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Purpose: To provide a retrospective analysis of lesions of the caruncle which have been very rarely reported in the literature. Methods: A retrospective review of all the caruncular lesions between January 2000 and January 2020 was done at a single tertiary eye care hospital. The lesions were classified as benign and malignant lesions. Clinicopathological correlation was done for the excised lesions. Results: A total of 87 caruncular lesions were included in the study. Males (59%) were affected more than females (41%). The mean age at presentation was 44 ± 20 years. The mean duration of complaint was 36 ± 62 months. A total of 36 patients underwent surgical excision whereas the rest opted for conservative management. Recurrence was noted in five patients. Fifteen different types of lesions were identified histopathologically. Benign lesions (78%) were far more common than malignant ones (22%). Epithelial inclusion cyst was the most common benign lesion and sebaceous gland carcinoma was the most common malignant lesion. Correct clinicopathological correlation was seen in 52.7% of the cases. Caruncular tuberculosis, oncocytoma, and basosquamous cell carcinoma were some of the rare lesions. Conclusion: Caruncular lesions are uncommon and very diverse, which makes clinical diagnosis challenging. Epithelial inclusion cyst and sebaceous gland carcinoma were the most common benign and malignant lesions respectively. Correct clinicopathological correlation was seen in more than half of the cases
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Purpose: To evaluate the effect of direct cell injury of cryotherapy on eyelid sebaceous gland carcinoma cells by an ex vivo cryotherapy experiment. Methods: It was a prospective interventional case series. Six patients with biopsy?proven nodular sebaceous gland carcinoma were included. After excision of the mass, a thin slice of the mass resembling the thickness of the conjunctiva was shaved off and was oriented over the broad end of a tissue forceps. Cryotherapy was applied to both its anterior and posterior aspects by the triple freeze?thaw technique. The mass was then labeled and sent separately for histopathological evaluation by fixation and staining. Results: A total of six patients with a mean age of 58.2 ± 15.5 years were included. There were four females and two males. The mean duration of the lesion was 21.6 ± 17.51 months. All patients had involvement of the upper eyelid. The patients were clinically staged as T2b (n=2), T1a (n=2), T2c (n=1), and T3a (n=1) respectively. There was no regional lymphadenopathy or metastasis in any of the cases. The experimental cryo?tissue containing the cryo?treated lesion revealed the presence of viable tumor cells (>50%) in all six specimens. Conclusion: The direct cell injury caused by cryotherapy may not be sufficient to kill all the residual sebaceous gland carcinoma cells on the tumor bed.
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Purpose: Eyelid sebaceous gland carcinoma (SGC) is an aggressive but rare malignancy of ocular region. Over-expression of PD-L1 and PD-1 has been demonstrated in a variety of solid tumors including conjunctival melanoma. PD-L1 is an immunoinhibitory molecule that suppresses the effective T cells response against tumor antigen leading to the progression of tumors. Inhibitors of the interaction of PD-L1 and PD-1 are associated with good clinical response various carcinomas. The prognostic value of the PD-1/PD-L1 axis in SGC remains unexplored. The purpose of this study was to evaluate expressions of PD-1 and its ligand PD-L1 in SGC and correlate its expression with clinicopathological features and patients survival. Methods: The immunohistochemical expression of PD-L1 and PD-1 was evaluated in 30 SGC cases. Results: PD-L1 immunopositivity was detected in 41.9% of the SGC cases. PD-1 expression in tumor infiltrative lymphocytes (TILs) was observed in 53.3% samples. Tumor PD-L1 positivity, PD-1 expression in TILs and tumor size (>10 mm) was associated with reduced disease-free survival. On multivariate analysis only tumor size (>10 mm) and a combined positivity of PD-L1 in tumor cells and PD-1 in TILs with an odds ratio of 5.212 (95% confidence interval 1.449-18.737) continued to be signifi�cantly associated with SGC recurrence. Conclusion: PD-L1 is overexpressed in 50% of SGC cases. The combined tumor PD-L1 positivity and TILs showing PD-1 expression within the same SGC patient's samples predict high-risk SGC, suggesting that the up-regulation of PD-L1 in tumor cells and PD-1 positivity within the same SGC patient may aggravate tumor recurrence.
