Pathology of eyelid tumors

Upper and Lower Eyelid Malignancies: Differences in Clinical Presentation, Metastasis, and Treatment

Approximately 5-15% of all dermatologic malignancies manifest in the upper and lower eyelids. The primary types include basal cell carcinoma, squamous cell carcinoma, and sebaceous cell carcinoma, with Merkel cell carcinoma and melanoma following closely behind. Basal cell carcinoma predominantly affects the lower eyelid, yet various other carcinomas, melanomas, metastases, and neoplasms of diverse origins can arise on both upper and lower eyelids. Risk factors such as advanced age, smoking, and notably, exposure to UV light significantly contribute to the development of these eyelid lesions. Despite the increasing incidence, research on dermatologic eyelid malignancies remains limited. However, such study is imperative given that many systemic oncologic malignancies initially present as metastatic eyelid lesions. This paper provides an in-depth exploration of eyelid anatomy, clinical presentation, diagnosis, and treatment management.Key Points: Eyelid metastases represent less than one percent of all eyelid cancers, yet they often serve as the initial indication of an underlying systemic malignancy. Early detection and treatment is crucial in improving prognosis and quality of life for patients. Treatment options encompass a range of modalities, with Mohs surgery as the gold standard for the removal of ocular tumors. Additional treatment options include local excision as well as non-surgical interventions such as radiotherapy, cryotherapy, immunotherapy, and topical medications.

Complications and Recurrences after Excision and Reconstruction of Eyelid Tumours

INTRODUCTION

The eyelids are a common site for skin tumours and account for 5-10% of all skin tumours. Treatment is mainly surgical and aims to preserve the anatomical structure of the eyelid, its function and not least its aesthetic appearance.

AIM

Presentation of recurrence and complication rates of tumour-related eyelid surgery in a cohort of 450 tumours.

RESULTS

Analysis of a cohort of 450 tumours operated on revealed 13 (2.8%) operations with recurrences and 32 (7%) with complications. The statistical significance of recurrences was observed for the involved and uninvolved ciliary margin. At the temporal canthus, 23.1% of recurrences occurred compared to 7.7% at the medial canthus. SGC has the highest recurrence rate. Complications include the following: ectropion, dehiscence, gross cicatrix with normal function, retraction, post-radiation damage, sub-graft haemorrhage and graft rejection.

CONCLUSIONS

The recurrence rate of eyelid tumours is lower than that of complications. The choice of surgical technique determines the frequency of complications and histological control of the excised tissue, as well as the frequency of recurrences.

Comparison of the clinical characteristics of benign and malignant eyelid lesions: an analysis of 1423 eyelid lesions, compared between ophthalmology department and plastics department

PURPOSE

Oculoplastic surgeons excise and reconstruct eyelid tumors, although plastic surgeons have traditionally managed these cases. Current demand of this surgery is growing, and planning referral services is a health management necessity. This pilot study retrospectively reviewed same population eyelid specimens excised by both disciplines comparing data.

METHODS

Clinical and epidemiologic features of 1423 eyelid lesions biopsied between 2015- 2020 in Emek Medical Center (EMC), Israel were reviewed.

RESULTS

Among 1423 specimens, 1210 (85.0%) were benign and 213 (15.0%) were malignant/pre-malignant. Mean age at diagnosis was significantly higher in malignant tumors than in benign tumors (76 and 59 years respectively, p value < 0.001). The most common benign eyelid lesions were soft fibroma (20.1%), seborrheic keratosis (11.0%) and melanocytic nevus (10.3%). The most common malignant/pre-malignant eyelid tumors were basal cell carcinoma (BCC) (9.2%), actinic keratosis (2.6%) and Bowen's disease (1.9%). Ophthalmology removed 37 malignant/pre-malignant lesions (5.4%) out of 683 compared to plastics removing 142 malignant/pre-malignant lesions out of 740 (19.2%) specimens. Eyelid malignancy in the plastics department was significantly higher than in the ophthalmology department (p value < 0.001). 270 (70.0%) lesions caused by UV exposure were removed by plastics and 116 (30.0%) were removed by ophthalmology (p value < 0.001).

