Eyelid skin adenoid cystic carcinoma: a clinicopathological study of one case simulating sebaceous gland carcinoma

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.

A rare masquerade of chalazion: Adenoid cystic carcinoma

Adenoid cystic carcinoma (ACC) is a rarely seen malignant epithelial tumor of the eyelids. We present a rare case of primary ACC arising from the tarsal plate of the lower lid that clinically resembled a chalazion. A 66-year-old female presented with a recurring nodule in her left lower lid. She gave history of surgery for chalazion removal from the same site twice earlier. An initial diagnosis of a recurrent chalazion was made, and incision and curettage was done. Light microscopy showed a solid tumor composed predominantly of sheet-like and nested pattern of basaloid to low-columnar cells with intervening fibrovascular septa and lacking an obvious cribriform or tubular architecture. The tumor cells were positive for pan-cytokeratin and CD117 and negative for adipophilin, HMB45, and BerEP4. A diagnosis of solid variant of ACC of the eyelid was made. Wide excision was performed and eyelid defect was reconstructed.

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.

Extra ocular sebaceous carcinoma of the thigh: A case report

CONTEXT

Sebaceous cell carcinoma is a malignant neoplasm, rarely recognized in extra ocular sites. His prognosis depends of the precocity of the diagnosis. This neoplasm is aggressive in 29%; lymph node and visceral metastasis aren't rare.

CASE REPORT

An 80-year-old male had an ulcerated and infected nodule located on the left thigh. The lesion appeared after five months ago. It suspected a squamous cell carcinoma. The histologic findings revealed an extra ocular sebaceous carcinoma. The patient died one month later due to heart insufficiency.

CONCLUSION

extra ocular sebaceous carcinoma is a rare neoplasm. It has more difficulties of diagnosis because it has diverse clinical presentations as well as a variety of histologic patterns. We will discuss the incidence, clinical, histological and the prognosis of this aggressive neoplasm.

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.

Sebaceous neoplasia and Torre-Muir syndrome

Sebaceous tumours include hyperplasia, adenoma, sebaceoma and carcinoma. Importantly, the latter three are potential markers of Torre-Muir syndrome; the hereditary association of sebaceous neoplasia and internal malignancy, most commonly colorectal carcinoma. The diagnostic features, differential diagnosis, molecular diagnostics and recent advances in pathogenesis of this rare group of tumours are discussed along with Torre-Muir syndrome and recommendations for screening for this important association.

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.

Adenoid Cystic Carcinoma Arising from the Lower Eyelid

BACKGROUND

Primary cutaneous adenoid cystic carcinoma is one of the rarest eyelid tumors.

CASE

A 39-year-old man presented with a small subcutaneous induration in his left lower eyelid close to the lower lacrimal punctum.

OBSERVATIONS

Under a clinical diagnosis of chalazion, the eyelid induration was extracted surgically via the palpebral conjunctiva. Histopathological examination of the extracted tumor revealed proliferation of basaloid cells with a prominent cribriform pattern containing Alcian blue-positive and periodic acid Schiff-positive material, leading to a diagnosis of adenoid cystic carcinoma. The patient subsequently underwent extended radical excision including the lacrimal sac. No recurrence was observed during 20 months after surgery.

CONCLUSIONS

Adenoid cystic carcinoma should be considered as a differential diagnosis of eyelid tumors simulating chalazion. Adenoid cystic carcinoma in the eyelid may have a more favorable prognosis than that in the lacrimal gland.