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Purpose: Comparison of outcomes of localized eyelid sebaceous carcinoma (American Joint Committee on Cancer (AJCC) 8th edition categories T1, T2, T3) following initial management with posterior lamellar resection (PLR) versus (vs) lumpectomy (nonposterior lamellar resection, non-PLR). Methods: This was a retrospective, comparative, interventional case series. Of 54 patients, 26 were managed by PLR and 28 by nonPLR. The main outcome measures were vision loss, orbital exenteration, lymph node metastasis, and remote metastasis were the main outcome measures. Results: A comparison of PLR vs nonPLR revealed no difference in mean age at presentation (70 vs 72 years), race (Caucasian 100% vs nonCaucasian 93%), gender (female 54% vs male 71%), entering mean visual acuity (20/30 vs 20/50), or corneal involvement (23% vs 11%). There was significant difference in clinical features with PLR demonstrating greater mean basal diameter (21 mm vs 12 mm, P = 0.004), and positive margins were seen more frequently in PLR (69% vs 46%). There was significantly less number of surgical procedures in PLR to achieve complete tumor control (1.7 vs 2.5, P = 0.001). Outcomes at mean 55 months follow-up revealed significantly better control with PLR (vs nonPLR) with fewer orbital exenterations (15% vs 43%, P = 0.038), fewer lymph node, and systemic metastases (0% vs 39%, P < 0.001). There was no significant difference in final mean visual acuity (20/60 vs 20/200). Conclusion: For eyelid sebaceous carcinoma, the initial management is critical to the patient's outcome. PLR demonstrates superior outcomes with regard to preservation of visual acuity and avoidance of exenterations, lymph node metastases, and systemic metastases compared to patients managed with other techniques.
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Los principales tumores malignos que afectan los párpados en orden de frecuencia son el carcinoma basocelular, el carcinoma de glándulas sebáceas, el carcinoma de células escamosas y el melanoma maligno. El carcinoma de glándulas sebáceas es una neoplasia originada en las glándulas sebáceas con predilección por cabeza y cuello, especialmente por las glándulas de Meibomio, aunque también puede afectar a las glándulas de Zeiss o ambas y su sitio de mayor presentación es en el párpado superior. Se presenta un paciente masculino de 46 años de edad quien presenta lesión pediculada y vascularizada en párpado inferior izquierdo posterior al drenaje de un supuesto chalazión. Se realiza rasurado de la lesión y recidiva por segunda ocasión. El carcinoma de células sebáceas se maneja con resección amplia y reconstrucción con técnica de Hughes(AU)
The main malignant tumors affecting the eyelids in an order of frequency are basal cell carcinoma, sebaceous gland carcinoma, squamous cell carcinoma and malignant melanoma. Sebaceous gland carcinoma is a neoplasm originating in sebaceous glands predominantly from the head and neck, particularly meibomian glands, though it may also affect the glands of Zeis or both, and its most common site of presentation is the upper eyelid. A 46-year-old male patient presents with a pediculated vascularized lesion on his lower left eyelid after drainage of a supposed chalazion. The lesion was shaved off and reoccurred a second time. Sebaceous cell carcinoma is managed with broad resection and reconstruction by Hughes' technique(AU)
Subject(s)
Humans , Male , Middle Aged , Sebaceous Gland Neoplasms/diagnostic imaging , Eyelid Diseases/epidemiology , Eyelid Neoplasms/diagnosis , Chalazion/etiology , Meibomian Glands/injuriesABSTRACT
A 60-year-old male presented with a 6-month-old history of a left upper lid mass. The mass was excised, and histopathological evaluation showed a well-circumscribed, multinodular, intradermal tumor consisting of round-to-oval cells with round nuclei and mucin filled cysts. On immunohistochemical analysis, the tumor cells stained positively for cytokeratin (CK)-7, CK-8, estrogen receptor (ER), progesterone receptor (PR), mucicarmine, synaptophysin, gross cystic disease fluid protein-15 (GCDFP-15), and neuron-specific enolase (NSE). A diagnosis of endocrine mucin-producing sweat gland carcinoma (EMPSGC) of the eyelid was made and at 6-month follow-up, no recurrence was noted. In this communication, we discuss the pathology and treatment options of EMPSGC of the eyelid. Although an uncommon entity, EMPSGC may be considered as a differential when encountered with a suspicious, potentially malignant eyelid mass.