CONCLUSIONS

Eyelid lesions in patients aged 76 or older are more likely to be malignant. Ophthalmology eyelid specimens in younger patients are more commonly benign and related to inflammation. Specimens from the plastics department are more commonly malignant, related to UV-exposure, and are from older patients. This difference may be due to a misconception that plastic surgeons have more eyelid cancer reconstruction experience than oculoplastic surgeons, or less awareness of the oculoplastic expertise available today.

Evaluation and management of benign tumors of the eye and eyelid

Benign tumors of the eye and eyelid are common in children and adults, and they rarely undergo malignant transformation. Their workup and management have evolved over the years with increasing advancements in surgical and laser therapies. This contribution focuses on describing the following benign eye and eyelid tumors and their diagnostic and treatment approaches: congenital and acquired melanocytic nevi; nevus of Ota (Hori nevus); conjunctival papilloma; seborrheic keratosis; epidermoid cyst; dermoid cyst; milium; xanthelasma; hemangioma (cherry angioma and pyogenic granuloma); neurofibroma; neurilemmoma (schwannoma); and fibroepithelial polyp. Surgical removal is the primary treatment approach for many of these benign tumors. With advancements in laser technologies, there are now several laser types that can be used in the treatment of these benign eye and eyelid tumors. Other treatment modalities include cryosurgery, electrosurgery, and topical or intralesional medications. We hope this review will provide a reference to dermatologists and ophthalmologists in their approach to evaluation and management of benign eye and eyelid tumors.

Isolated cavernous venous malformation of the eyelid

Cavernous hemangioma, currently known as "cavernous venous malformation," is a common, benign, non-infiltrative, slowly progressive vascular malformation of the orbit presenting in adults. We report the case of a 9-year-old girl who presented with a painless palpable mass over the right upper eyelid of 7 years' duration. A computed tomography scan of the orbits revealed a heterogeneously enhancing, well-circumscribed mass in the right upper eyelid with no orbital extension. A transcutaneous excisional biopsy with histopathology disclosed cavernous venous malformation. The majority of cavernous venous malformations are intraconal and present in the fourth to fifth decade of life.

Squamous cell carcinoma of the eyelid

Eyelid squamous cell carcinoma is a major type of rare eyelid cancer, together with basal cell carcinoma and sebaceous gland carcinoma. It is a painless disease that progresses slowly and is often detected by the appearance of nodules or plaques. Risk factors include exposure to ultraviolet light, fair skin, radiation and human papillomavirus infection. The standard treatment is surgical removal, and in cases of orbital invasion, orbital content removal is required. If sentinel node biopsy reveals a high risk of lymph node metastasis, adjuvant radiotherapy may be considered. Local chemotherapy, such as imiquimod and 5-fluorouracil, may be used for eyelid squamous cell carcinoma in situ. When surgery or radiotherapy is not recommended for distant metastases or locally advanced disease, drug therapy is often according to head and neck squamous cell carcinoma in Japan. The treatment often requires a multidisciplinary team to ensure the preservation of function and cosmetic appearance.

HPV-Associated Squamous Cell Carcinoma of the Eyelid: Diagnostic Utility of p16 Immunohistochemistry and mRNA In Situ Hybridization

BACKGROUND

High-risk (HR) Human papillomavirus (HPV) has been implicated in pathogenesis of squamous cell carcinomas (SCC) at several sites with mucocutaneous junctions, including the head and neck. SCC is the second most common eyelid malignancy. However, its association with transcriptionally active HR-HPV has not been adequately studied.

METHODS

Two index cases of eyelid HPV-associated SCC are described in detail. A retrospective cohort of eyelid SCC was examined for p16 immunoexpression. Cases demonstrating p16 positivity or equivocal staining were subjected to high-risk HPV mRNA in situ hybridization (ISH). Quantitative real-time PCR (qPCR) was performed in mRNA ISH-positive cases for HPV genotyping.

