Challenging Diagnosis in a Pediatric Eyelid Mass: Resection of a Subcutaneous Pyogenic Granuloma Versus Sarcoma.

Introduction: Pediatric eyelid masses pose a diagnostic challenge, with overlapping presentations between infectious, inflammatory, and neoplastic etiologies. Subcutaneous pyogenic granulomas (SPG), a rare variant, can mimic malignant tumors such as soft tissue sarcomas, leading to potential delays in appropriate management. This case report details the surgical resection of a rapidly growing pediatric eyelid subcutaneous mass, ultimately diagnosed as a subcutaneous pyogenic granuloma with histologic variation.

Methods: A 4-year-old male presented with a rapidly growing left upper eyelid mass. Ophthalmologic evaluation, ultrasonography, and orbital MRI with contrast were performed, revealing a highly vascular lesion. Due to rapid growth and concern for malignancy, the patient underwent a surgical biopsy with a frozen section, followed by complete excision. Intraoperative dissection was performed carefully to preserve surrounding eyelid structures.

Results: The excised mass measured ~2×3 cm and was highly vascular. Histopathology revealed anastomosing capillary nodules with mild mitotic activity and minimal atypia, consistent with SPG. At postoperative day 37, the patient showed no signs of recurrence.

Conclusions: Accurate diagnosis of pediatric eyelid masses is essential to guide treatment and avoid unnecessary morbidity. When clinical and imaging findings are inconclusive, surgical excision with histopathologic examination remains the gold standard. This case highlights the importance of a broad differential and multidisciplinary approach in managing pediatric eyelid lesions.