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Sebaceous gland carcinoma of the eyelid is an aggressive malignant tumor derived from adnexal epithelium of sebaceous glands. Sebaceous gland carcinoma took the second place of all malignant eyelid tumors and occurred in 19.1%. The upper lid involved by sebaceous gland carcinoma is 54.6% and has a predilection 3 times more than the lower lid. It presents as a poorly differentiated lesion[1], which suggests a possibility of misdiagnosis because of it similarities to basal or squamous cell carcinoma. A 55-year-old male presented with a left upper eyelid swelling with an ulcerated wound over the lateral 2/3rd of the upper eyelid. A differential diagnosis of sebaceous gland carcinoma, squamous cell carcinoma and basal cell carcinoma of the eyelid was made. The X-ray orbit showed that there is a homogenous soft tissue density lesion along the lateral aspect of orbit on left side and a bony irregularity seen along the lateral margin of orbit on left side. B-scan showed mixed echogenic lesions in the subcutaneous plane involving the upper eyelid. A wide excision with lower lid switch and cheek rotation flap was performed. The diagnosis of sebaceous gland carcinoma was confirmed on histopathological findings. An early diagnosis and appropriate treatment may decrease the long-term morbidity. It may also extend the survival rates of such patients.
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The eyelids are composed of four layers: skin and subcutaneous tissue including its adnexa, striated muscle, tarsus with the meibomian glands, and the palpebral conjunctiva. Benign and malignant tumors can arise from each of the eyelid layers. Most eyelid tumors are of cutaneous origin, mostly epidermal, which can be divided into epithelial and melanocytic tumors. Benign epithelial lesions, cystic lesions, and benign melanocytic lesions are very common. The most common malignant eyelid tumors are basal cell carcinoma in Caucasians and sebaceous gland carcinoma in Asians. Adnexal and stromal tumors are less frequent. The present review describes the more important eyelid tumors according to the following groups: Benign and malignant epithelial tumors, benign and malignant melanocytic tumors, benign and malignant adnexal tumors, stromal eyelid tumors, lymphoproliferative and metastatic tumors, other rare eyelid tumors, and inflammatory and infections lesions that simulate neoplasms.
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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.
Subject(s)
Humans , Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Diagnosis , Eyelids , Korea , Medical Records , Melanoma , Prognosis , Recurrence , Retrospective Studies , Sebaceous Glands , SeoulABSTRACT
A sebaceous gland carcinoma was diagnosed in an adult African hedgehog (Atelerixalbiventris). The neoplasm, was localized in the subcutis of the cervicall region and extendend towards the axilar region and along the thorax. The animal was admitted for surgical removal of the tumor but died during the procedure. It was not possible to rule out metastatic dissemination since the post-mortem study was not authorized by the owner. The aim of this report is to describe the microscopic and ultrastructural morphology of this neoplasm, as well as the clinical and surgical management of the patient, in order to bring information about neoplastic diseases in this species. There is little information on diseases affecting wildlife animals. Currently, in Mexico, there is big interest on acquiring pygmy African hedgehogs as pets. For this reason, it is necessary that veterinarians, working on these type of animals, have more information and take into account the sebaceous gland carcinoma as differential diagnosis among skin tumors in the hedgehog.