RESULTS

The two index patients were older adult females, with upper eyelid tumours. On histology, both tumours were non-keratinizing SCC with trabecular and nested architecture reminiscent of oropharyngeal HPV-associated non-keratinizing SCC, prompting p16 immunohistochemistry, which was positive. HR-HPV mRNA ISH was positive, and qPCR detected HPV16 in both cases. Three of 20 (15%) archival cases showed p16 immunopositivity and two (10%) showed equivocal staining. However, mRNA ISH was negative. All cases showing p16 immunostaining and lacking HR-HPV were keratinizing SCCs. Thus, 9% of all eyelid SCC examined demonstrated HR-HPV.

CONCLUSION

The prevalence of HR-HPV in eyelid SCC is low in Indian patients. HPV-associated SCC may mimic commoner eyelid carcinomas as it lacks overt keratinization. In basaloid-appearing eyelid carcinomas, p16 immunopositivity should be followed by reflex HR-HPV mRNA ISH, as p16 immunohistochemistry alone has low specificity. The prognostic role, if any, of HPV association needs further evaluation.

A Solitary Fibrofolliculoma in Close Proximity to the Medial Canthus

Fibrofolliculomas are benign connective tissue tumours of the hair follicle that typically present as multiple lesions over the head and neck. A solitary fibrofolliculoma is a rare entity and has not been previously described in the canthal region. The authors report an unusual case of a 43-year-old female who was found to have a solitary fibrofolliculoma located in close proximity to the medial canthus following an excision biopsy. Whilst rare, fibrofolliculomas should be considered in the differential diagnosis of an eyelid lesion.

Eyes, menstruation and endometriosis

Vicarious menstruation refers to cyclical bleeding outside the uterine cavity during the menstrual cycle. Haemolacria, or blood in tears, is a rare medical phenomenon that can occur with menstruation or in association with endometriosis. Endometriosis, defined by the presence of endometrial-like tissue in extra-uterine sites, affects around 10% of fertile women; the ocular system is one of the rarest sites it can be present in. Endometriosis usually requires a biopsy for diagnosis, and the anatomic difficulty of obtaining a biopsy of the ocular system makes ocular endometriosis diagnosis more obscure. However, few cases have been described in the literature and due to the psychological, physical, and social implications of haemolacria on the patient, treatment is of utmost importance. We reviewed the literature on ocular endometriosis and ocular vicarious menstruation with the aim to discuss the clinical presentation, necessary workup and various treatment modalities, while also shedding light on the connection between the eyes and endometriosis in general. It is hypothesised that uterine endometrial cells can travel lymphatically or haematogenously and deposit extra-uterine endometriotic lesions that bleed in response to hormonal changes in the menstrual cycle. Additionally, the conjunctival vasculature has been found to be responsive to hormonal changes due to the presence of oestrogen and progesterone receptors, causing bleeding at the corresponding sites, even without endometriotic lesions. Clinical correlation of the haemolacria with the menstrual cycle can suffice for a diagnosis of vicarious menstruation, and thus opens the possibility of treatment to provide symptomatic treatment for the patient.

Clinicopathological analysis of eyelid lesions in Sri Lanka

PURPOSE

We intended to review the clinical features and histological findings of eyelid lesions in Sri Lanka.

METHODS

We conducted a descriptive cross-sectional study to analyse clinicopathological characteristics of eyelid lesions from 2013 to 2017 in the National Eye Hospital of Sri Lanka.

RESULTS

The age of patients ranged from 3 months to 83 years (mean = 46 ± 21 years). The male-to-female ratio in the sample was 1:1.3. Among 654 histologically confirmed eyelid lesions, the majority (n = 407/654, 62%) were neoplastic lesions including 322 benign, 11 premalignant and 74 malignant neoplasms. The commonest benign tumour was seborrheic keratosis (n = 98), and the commonest non-neoplastic lesion was pyogenic granuloma (n = 64). Seventy-four patients had malignant neoplasia including 24 sebaceous carcinoma, 18 basal cell carcinoma, and 14 squamous cell carcinoma. The most common site of malignant lesions was the upper eyelid. The mean age of patients with malignant eyelid lesions was 64 ± 13 years.

