Reconstrucción palpebral luego de una resección total por cáncer / Palpebral reconstruction after total resection due to cancer

Introducción: La incidencia de los tumores malignos palpebrales varía según las diferentes razas. Su frecuencia aumenta con la edad y su aparición está relacionada con factores genéticos, virales y ambientales. Objetivo: Presentar un caso con una lesión tumoral en el párpado inferior al que se le realizó la reconstrucción palpebral luego de una resección parcial por cáncer con técnica combinada que incluyó Mustardé e injerto de mucosa. Presentación de caso: Paciente masculino de 76 años de edad con antecedentes de salud. Hace un año atrás comenzó a presentar una lesión endurada en el párpado inferior izquierdo hacia el canto interno del ojo, que fue aumentando de volumen, con una ulceración posterior. En el examen físico se observó una lesión ulcerada y sucia de aproximadamente 2 ( 2,5 cm, que comprometía los 2/3 mediales del parpado inferior, incluyendo la vía conducto lagrimal. Tras la intervención quirúrgica la extirpación creó un defecto correspondiente a la ausencia en todos los planos anatómicos en casi la totalidad del párpado inferior izquierdo, por lo que se planeó un colgajo de avance de la mejilla. El estudio histopatológico confirmó un carcinoma epidermoide completamente resecado. Conclusiones: Esta cirugía combinada permitió una exéresis amplia del tumor con el margen oncológico requerido y la sustitución aproximada de las estructuras del párpado. Se lograron una funcionabilidad adecuada y una cubierta del globo ocular óptima en su porción inferior, además de armónico con el contralateral(AU)

Introduction: The incidence of palpebral malignant tumors varies according to different races. Its frequency increases with age and its occurrence is related to genetic, viral and environmental factors. Objective: To present a case with a tumor lesion in the lower eyelid, who underwent palpebral reconstruction after a partial resection due to cancer with a combined technique including Mustardé and mucosal graft and its clinical evolution. Case presentation: 76-year-old male patient with a medical history. One year ago he began to present an indurated lesion on the left lower eyelid towards the inner canthus of the eye that was increasing in volume, with subsequent ulceration. Physical examination revealed an ulcerated and dirty lesion of approximately 2 ( 2.5 cm involving the medial 2/3 of the lower eyelid, including the lacrimal duct. After surgery the excision created a defect corresponding to the absence in all anatomic planes in almost the entire left lower eyelid, so a cheek advancement flap was planned. Histopathologic study confirmed a completely resected epidermoid carcinoma. Conclusions: This combined surgery allowed wide excision of the tumor with the required oncologic margin and approximate replacement of the eyelid structures. Adequate functionality and optimal eyeball cover was achieved in its lower portion, as well as harmonic with the contralateral one(AU)

Clinical Characteristics of Benign Eyelid Tumors

PURPOSE: To report the relative frequency and clinical characteristics of patients with benign eyelid tumors. METHODS: A retrospective study of 192 consecutive patients admitted to Korea University Ansan Hospital with benign eyelid tumor between January 2009 and December 2014 was undertaken, and clinical records including age, sex, involved site, and pathology of tumors were reviewed retrospectively. All eyelid tumors were confirmed histopathologically. RESULTS: The sexual distribution revealed 87 males and 105 females with benign eyelid tumors. The mean age at diagnosis was 42.6 +/- 19.2 years. Molluscum contagiosum (5.5 +/- 3.5 years) and pilomatrixoma (14.0 +/- 15.6 years) were generally found in younger individuals, while seborrheic keratosis (60.2 +/- 15.8 years) and squamous cell papilloma (50.5 +/- 13.4 years) occurred predominantly in elderly patients. Tumors were most common on the upper lid (63.0%). The four most frequent subtypes were melanocytic nevus (37.5%), epidermal cyst (8.3%), squamous cell papilloma (5.7%), and seborrheic keratosis (5.2%). CONCLUSIONS: The most common histopathological diagnosis of benign eyelid tumors was melanocytic nevus. The results of this study provide epidemiological information that will be useful for diagnosis and therapy of such tumors.

