Purpose

To report a rare case of hidradenoma papilliferum (HAP) arising from the conjunctival caruncle and to expand the differential diagnosis of caruncular lesions by documenting the second case described in the ophthalmic literature.

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Methods

An elderly female patient presented with a progressively enlarging, painless cystic lesion of the left caruncle. Comprehensive ophthalmological examination was performed, followed by complete surgical excision under local anesthesia. The excised specimen underwent histopathological evaluation with hematoxylin–eosin staining to establish the definitive diagnosis.

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Results

Clinical examination revealed a well-circumscribed, cystic caruncular mass measuring approximately 1 × 1 cm, without globe involvement or restriction of ocular motility. The lesion was excised en bloc without complications. Histopathological analysis demonstrated a subepithelial cystic tumor with papillary architecture, lined by epithelial cells with eosinophilic cytoplasm and focal oncocytic features. The lesion was sharply demarcated and completely excised with clear margins. No evidence of atypia, inflammation, or malignancy was observed. The final diagnosis was hidradenoma papilliferum of the caruncle.

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Conclusion

Hidradenoma papilliferum is a rare benign adnexal tumor typically occurring in the anogenital region, with ocular adnexal involvement being exceptionally uncommon. Caruncular manifestation is extremely rare, with only one previously reported case in ophthalmic literature. This case highlights the importance of considering HAP in the differential diagnosis of cystic or nodular caruncular lesions. Complete surgical excision is curative, and histopathological examination remains essential for definitive diagnosis. Awareness of this rare entity is crucial for both ophthalmologists and pathologists when evaluating atypical caruncular masses.

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Additional Authors

First name	Last name	Base Hospital / Institution
Antonia	Hehr	Klinikum Kassel – Kassel – Germany
Irina	Berger	Klinikum Kassel – Kassel – Germany
Felix	Treumer	Klinikum Kassel – Kassel – Germany

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