CONCLUSIONS

Neoplastic lesions outnumbered nonneoplastic lesions, while benign neoplasia was more common than malignant neoplasia. In contrast to the western reports, the commonest malignant neoplasm was sebaceous carcinoma.

[Diagnosis and treatment of benign eyelid tumors]

BACKGROUND

Benign tumors of the eyelids are frequent entities. They are often cause for cosmetic concern or can lead to irritation of the ocular surface. The differentiation from premalignant or malignant eyelid tumors is particularly important. In most cases this can be done clinically; however, in some cases histological evaluation is warranted.

OBJECTIVE

The aim of this article is to characterize the most important benign tumors of the eyelid and to ascertain when a histological examination is necessary. Furthermore, fundamental treatment procedures are discussed.

METHODS

This narrative review was prepared based on a selective literature search. The characteristics of some eyelid tumors are underlined with illustrations from clinical cases.

RESULTS

Most benign eyelid tumors are treated because of cosmetic or functional concerns. Some of them, including actinic keratosis, keratoacanthoma, cutaneous horn, trichofolliculoma, resemble malignant lid tumors or precancerous lesions and are thus excised in oder to obtain a diagnosis. Dermoid cysts can cause complications and congenital melanocytic naevi can exhibit malignant transformation and may need treatment. Inflammatory tumors can be treated conservatively in most cases but might require surgery in certain cases. Systemic associations exist with some of the benign lid tumors and should not be overlooked as they can be crucial for overall patient morbidity.

CONCLUSION

Benign tumors of the eyelids are frequent and can be found at any age depending on the diagnosis. This article describes the lesions most commonly encountered in the clinical routine and helps at making a plan for further management.

Clinical Signs for Differential Diagnosis of Eyelid Tumours

This article aims to present the differential diagnostics of benign and malignant eyelid tumours. The most common malignant eyelid tumour is basal cell carcinoma, followed by squamous cell carcinoma. The common signs of malignity are loss of lashes, ulceration, and infiltration of the lesion. Often the clinical appearance is various and therefore only a histological analysis gives the proper diagnosis. For most tumours, surgical resection is the gold standard of therapy. The reconstruction of the defects should be performed by an experienced oculoplastic surgeon. In malignant tumours that require large safety margins, the defect can be easily very large, and the reconstruction must then be performed with advanced ophthalmic plastic reconstruction techniques.

Conjunctival Perivascular Epithelioid Cell Neoplasm With RBM10-TFE3 Fusion Presenting as Recurrent Subconjunctival Hemorrhage

Subconjunctival hemorrhages commonly present to eye care professionals and are frequently regarded as benign self-limited conditions. In selected cases, subconjunctival hemorrhages can be a harbinger of more severe disease. Perivascular epithelioid cell tumors, or PEComas, are rare mesenchymal neoplasms believed to originate from perivascular myoid cells and are rarely present in ocular structures. We present a rare case of a conjunctival perivascular epithelioid cell tumor that initially presented with recurrent subconjunctival hemorrhage. To our knowledge, this is the first description of a PEComa with a RBM10-TFE3 gene fusion, only previously seen with renal cell carcinoma. Physicians should be aware of this rare condition, its location in the fornix and its presentation as a recurrent subconjunctival hemorrhage.

A rare case of primary adenocarcinoma of the eyelid

Introduction. primary mucinous carcinoma of the eyelid skin is a rare adenocarcinoma of skin glands. This tumor rarely metastasizes but frequently recurs.

The study objective is to describe a rare clinical case of primary mucinous carcinoma of the eyelid skin, present macroscopic, histological and immunohistological descriptions of this pathology.

Clinical case. male, 66 years old, sought medical care due to a neoplasm of the lower eyelid. macroscopically a subcutaneous node 1.2 × 1.0 cm was observed, of yellow-brown color, gelatinous in section. microscopic examination showed that the tumor consists of islands of epithelial cells surrounded by mucinous “lakes”. Immunohistochemical examination showed Ck7, estrogen, p53 expression in the tumor cells, as well as absence of Ck20 expression. Based on the data of macro-, microscopic and immunohistochemical examinations, primary mucinous carcinoma of the eyelid skin was diagnosed. Observed morphological signs of this tumor allow to differentiate it from cancer metastasis.

