Purpose

To present an unusual case of a clinically presumed dermoid cyst of the brow, which on histopathological examination was identified as a lymph node harboring a low-grade B-cell lymphoma, highlighting diagnostic challenges in periocular lesions.

---

Methods

A 53-year-old female presented with a 3-year history of a painless, mobile mass beneath the left eyebrow, associated with upper lid heaviness but no visual or inflammatory symptoms. Clinical assessment suggested a benign lesion, most likely a dermoid cyst. Excision was performed and the lesion sent for histopathology.

---

Results

Histopathology unexpectedly demonstrated an 8 mm lymph node with features of low-grade B-cell lymphoma. The specimen lacked skin adnexa or adipose tissue, arguing against a subcutaneous lesion, and the location was atypical for facial lymphatic drainage. Specimen traceability was rigorously reviewed and confirmed correct.Clinical reassessment revealed no lymphocytosis on peripheral blood testing.The patient reported additional longstanding nodules on the left leg, previously inconclusive on ultrasound. Past medical history included treated right breast carcinoma (2012). She was referred urgently to haematology.

---

Conclusion

This case highlights how seemingly benign, longstanding periocular lesions may conceal underlying lymphoproliferative disease, even when clinical features strongly suggest a diagnosis such as a dermoid cyst.
It reinforces the importance of routine histopathological evaluation of all excised lesions and maintaining a broad differential diagnosis, even in lesions suggestive of dermoid cysts.
Additionally, it underscores the need for multidisciplinary collaboration when histological findings are discordant with clinical expectations, as well as maintaining diagnostic vigilance to ensure timely recognition and management of potentially systemic disease.

---

Additional Authors

First name	Last name	Base Hospital / Institution
Hong Kai	Lim	Maidstone and Tunbridge Wells NHS Trust
Christina	Lim	Maidstone and Tunbridge Wells NHS Trust
Sarju	Athwal	Maidstone and Tunbridge Wells NHS Trust
Allan	Nghiem	Maidstone and Tunbridge Wells NHS Trust

↑ Back to top