A Case of Intravascular Papillary Endothelial Hyperplasia of Eyelid

PURPOSE: To report a case of intravascular papillary endothelial hyperplasia of the eyelid. CASE SUMMARY: A 30-year-old male presented with a right upper eyelid mass, which had been growing in size for three years. The mass was about 7 mm in diameter, purplish, spherical, and cystic. Incision and drainage were performed, but the cystic mass instantly refilled with blood. Excisional biopsy was performed. On microscopic examination, a myriad of small delicate papillae projections into the dilated vascular lumen with organizing thrombus were noted. Each papilla was lined with a single layer of endothelial cells, surrounding a collagenized core. The endothelial cells were reactive for CD31 on immunohistochemical staining. There were focal areas of frequent mitoses, but neither cytological atypia nor necrosis was found. Hence, the lesion was diagnosed as intravascular papillary endothelial hyperplasia. CONCLUSIONS: Intravascular papillary endothelial hyperplasia in the periorbital area is rarely reported, and it is important to distinguish it from hemangioma or angiosarcoma. Complete surgical excision is necessary to prevent recurrence. The authors report a case of intravascular papillary endothelial hyperplasia of the upper eyelid, which should be considered in the differential diagnosis of eyelid or orbital tumor.

A Case of Metastatic Colonic Adenocarcinoma of the Eyelid

PURPOSE: To report a metastatic colonic adenocarcinoma in the left upper eyelid. CASE SUMMARY: A 73-year-old male presented to our clinic with a palpable mass in his left upper eyelid that had appeared 10 days prior. The patient had a history of colon cancer that was diagnosed 2 years previously with liver and lung metastases, and he had underwent colon resection followed by chemotherapy. A 10.7 x 14.7 x 9.0 mm mass was observed on orbital computed tomography and a biopsy confirmed that the mass was a metastatic colonic adenocarcinoma. Because radical resection of the mass could not be performed, a debulking surgery was performed instead. The patient was followed up while receiving conservative treatment, but he died 3 weeks after surgery. CONCLUSIONS: Metastatic tumors in the eyelids are very rare and colonic adenocarcinoma metastases in the eyelids are even less common. Thus, a biopsy examination and appropriate treatment should be administered to patients with a history of malignancy who present with an eyelid mass.

Clinicopathological Characteristics of Malignant Eyelid Tumor in Korea

PURPOSE: To determine the clinical characteristics of patients with malignant eyelid tumors in Korea. METHODS: We performed a retrospective review of the medical records of 73 patients with malignant eyelid tumors who were histologically diagnosed at Seoul St. Mary's hospital from April 2004 to September, 2012 and followed for 6 months or longer. RESULTS: Of 73 cases, 41 (56.2%) were diagnosed as basal cell carcinoma, 17 (23.3%) as squamous cell carcinoma, 11 (15.1%) as sebaceous gland carcinoma, 3 (4.1%) as malignant melanoma, and 1 (1.4%) as basosquamous cell carcinoma. The mean age at diagnosis was 68.4 +/- 11.5 years. Tumors developed more commonly on the lower lid (54.8%). Most cases were treated by complete resection of tumors and eyelid reconstruction (95.9%). The prognosis of patients with basal cell carcinoma and squamous cell carcinoma was good, while that of the other tumors was relatively poor. CONCLUSIONS: The most common diagnosis was basal cell carcinoma (56.2%). Recurrence after complete surgical excision and reconstruction was uncommon.

Eccrine Ductal Carcinoma Arising in the Eyelid

PURPOSE: Eccrine ductal carcinoma is an extremely rare tumor that arises in the eccrine sweat glands. The authors of the present study describe a case of an eyelid mass diagnosed as eccrine ductal carcinoma. CASE SUMMARY: A 74-year-old woman visited our institute with a 3-month history of a mass in the left medial canthus. The lesion appeared as a solitary nodule with central ulceration. A magnetic resonance imaging (MRI) of the orbit showed a relatively well enhanced 0.8 cm x 0.8 cm-sized ovoid soft tissue mass. A mass excision was performed under frozen section control. The tumor was completely excised with margin clearance and medial canthal reconstruction was performed. Histopathological examination revealed a tumor composed of numerous duct-like structures lined with pleomorphic cuboidal epithelium that was diagnosed as eccrine ductal carcinoma of the eyelid. CONCLUSIONS: This is the first description of eccrine ductal carcinoma in a patient in Korea. The possibility of the eccrine ductal carcinoma should be considered in the differential diagnosis in an elderly patient with an eyelid mass.

