Interactive Case Study - 06- June 2024

Odd solitary plaque in the right lower eyelid

Arkar Htoo, MD

Rose Sneha George, MD

Aimi Toyama Rothrock, MD

A 66-year-old female presented with an indurated plaque under her right lower eyelid (Figure 1). The patient denied numbness, changes in vision, eye pain, respiratory problems, or bruising. A 4 mm punch biopsy showed the following histomorphology (Figure 2A-B). Colloidal iron and Alcian blue (before and after hyaluronidase digestion) stains are also provided (Figure 3A-B).

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Figure 1. A unilateral, horizontal plaque was seen in the right lower eyelid.

Figure 2. H&E staining showed granulomatous inflammation within the mid to deep dermis and extending into the subcutis (A, 20x). Histiocytes are seen palisaded around aggregates of acellular, slightly basophilic, glassy material (B, 100x).

Figure 3. Colloidal iron (A, 40x) and Alcian blue pH 2.5 (without hyaluronidase) (B, 40x) revealed positive staining of the mucin-like material. The absence of the material (black arrows) was noted upon addition of hyaluronidase digestion prior to staining with Alcian Blue pH 2.5 (inset, 100x).

What pertinent clinical history/findings would best correspond to the histopathologic findings seen in this case?

Bilateral, symmetrical hilar, and paratracheal lymphadenopathy on chest radiograph (CXR)

Clinical suspicion of scleromyxedema

Multiple annular plaques on the hands and feet

Patient went on a recent bat watching tour in the Mississippi River Valley

Prior history of facial filler administration

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Acknowledgements

Author Profiles

Arkar Htoo, MD

Department of Pathology and Laboratory Medicine, Albany Medical Center

Arkar Htoo, MD is a fourth-year pathology resident at Albany Medical Center with a subspecialty interest in dermatopathology. His primary interest within dermatopathology is in melanocytic lesions. Currently, he and his mentor (Aimi Toyama Rothrock, MD) are conducting research studies regarding the biologic behavior, immunohistochemical and molecular expression of melanocytic lesions. He has done dermatopathology electives under Dr. Phelps at Mount Sinai New York and Dr. LeBlanc at Dartmouth-Hitchcock Medical Center. He is currently seeking dermatopathology fellowship.

Rose Sneha George, MD

Department of Pathology and Laboratory Medicine, Albany Medical Center

Rose Sneha George, MD is a fourth-year pathology resident who will be pursuing her subspecialty fellowship in genitourinary pathology at MSKCC. She also has a special interest in Dermatopathology and is actively involved in helping colleagues with Dermatopathology related research activities.

Aimi Toyama Rothrock, MD

Department of Pathology and Laboratory Medicine, Albany Medical Center

Aimi Toyama Rothrock, MD, is currently a member of the faculty at Albany Medical Center. She completed Dermatopathology fellowship training at the University of Texas MD Anderson Cancer Center following Anatomic and Clinical Pathology residency at the University of Minnesota.

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Interactive Case Study - 06- June 2024

Acknowledgements

Author Profiles

Odd solitary plaque in the right lower eyelid

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