Conclusion. primary mucinous carcinoma of the skin should be differentiated from metastasis of mucinous carcinoma of the breast, lung, colon, et al. macro- and microscopic signs of this tumor are subjective. Immunohistochemical examination is a more reliable diagnostic tool.

Mohs micrographic surgery versus wide local excision for eyelid melanoma: An analysis of a national database

BACKGROUND

Although eyelid melanomas represent less than 1% of eyelid neoplasms, they have the worst prognosis. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are mainstay treatment options. We conducted a retrospective analysis to assess all-cause and cause-specific mortality rates in patients undergoing WLE or MMS for eyelid melanoma.

METHODS

A retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) registry was performed for eyelid melanoma treated with WLE or MMS. Cases were limited to American Joint Committee on Cancer (AJCC) stage T1 primary malignancies.

RESULTS

A total of 45 cases of WLE were identified along with 48 cases of MMS for eyelid melanoma. There was no significant difference between subgroups in age group, sex, race, ethnicity, marital status at diagnosis, AJCC N stage, AJCC M stage, melanoma histology, chemotherapy use, and radiotherapy use. Among the cohort, all tumors were unilateral. Kaplan-Meier analysis with log-rank demonstrated no significant difference between MMS and WLE subgroups with regard to overall survival (P = 0.662) and cancer-specific survival (P = 0.494). Cox regression adjusting for variables with α<0.10 and found no significant difference in all-cause mortality (HR, 0.923; 95% CI 0.310-2.747; P = 0.885) or cancer-specific mortality (HR, 0.518; 95% CI 0.047-5.711; P = 0.591) when patients who underwent MMS were compared to those who underwent WLE.

CONCLUSION

While our study is limited by a small number of patients, our analysis demonstrated no significant difference in all-cause or cause-specific survival for patients with eyelid melanoma treated with MMS compared with WLE. In areas requiring preservation of tissue due to cosmetic or functional purposes, MMS is a reasonable surgical approach.

Dacryops and clinical diagnostic challenges

OBJECTIVE

The study aims to describe the clinical and histopathologic features of different types of dacryops and their clinical diagnostic challenges.

METHODS

This is a retrospective cohort study of all surgically excised cases of dacryops in 2 tertiary eye hospitals in Riyadh, Saudi Arabia.

RESULTS

The study included 58 dacryops specimens from 55 patients with an average age of 41.2 years (range, 4-78 years). The most common location was the upper lid (60.3%), whereas the least expected location was the caruncle (6.9%). The most common site of dacryops occurrence was in the accessory lacrimal gland (55.2%), the main lacrimal gland (32.8%), and then ectopic dacryops (12%). All patients presented with lid swelling alone except for 3 patients who experienced secondary mechanical ptosis. On physical examination, conjunctival scarring existed in 4 patients (6.9%). Preoperative diagnosis of dacryops was accurate in 44.8% of the cases. Dacryops of the main lacrimal gland was accurately diagnosed clinically in all cases compared with other locations, which was statistically significant (p < 0.001). The causes of inaccurate clinical diagnoses were hidrocystoma (26.9%), inclusion cyst (11.5%), and dermoid cyst (7.7%), whereas the remaining cases were diagnosed as cysts without a specific subtype (53.9%). Recurrence of the lesion was observed in 2 cases (3.5%). No clinical or histopathologic factors were associated with a risk of recurrence.

CONCLUSION

Dacryops can represent a diagnostic challenge to ophthalmologists. Familiarity with clinical presentations and findings is required to diagnose dacryops outside the main lacrimal gland.

Clinicopathological features of patients with wide local excision of eyelid malignant neoplasms: a more than five years retrospective study from China

Background

To investigate the correlation between the clinical and pathological characteristics and outcomes in patients with eyelid malignant tumors underwent wide local excision.