Caracterización clinicoepidemiológica de pacientes con tumores palpebrales malignos / Clinical and epidemiological characterization of patients with malignant eyelid tumors

Se efectuó un estudio observacional, descriptivo y transversal de 61 pacientes con tumores palpebrales malignos, atendidos en la consulta de Oftalmología del Instituto Nacional de Oncología y Radiobiología de Ciudad de La Habana, durante el 2011, a fin de caracterizarles según variables clinicoepidemiológicas de interés para la investigación. En la serie, los más afectados fueron el sexo masculino (68,6 por ciento) y los pacientes de piel blanca (86,9 por ciento); predominaron el grupo etario de 61-70 años (37,0 por ciento), el carcinoma basocelular como el tumor palpebral maligno más frecuente (73,8 por ciento) y la agricultura como la labor fundamental que realizaban los enfermos (67,2 por ciento)

An observational, descriptive and cross-sectional study was conducted in 61 patients with malignant eyelid tumors, treated at the Ophthalmology Department of the National Institute of Oncology and Radiobiology, Havana, during 2011, in order to characterize them according to clinical and epidemiological variates of interest to research. Male sex (68.6 percent) and white patients (86.9 percent) were the most affected in the series. Also, the age group of 61-70 years (37.0 percent), basal cell epithelioma as the most frequent malignant eyelid tumor (73.8 percent) and agriculture as the essential work performed by patients (67.2 percent) prevailed

A Case of Primary Eyelid Peripheral T-Cell Lymphoma, Not Otherwise Specified

PURPOSE: To report a case of primary peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), of the eyelid. METHODS: A 48-year-old healthy male patient presented with a mass on the upper lid of 2 months in duration. The lesion was reddish, well-demarcated, oval shaped, and measured approximately 8 x 4 mm. The mass did not respond to incisional drainage and intra-lesional triamcinolone. An excisional biopsy for diagnosis was performed. RESULTS: On microscopic examination, a localized dense lymphocytic infiltration was observed in the subepithelial area, and cytologic atypia was observed under high power. On immunohistochemical examination, tumor cells were positive for CD3 but negative for CD20, CD30, CD56, k-light chain immunoglobulin, lambda-light chain immunoglobulin, and increased Ki-67 activity was noted. A histopathological diagnosis of PTCL-NOS was made. CONCLUSIONS: PTCL-NOS, which rarely occurs on the eyelids, commonly accompanies generalized lymphadenopathy and "B symptoms" such as fever and weight loss. Herein, the authors report a case of PTCL-NOS of the eyelid presenting as a rapidly growing solid mass in an otherwise healthy patient.

A Case of Eyelid Steatocystoma

PURPOSE: To report a case of eyelid steatocystoma. CASE SUMMARY: A 65-year-old woman presented with a mass around the punctum in the right lower eyelid margin, which developed several years earlier. The mass was a light yellowish cystic nodule and there were no other ocular abnormalities. Under local anesthesia, the mass was completely excised. Histopathologic examination showed a cyst surrounded by stratified squamous epithelium and a sebaceous duct which entered the hair follicle, compatible with the diagnosis of steatocystoma. CONCLUSIONS: Steatocystoma should be considered as a differential diagnosis of a solitary cystic eyelid tumor.