Se diagnosticó un carcinoma de glándulas sebáceas en un erizo africano adulto (Atelerixalbiventris). La neoplasia estaba localizada en el tejido subcutáneo de la región cervical y se extendía hacia la zona axilar y parte de la pared torácica. El erizo fue internado para realizar la remoción quirúrgica de la neoplasia, pero murió durante el periodo transoperatorio. No fue posible determinar si existía metástasis, ya que los dueños del animal no permitieron el estudio post mortem. El presente trabajo tuvo como propósito describir la morfología microscópica y ultraestructural de dicha neoplasia, así como el manejo clínico y quirúrgico del paciente, para aportar información sobre enfermedades neoplásicas en el erizo. En general, es escasa la información acerca de las enfermedades que afectan a la fauna silvestre. Actualmente en México muchas personas están interesadas en adquirir al erizo pigmeo africano en calidad de animal de compañía. Es necesario que el médico veterinario dedicado a la clínica de este tipo de animales, tenga la mayor información posible y considere al carcinoma de glándulas sebáceas como diagnóstico diferencial entre los tumores cutáneos del erizo.
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PURPOSE: To investigate the clinical features and treatment results in eyelid sebaceous gland carcinoma. METHODS: A retrospective chart review was conducted on 28 adult patients that were histopathologically diagnosed with eyelid sebaceous gland carcinomas from April 1981 to March 2005 in Seoul National University Hospital. RESULTS: Among the 28 cases of eyelid sebaceous gland carcinoma, 9 cases (32.1%) had evidences of local invasion or metastasis at the initial diagnosis. Surgical resection was performed in the 27 cases (96.4%), and conjunctival cryotherapy, surgeries, such as maxillectomy, parotidectomy, and neck dissection, or radiation therapy were combined in cases of local invasion or metastasis. In the 19 cases of the localized tumor group, there were 2 cases (10.5%) of recurrence after an average 30 months of follow-up. The locally invasive tumor group (2 cases) showed 1 case of recurrence after 12 months of follow-up. In the 7 cases of the distant metastasis tumor group, tumors in 3 cases (42.9%) could not be controlled, and 3 cases (75.0%) showed recurrence after an average 45 months of follow-up. CONCLUSIONS: Eyelid sebaceous gland carcinomas with local invasion or metastasis afford higher potential for treatment failure, so early diagnosis is crucial. Because recurrence is possible, even when the tumor is completely removed, the extent of the tumor should be examined thoroughly and microscopically.
Subject(s)
Adult , Humans , Cryotherapy , Early Diagnosis , Eyelids , Follow-Up Studies , Neck Dissection , Neoplasm Metastasis , Recurrence , Retrospective Studies , Sebaceous Glands , Treatment FailureABSTRACT
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.
Subject(s)
Biopsy , Brain , Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Chalazion , Conjunctivitis , Delayed Diagnosis , Diagnosis , Eyelids , Frozen Sections , Mortality , Paranasal Sinuses , Recurrence , Sebaceous GlandsABSTRACT
We studied retrospectively 46 patients of primary malignant eyelid tumors who were histologically diagnosed in Korea Cancer Center Hospital from May, 1987 to December, 1994 and followed for 6 months or longer. 46 patients consist of, 22 cases of basal cell carcinoma(47.8%), 10 cases of squamous cell carcinoma(21.7%), 9 cases of sebaceous gland carcinoma(19.6%), and 5 cases of malignant melanoma(10.9%). Our modalities of treatment for eyelid malignancy included excision under frozen-section control, radiotherapy and cryotherapy. In case of regional lymph node metastasis we performed radiation treatment with or without excision of primary tumor and regional lymph node dissection. A case with distant metastasis underwent radiotherapy combined with chemotherapy. Following initial treatment, 4 cases showed recurrence and 3 cases developed regional or distant metastasis. In this study, we emphasize that suspected eyelid malignancy should be histologically diagnosed with biopsy and treated adequately at an early stage to reduce recurrence or metastasis.