Methods

This retrospective study included 141 cases of eyelid malignant neoplasms from January 2010 to December 2015 in Shanxi eye hospital. Demographic and clinical information were collected. The Kaplan–Meier method was used to calculate survival curves, and the log-rank test method was used to compare survival between groups. Cox proportional regression models were used to calculate the hazard ratios (HR) of total recurrence rate and metastasis rate.

Results

Overall, there were 141 eyelid malignant neoplasms cases aged 65.34 ± 9.69 (range, 41—88) years old. The duration time range was from 1 to 828 (61.09 ± 122.21) months. Basal cell carcinoma (BCC) is the most common of all eyelid malignancies, accounting for 84 (59.5%), followed by Sebaceous gland carcinoma (SGC, 41, 29%), Squamous Cell Carcinoma (SCC, 11, 7.8%), Malignant Melanoma (MM, 3, 2.1%)。On cox-regression analysis, pathological classification (HR 1.959; 95% CI 1.012–3.790; p = 0.046) and eyelid tumor surgery history (HR 17.168; 95% CI 1.889–156.011; p = 0.012) were independently associated with recurrence in patients with eyelid malignant neoplasm. Pathological classification (HR 2.177; 95% CI 1.423 -3.331; p < 0.001) was independently associated with metastasis in patients with eyelid malignant neoplasm. Recurrence and metastasis were most likely to occur in 3 years after surgery.

Conclusion

Wide local excision is an effective and economical treatment for eyelid malignant neoplasms. The prognosis is mainly related to pathological types, eyelid tumor surgical history and TNM stages.

Modified argon laser therapy for benign tumor of the eyelid

Background

To report about the therapy of benign eyelid tumors with a modified argon laser technique as an alternative to surgery.

Methods

Nineteen benign tumors of the eyelid were included in this study. After staining the surface of the tumor with a violet marker, low-energy argon laser photoablation was performed. A mean number of 312 spots (spot size ranging from 150 to 500 μm) with a power of 200 to 400 mW, and a duration between 0.1 and 0.2 s were applied.

Results

The eyelid tumors were located mainly in the lower eyelid (58%). Dermal nevi and papilloma were the most frequently treated lesions. Over a mean follow-up period of 10.5 months (range 6–18 months), all eyelid tumors were successfully treated by a single session of laser therapy. All patients were satisfied with the laser therapy and the cosmetic result. No postoperative complications were observed. No relapses occurred during follow-up.

Conclusions

Our modified method of argon laser therapy utilizes the staining of the surface of the eyelid tumor to increase the amount of thermal laser energy absorbed by the target. This novel technique is simple and effective for treating benign eyelid tumors.

The Eyelid Angiosarcoma: A Systematic Review of Characteristics and Clinical Course

A systematic search for eyelid angiosarcoma was performed from inception to December 2020 in Medline, EMBASE, and the Cochrane databases. Forty two eyelid angiosarcoma cases in 32 articles were analyzed. Eyelid angiosarcomas showed an incidence peak in the eighth decade of life, and was reported more frequently in Caucasian males. Eyelid angiosarcomas were associated with a mortality rate of 26.2%, a recurrence rate of 14.3%, and a cure rate of 45.2%. Four years event-free survival (EFS) rate was 36.0%, with median EFS of 36 months. Eyelid angiosarcomas with bilateral involvement or metastasis showed higher mortality and recurrence rates than unilateral eyelid invasion cases. In the prognosis analysis according to treatment modalities, the mortality and recurrence rates were the lowest in patients who underwent surgical excision. The 4-year EFS probability in a group with surgical excision was 60.6%, but in a group without surgical excision it was 30.3%. A total of 45.2% of the cases was misdiagnosed and 21.4% of the cases could not be correctly diagnosed with the first biopsy trial. The prognosis for eyelid angiosarcomas was better than that of angiosarcomas invading the face and scalp. Surgical excision was the most important treatment modality; thus, should be considered as the first treatment of choice.