A Case of Muir-Torre Syndrome

PURPOSE: To present a rare case of Muir-Torre syndrome characterized by the association of sebaceous skin tumors and systemic malignancies. CASE SUMMARY: A 65-year-old female visited our clinic with an irregular nodular mass of the right lower eyelid, which developed 1 year earlier. An excisional biopsy and lower lid reconstruction with Tenzel's semicircular rotational flap was performed under local anesthesia. Histopathologic examination showed well-differentiated sebaceous cells, consistent with sebaceous adenoma. The patient had undergone total abdominal hysterectomy and lower anterior resection due to endometrial cancer and sigmoid colon cancer 5 years before, and nephroureterectomy due to papillary urothelial carcinoma 3 years before. Based on the history of systemic malignancy and sebaceous skin cancer, a diagnosis of Muir-Torre syndrome was made. CONCLUSIONS: When a sebaceous gland tumor of the eyelids is detected, Muir-Torre syndrome should be included in the differential diagnosis, and systemic work-up for the internal malignancy must be performed.

A Case of Nodular Fasciitis in the Upper Eyelid

PURPOSE: To report a rare case of nodular fasciitis in the upper eyelid. CASE SUMMARY: A 42-year-old woman presented with rapid enlarging mass, 15x12 mm in size at left upper eyelid. Orbit CT disclosed an enhanced, well-circumscribed preseptal lid mass. The histopathologic and immunohistochemical analyses after excisional biopsy were consistent with nodular fasciitis. There was no recurrence of the tumor after excision. CONCLUSIONS: For rapidly enlarging lid mass, nodular fasciitis should be considered as a differential diagnosis of sarcoma.

Juvenile Xanthogranuloma Presenting as a Nodule of the Eyelid

PURPOSE: To report one case of juvenile xanthogranuloma presenting as a unilateral nodule of the eyelid. CASE SUMMARY: A 4-year-old girl presented with a solitary eyelid nodule. There were no other ophthalmologic problems. Excisional biopsy and simple wound closure were performed. A biopsy showed intense infiltration of histiocytes, lymphocytes, and multinucleated giant cells in the dermis, which was compatible with juvenile xanthograunuloma. CONCLUSION: Juvenile xanthogranuloma should be considered in the differential diagnosis of a solitary eyelid tumor.

Primary Cutaneous Anaplastic Large Cell Lymphoma of the Lower Lid

PURPOSE: Primary cutaneous anaplastic large cell lymphoma is rarely encountered in the lower eyelids. We report a patient with primary cutaneous anaplastic large cell lymphoma arising from the lower eyelid. METHODS: A 39-year-old man presented with a relatively fast growing mass on the center of his left lower eyelid for one month. The mass did not respond to local injection of triamcinolone at a local clinic. The lesion appeared as a solitary reddish nodule with ulceration, was non-tender, round, crusted, and measured 13 mm x 11 mm x 5 mm. Well- developed superficial vessels were found on the surface of the nodule. An incisional biopsy was performed. RESULTS: Histologic examination revealed that the bulk of the infiltrate was in the papillary and reticular dermis. Tumor cells had abundant, well-defined cytoplasm and pleomorphic nuclei with multiple nucleoli. The majority of the neoplastic cells showed immunoreactivity for CD 30 (Ki-1) along the cell membrane. A histopathological diagnosis of primary cutaneous anaplastic large cell lymphoma was made. CONCLUSIONS: Most cases of primary cutaneous anaplastic large cell lymphoma arise from the body and extremities. However, since primary cutaneous anaplastic large cell lymphoma may occur in the eyelid, it should be differentiated from nodular and relatively fast growing inflammatory tumors despite local steroid treatment.

Preoperative Evaluation of Eyelid Tumor by Ultrasound Biomicroscopy

PURPOSE: To evaluate the extent of lesion by using ultrasound biomicroscopy in eyelid tumor. METHODS: We retrospectively analyzed 17 patients with eyelid tumor, who had undergone preoperative ultrasound biomicroscopy to access the extent of the lesion and the depth of involvement, excision and biopsy. These data were compared to the histopathologic findings. RESULTS: On ultrasound biomicroscopic examination, the eyelid tumor showed greater homogeneous hypoechoic density or heterogenous echo density than that of the surrounding tissue, leading to identifying the lateral margin of the lesion and depth of involvement. The mean maximum thickness of the lesion measured by ultrasound biomicroscopy was 2.26 +/- 0.49 mm and that of the histopathologic depth was 2.22 +/- 0.56 mm. Linear regression demonstrated that lesion depth measured by ultrasound biomicroscopy was correlated with histopathologic depth. CONCLUSIONS: In eyelid tumor, ultrasound biomicroscopy is helpful in assessing the extent of the lesion and the depth of involvement preoperatively, and in obtaining good postoperative results.

