THE DESCRIPTION OF AN ADENOMA OF 
THE CARUNCLE 
A CONTRIBUTION FROM THE LABORATORY OF THE ALUMNI 
ASSOCIATION OF THE COLLEGE OF PHYSICIANS 
AND SURGEONS, N. Y. 
BY 
T. MITCHELL PRUDDEN, M.D. 
DIRECTOR OF THE LABORATORY; PATHOLOGIST TO THE MANHATTAN EYE AND EAR HOSPITAL 
NEW YORK 
[Reprinted from the Archives of Ophthalmology, Vol. xv., No. i, 1886] THE DESCRIPTION OF AN ADENOMA OF THE 
CARUNCLE. 
A CONTRIBUTION FROM THE LABORATORY OF THE ALUMNI 
ASSOCIATION OF THE COLLEGE OF PHYSICIANS 
AND SURGEONS, N. Y. 
By T. MITCHELL M.D., 
DIRECTOR OF THE LABORATORY ; PATHOLOGIST TO THE MANHATTAN EYE AND EAR HOSPITAL, 
NEW YORK. 
THE small tumor was removed at the eye clinic of the 
College of Physicians and Surgeons, New York, by 
Prof. Agnew, to whom the writer is indebted for the speci- 
men. It was removed from the inner canthus of the left eye 
of a woman seventy-four years of age, and had been growing 
slowly for seven years. It had given rise to inconvenience, 
but had caused no pain. It occupied the position of the 
caruncle. The gross and microscopical appearances which 
it presented after removal are as follows : 
The tumor is globular in form, about 4 mm. in width and 
5 mm. long, reddish and soft. On hardening in alcohol, it 
shrinks slightly, but preserves its general shape. On a 
transverse section through the middle of the growth, three 
tolerably distinct portions are visible to the naked eye: Ist, 
the tumor is surrounded by a thin dense portion having the 
appearance of a capsule ; 2d, the mass of the tumor, which 
is spongy in texture, and presents along the middle 3d a 
long, irregular, branching cleft or fissure, running from side 
to side. 
On microscopical examination, the central spongy portion, 
which makes up most of the mass, of the tumor, is seen to 
consist (see fig.) of a congeries of tubular branching struc- 
Reprinted from the Archives of Ophthalmology, VoI. xv., No. i, 1886. T. Mitchell Prudden. 
tures, having larger and smaller, mostly central, lamina, and 
running in all directions. These structures, which resemble 
tubular follicles, and are lined with cuboidal and cylindrical 
epithelium, appear to be without distinct membranser pro- 
priae. Between the follicular growths is a small amount of 
loose fibrillar connective-tissue stroma, containing a mod- 
erate number of flattened cells and a few thin-walled blood- 
vessels. The calibre of the lumen of these follicles is very 
variable. In some of them there is a small round opening, 
as seen on transverse section, while some are widely dilated, 
forming globular or irregular shaped cyst-like cavities, some 
of which are empty, some filled with granular material and 
fragments of degenerated and disintegrated cells. The 
general character is that of an atypical growth of branching 
tubular glands. The above-mentioned central fissure ap- 
pears to be one of the much-dilated irregular tubules, being 
lined with epithelium similar to that lining the smaller 
tubules. The glandular mass is surrounded by a compressed 
capsule of connective tissue, which contains a considerable 
number of dilated blood-vessels, and at one side a small 
cluster of fat cells. Among these fat cells are seen sections 
of tubules resembling the excretory portion of sweat glands. The Description of an Adenoma of the Caruncle. 
3 
In the connective-tissue capsule near the periphery are seen 
portions of a few hair follicles and small sebaceous glands. 
The whole is covered, except at the surface of attachment 
to the underlying tissues, with epithelium which presents 
the usual characters of that covering the caruncle, except 
that it is in places moderately thickened. No trace of the 
ordinary caruncular glands—the modified sweat glands of 
the Germans—can be found unless the above-mentioned 
excretory portion running through the fat tissue toward 
the surface may be considered as such. 
The tumor is accordingly an Adenoma of the Caruncle, 
apparently originating in the caruncular glands. 
The lesions of the caruncle as a separate structure have 
been very little described except in so far as they are apt 
to be associated with those of the conjunctiva and the plica 
semilunaris, and the writer has not found in the literature any 
record of a tumor of this part of the above character. On 
the contrary adenomata of the lachrymal gland are not so 
very infrequent. Although there is no intrinsic reason why 
adenomata of this part should not occur, this tumor seems 
worth recording partly because of its apparent rarity and 
partly because of the peculiar nature of the part in which it 
occurs. 
Owing to the multiplicity of structures which the caruncle 
presents and its—so to say—almost anomalous position, 
being an islet of skin thrust in on to the conjunctiva, some- 
times quite separate, sometimes still connected with adja- 
cent dermal structures ; • and furthermore, owing to the 
peculiar character of the caruncular glands themselves, 
which may be regarded as a transitional form of glands 
from one type to another, the occurrence of such a growth 
here may have some bearing upon the etiology of tumors in 
general, since it would tend to confirm the embryonal origin 
of tumors as suggested by Cohnheim. At any rate, in the 
present state of our knowledge of the etiology of tumors, 
the description of every sharply circumscribed tumor of 
this kind, which is so small and so separated from other 
similar structures as to permit of a satisfactory demonstra- 
tion of its exact origin, can hardly be without value. PUTNAMS’ PRINT