Reactive Lymphoid Hyperplasia of the Eyelid

A 53-year-old female presented with a several-month history of a painless left eyelid lesion. Exam revealed a circumscribed pink 0.5 × 0.4 cm superficial papule in the central left upper eyelid superior to the tarsus (Fig. A). Excisional biopsy disclosed a lymphocyte proliferation (Fig. B) that was polytypic with a minority staining for the B-cell marker CD20 (Fig. C) and the majority staining for the T-cell marker CD3 (Fig. D). Gene rearrangement also confirmed polyclonality and the diagnosis of eyelid reactive lymphoid hyperplasia (LH). Systemic workup was negative and surveillance has shown the patient to be free of both local and distant disease during 14 months of follow-up. Although ocular adnexal LH is not uncommon, LH of the eyelid is exceptionally rare.A, Clinical photograph showing left upper lid papule. B, Histopathology of biopsy specimen displaying a polytypic proliferation of lymphocytes (H&E, 20X). The minority of cells stained with CD20 (C, 40X), while the majority stained with CD3 (D, 40X).