Ectopic Lacrimal Gland Underlying a Caruncular Nevus

      A 55-year-old man presented with an asymptomatic left pigmented caruncular lesion (Fig 1). The lesion was excised and histopathology (H&E) revealed non-keratinizing squamous epithelium containing goblet cells. Numerous large nests of bland-appearing nevus cells are seen in the superficial substantial propia (Fig 2, black arrows) creating pseudopapillae. Densely populated nevus cells (Fig 2, white arrow), pilosebaceous units, and lacrimal gland acini (Fig 2, asterisks) are seen below the nests. Ectopic lacrimal gland tissue is rare but has been reported in the orbit, lids, adnexa, and within the globe. Neoplastic transformation of the ectopic tissue may occur.
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