus can be classified as a caruncular lesion. Their description suggests that the lesion was primarily of the medial rectus, which extended to the caruncle, and was not a caruncular lesion per se. The abstract mentions an impressive clinicopathological correlation of 84.09%, but no supporting evidence is provided in the body of the article. It is likely that some lesions were clinically misdiagnosed, but such information is lacking. In contrast, we provided a detailed analysis of all the clinically misdiagnosed lesions in our series on caruncular lesions.[2]Table 1: Comparison of the results of caruncular lesions by Thrishulamurthy et al.[ 1 ] and Alam et al.[ 2 ]Furthermore, their reported concentration of topical mitomycin-C at 0.2%, far exceeds the recommended 0.02 to 0.04%.[3] In their discussion, the authors hypothesize the role of testosterone and estrogen in the development of caruncular lesions but provide little rationale or supportive evidence. Although they mention that different caruncular tumors are common in different age groups, no data is provided to support this claim. Their comment regarding ‘limited statistical power’ due to a small sample size is unsubstantiated, as no analysis was conducted apart from descriptive reporting. They cite long-term outcomes as the strength of their study; however, there is no mention of the follow-up period anywhere in the article. In conclusion, for the benefit of the readers, we have added a table providing key information on caruncular lesions, comparing our study with the recently published one [Table 1]. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.