Two Cases of Merkel Cell Carcinoma of Eyelid and Neck

Merkel cell carcinoma is a neuroendocrine tumor of the skin and mucosa;it typically develops on sun-exposed areas in the head, neck, and upper extremities.It is difficult to distinguish Merkel cell carcinoma from any other lid carcinomas.Merkel cell carcinoma has a tendency to spread to the regional tissue, lymphatics, and systemic organs.Because of its poor prognosis, early diagnosis and appropriate treatment by wide surgical excision is necessary. We report two cases of Merkel cell carcinoma.One case is Merkel cell carcinoma involving right upper eyelid and parotid gland which was diagnosed clinically and histologically. The patients was managed by wide surgical resection and radiotherapy.The other case is Merkel cell carcinoma involv-ing the eyelid with extension to retrobulbar space and neck.

A clinical review of eyelid sebaceous carcinoma

Malignant tumors of the eyelid pose a serious threat because of their proximity to the globe, brain & paranasal sinuses. Three types of carcinomas account for the vast majority of the malignant eyelid tumors: basal cell carcinoma, squamous cell carcinoma, and sebaceous gland carcinoma. In these malignancies, basal cell carcinoma is the most common. However, sebaceous gland carcinoma has a high recurrence rate and a moderately high 5-year mortality rate because of late diagnosis and incomplete surgical removal. This tumor may be clinically misdiagnosed frequently as a chronic unilateral conjunctivitis, chalazion, basal cell carcinoma, or squamous cell carcinoma in initial biopsy. Suspicious lid lesions should be managed with incisional biopsy initially. If they are positive for sebaceous gland carcinoma, wide excision and frozen section monitoring of surgical margin is the treatment of choice. The final diagnosis should be confirmed by special stain for lipid. We experienced 12 cases of malignant eyelid tumors including 3 cases of sebaceous gland carcinoma. In cases of sebaceous gland carcinoma, wide surgical excision with frozen section monitoring was performed and followed by eyelid reconstruction with intact eyelid tissue remained and adjuvant radiotheraphy. Guidelines for management are discussed.

Classification and Therapeutic Effect of Benign and Malignant Eyelid Tumors

The authors reviewed 73 cases of the eyelid tumors diagnosed histopathologically at Department of Ophthalmology, Yeungnam University Medical Center from March, 1984 to December, 1995. Twenty-three persons were men and fifty persons were women. The benign tumors were distributed evenly in all decades, but the malignant tumors were noted frequently in seventh and eighth decades. Histologically, benign tumors were 58 cases and malignant tumors were 15 cases. The frequency of benign eyelid tumors was noted in this order : nevus, cyst, squamous papilloma, hemangioma, seborrheic keratosis. Malignant eyelid tumors included 10 cases of basal cell carcinoma, 5 cases of meibomian gland carcinoma. The location of the benign tumors of the lids was noted in this order : the upper eyelid(30 cases), the lower eyelid(23 cases), the medial canthus(3 cases) and both eyelids(2 cases). In malignant tumors, the locations of basal cell carcinoma were the lower eyelid(6 cases), the medial canthus(3 cases) and the upper eyelid(1 case). Meibomian gland carcinoma was found in the upper eyelid(3 cases) and in the lower eyelid(2 cases). Excisional biopsy was performed in all of benign tumors(58 cases, 100%). For the treatment of the malignant tumors, simple excision(5 cases, 33%), excision and reconstruction(6 cases, 40%), excision and skin graf(3 cases, 20%) were performed. Exenteration and several courses of radiation therapy were carried out for a recurred meibomian gland carcinoma(1 case, 7%).