Primary cutaneous adenoid cystic carcinoma of the eyelid

Adnexal neoplasms of the eye

Adnexal neoplasms of the eyelid encompass a wide variety of benign and malignant tumors of sebaceous, follicular, and sweat gland origin. Due to the specialized structures of the eyelid, these neoplasms present differently when compared with those of other locations. Although most dermatologists and ophthalmologists are familiar with the commonly reported adnexal tumors of the eyelid, such as hidrocystoma, pilomatrixoma, and sebaceous carcinoma, many other adnexal neoplasms have been reported at this unique anatomic site. Accurate and timely identification of these neoplasms is essential, as alterations of eyelid anatomy and function can have a negative impact on eye health, vision, and quality of life. We review the clinical and histopathologic features of common and rare eyelid adnexal neoplasms and discuss proposed treatment options.

Adenoid Cystic Carcinoma of the Eyelid Can Locally Recur and Mimic Basal Cell Carcinoma: Case Report and Review of the Literature

Adenoid cystic carcinoma (ACC) of the eyelid is a very rare tumor, and only 11 cases have been previously reported in the literature. Here the authors report the 12th case of eyelid ACC that was initially diagnosed as adenoid basal cell carcinoma. This is the first report of local recurrence after wide local excision using the Mohs technique. Additionally, this is the first report that demonstrates that ACC can present clinically and histologically similar to basal cell carcinoma. The authors summarize the previous reports of eyelid ACC to compile a reference for this growing body of literature. It is important for oculoplastic surgeons and dermatopathologists to keep ACC in the differential diagnosis of eyelid tumors and carefully examine histology specimens with this differential in mind.

Multidisciplinary management of primary adenoid cystic carcinoma of the eyelid with perineural invasion

Primary cutaneous adenoid cystic carcinoma of the eyelid is an extremely rare entity with the propensity to recur locally, spread to regional lymph nodes, and invade perineural spaces. Of the 8 cases previously reported in the literature, only 2 were noted to be associated with perineural invasion, and neither of these was treated with radiation therapy. The authors report the case of a 35-year-old woman who presented with a progressively enlarging left lower eyelid lesion. An excisional biopsy with wide margins revealed a diagnosis of primary adenoid cystic carcinoma of the eyelid with perineural invasion. Because of the high risk of recurrence associated with perineural invasion, the patient received postoperative adjuvant radiation in the form of 50 Gy relative biological effectiveness of proton beam therapy to the postoperative tumor bed and to the infraorbital nerve tracking back to the apex of the orbit, followed by a 10-Gy boost to the lower eyelid tumor bed with orthovoltage x-rays.

Primary cutaneous adenoid cystic carcinoma in the United States: incidence, survival, and associated cancers, 1976 to 2005

BACKGROUND

Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare appendageal tumor of uncertain origin. Details on epidemiologic features of PCACC are sparse and largely based on clinical reports.

OBJECTIVE

We sought to develop an understanding of PCACC incidence, survival, and associated cancers using population-based data.

METHODS

We used the Surveillance, Epidemiology, and End Results program to calculate age-adjusted incidence rates (IRs), IR ratios, 95% confidence intervals, standardized incidence ratios (SIRs), and 5-year relative survival of PCACC diagnosed during 1976 to 2005.

RESULTS

In a population of 723,174,580 person-years, the overall PCACC IR was 0.23 per 1 million person-years (n = 152), with similar IRs among male and female patients (IR = 0.24). Most cases of PCACC presented at a localized stage and arose on the face/head/neck. Among 122 of the 2-month survivors of PCACC and more than 2.4 million 2-month cancer survivors, risk of associated cancers overall was not significantly increased (SIR = 1.17 [n = 24] and SIR = 1.43 [n = 16], respectively). However, PCACC was associated with significantly increased risks of subsequent lymphohematopoietic (n = 6; SIR = 3.70) and thyroid (n = 2; SIR = 15.25) cancers, whereas the converse associations were not observed. Five-year relative survival was excellent (96.1%; n = 122) with more favorable survival noted for PCACC involving the face/head/neck than the trunk.

LIMITATIONS

A pathologic review of reported cases was not undertaken.

CONCLUSION

PCACC is a rare appendageal tumor that affects male and female individuals equally, primarily presents at localized stage, predominates in the face/head/neck, and is associated with favorable survival. Immunosuppression does not appear to contribute to the development of PCACC, and the observed associated cancer patterns will need to be confirmed in larger studies.

Primary cutaneous adenoid cystic carcinoma

Primary cutaneous adenoid cystic carcinoma is a rare, slow-growing malignancy first described by Boggio in 1975. This tumor characteristically consists of basophilic cells with a distinct adenoid or cribriform pattern in the mid to deep reticular dermis. Modified myoepithelial cells with prominent basement membrane material often surround true lumina. Definitive diagnosis relies on the characteristic histologic features and the exclusion of metastatic disease. We describe two patients who presented with painful papules of the scalp and were successfully treated with wide local excision.

Adenoid-zystisches Karzinom des Oberlids

Adenoid cystic carcinoma (ACC) is a rare epithelial malignancy, which tends to grow slowly. ACC is an intractable neoplasm due to its ability to invade perineural spaces. Local recurrence after excision is not unusual. ACC most commonly arises in the lacrimal gland. Very rarely, ACC originates from accessory lacrimal gland tissue. Here, we present a patient with a large ACC of the central upper eyelid, which had been misdiagnosed and treated as a chalazion without histological examination. Its origin most likely is an accessory lacrimal gland.

[Pathology of the eyelid in elderly patients]

OBJECTIVE

Didactic review of the various features of eyelid pathology in elderly patients.

METHODS

Illustrated review centered on diagnosis of the usual aspects and pitfalls of eyelid pathology divided into semiological chapters (tumors, blisters, erythema, etc.).

RESULTS

Pathology of the eyelids in elderly patients is extremely polymorphic. It is mainly centered on skin cancers (basal cell carcinoma, squamous cell carcinoma, adnexal carcinomas, and melanoma). Most severe aspects of the inflammatory diseases of the eyelid are bullous diseases (cicatricial pemphigoid, pemphigus, Stevens-Johnson syndrome, etc.). A number of rare diseases deserve mention since their presence could lead to the diagnosis of internal or systemic diseases (dermatomyositis, necrobiotic xanthogranuloma, Erdheim-Chester, etc.). In such conditions, early diagnosis is often based on the observation of isolated periocular symptoms.

CONCLUSIONS

Even though topographic dermatology is a somewhat reductive vision of skin diseases, pathology of the eyelids deserves special mention because of its polymorphism as well as its diagnostic and/or therapeutic significance.