Ciliary Gland Adenocarcinoma of the Eyelid Arising in Hidrocystoma: Case Report and Review of Previously Reported Cases

ABSTRACT

Moll gland is a modified tubular-shaped apocrine sweat gland, which is located on the margin of the eyelid. Moll glands are also known as ciliary glands. The function of these glands was not well known for a long time. However, based on the different studies, it was proved that Moll glands are active from birth and have local immunologic function producing immunoglobulin A. We present a case of Moll adenocarcinoma, a type of apocrine carcinoma, arising from the right upper eyelid of a 57-year-old man. Although Moll gland cysts are frequently seen, this type of adnexal malignancy is extremely uncommon. These tumors can have variable presentation and behavior from less invasive forms to highly malignant metastatic recurrent lesions.

Artificial intelligence to detect malignant eyelid tumors from photographic images

Malignant eyelid tumors can invade adjacent structures and pose a threat to vision and even life. Early identification of malignant eyelid tumors is crucial to avoiding substantial morbidity and mortality. However, differentiating malignant eyelid tumors from benign ones can be challenging for primary care physicians and even some ophthalmologists. Here, based on 1,417 photographic images from 851 patients across three hospitals, we developed an artificial intelligence system using a faster region-based convolutional neural network and deep learning classification networks to automatically locate eyelid tumors and then distinguish between malignant and benign eyelid tumors. The system performed well in both internal and external test sets (AUCs ranged from 0.899 to 0.955). The performance of the system is comparable to that of a senior ophthalmologist, indicating that this system has the potential to be used at the screening stage for promoting the early detection and treatment of malignant eyelid tumors.

The spectrum and clinicopathological correlation of eyelid lesions: Twenty years' experience at a tertiary eye care center in South India

Purpose:

To study the epidemiological pattern and diagnostic accuracy of histopathologically proven eyelid lesions over a period of two decades.

Methods:

A retrospective study of all histopathologically proven eyelid lesions from April 1996 to March 2016 was conducted. The lesions were broadly categorized as benign or malignant. Inflammatory and infectious lesions were included under the benign category. The percentage and diagnostic accuracy of each lesion was calculated.

Results:

There were a total of 994 (M = 551, F = 443) cases. The mean age of the patients was 43.5 ± 19.9 years. There were 809 (81.4%) benign and 185 (18.6%) malignant lesions. Benign lesions were commonly seen in the fourth decade, while the malignant ones in the late fifth decade. The upper lid was the most common site in both groups (n = 481, 48.4%). The commonest benign lesion was chalazion (n = 484, 59.8%). Dermal nevus (n = 94, 11.6%) was the most common benign neoplasm, while Molluscum contagiosum (n = 25, 3.09%) was the most common infectious lesion. Sebaceous gland carcinoma (SGC) (n = 103, 55.7%) was the leading malignant lesion followed by basal cell carcinoma (n = 39, 21.1%). Eleven malignant cases were misdiagnosed as benign (5.9%). Chalazion (99.1%) and SGC (65%) had the highest diagnostic accuracy, while Molluscum (40%) and squamous cell carcinoma (40%) were the most misdiagnosed lesions in the respective groups.

Conclusion:

Benign eyelid lesions are far more common than malignant ones. Atypical and rare presentations may lead to misdiagnosis. Knowledge of epidemiological patterns and clinical features can help in achieving higher diagnostic accuracy.

Clear cell variant of squamous cell carcinoma of eyelid, mimicking sebaceous carcinoma: A rare case report

Clear cell variant of squamous cell carcinoma (SCC) is an extremely rare neoplasm. Here, we report a case of clear cell variant of SCC which presented as an eyelid nodule. A 56-year-old male presented with a painless, small, pedunculated nodule in the left upper eyelid. On microscopic evaluation, tumor cells were arranged in nests and lobules with few foci of necrosis. Tumor cells were polygonal in shape, having abundant clear and vacuolated cytoplasm with peripherally pushed hyperchromatic nuclei. Two main differential diagnoses considered were sebaceous carcinoma and clear cell variant of SCC. On immunohistochemistry, tumors cells were negative for androgen receptor. A final diagnosis of clear cell variant of SCC was made. In a malignant eyelid tumor with clear cell morphology, a differential diagnosis of clear cell variant of SCC should be kept in mind before making a diagnosis of sebaceous carcinoma because sebaceous carcinoma possesses a poorer prognosis.

Ocular and periocular tumors in 855 Asian Indian geriatric patients

OBJECTIVE:

The objective of this study was to describe the eye tumors in Asian Indian geriatric population (age >60 years) presenting to a multitier ophthalmology hospital network in India.

METHODS:

This was a retrospective study of 855 Asian Indian geriatric patients.

RESULTS:

During the 3-year study period, 855 geriatric patients were diagnosed with eye tumors. The mean age at presentation with an ocular or periocular tumor was 68 years (median, 67 years; range, 60–91 years). There were 458 (54%) benign tumors and 397 (46%) malignant tumors. The distribution of benign versus malignant tumors in different age groups was 324 (71%) versus 259 (65%) in 60–70 years, 116 (25%) versus 99 (25%) in 71–80 years, and 18 (4%) versus 39 (10%) in >80 years' age groups. The three most common benign tumors included eyelid cyst (n = 99, 22%), eyelid nevus (n = 50, 11%), and pseudotumor or nonspecific orbital inflammatory disease (n = 38, 8%). The three most common malignant tumors included ocular surface squamous neoplasia (OSSN) (n = 208, 52%), periocular sebaceous gland carcinoma (n = 68, 17%), and periocular basal cell carcinoma (n = 25, 6%). Overall, OSSN was the most common tumor in all age groups (22% of all tumors in 60–70 years, 27% in 71–80 years, and 39% in >80 years' age groups).

CONCLUSION:

Overall, there is an increasing trend of malignant tumors with increasing age. OSSN is the most common tumor in the geriatric population encountered in a referral-based comprehensive ocular oncology practice in India.

MicroRNA-3907 promotes the proliferation and migration of sebaceous gland carcinoma of the eyelid by targeting thrombospondin 1

MicroRNAs (miRNAs/miRs) play an important role in various types of carcinoma, including sebaceous gland carcinoma (SGC) of the eyelid. miR-3907 was found to be highly expressed in lung cancer; however, to the best of our knowledge, the biological role of miR-3907 in SGC has not previously been evaluated. The aim of the present study was to determine the role and mechanism of miR-3907 in the occurrence and development of SGC. miR-3907 was screened and identified as a novel upregulated miRNA in SGC tissues and cells, as determined using miRNA microarrays and reverse transcription-quantitative (RT-q) PCR analyses. Compared with the control group, cellular proliferation and migration were enhanced in the miR-3907 mimics group, and decreased in the miR-3907 inhibitor group. Moreover, miR-3907 negatively regulated thrombospondin 1 (THBS1) expression, as shown by bioinformatics prediction, RT-qPCR, western blotting and dual-luciferase reporter assays. In addition, compared with the control group, the small interfering (si) siRNA-THBS1 group exhibited enhanced proliferation and migration abilities, which were decreased in the THBS1 overexpression group. Furthermore, THBS1 overexpression was found to attenuate the stimulative effect of miR-3907 mimics, and THBS1-knockdown reversed the inhibitory effect of the miR-3907 inhibitor in SGC cells. Collectively, the results of the present study indicated that miR-3907 promoted the proliferation and migration of SGC by downregulating THBS1, and that this axis may be a potential target for the prognostic assessment and treatment of SGC.

Periorbital Soft Tissue Trauma

Eyelid trauma occurs across a broad spectrum of pathology, ranging from simple periorbital lacerations to severe, vision-threatening injuries requiring expert oculoplastic consultation. Any injury, no matter how benign, is also inherently cosmetically sensitive, further adding to the reconstructive challenge. In this review, we discuss the anatomy of the eyelid and develop an understanding of evaluating for signs of more serious, potentially occult, trauma. A framework is developed for approaching the patient with periorbital trauma to assess for injury and triage necessary treatments. Damage to the lacrimal drainage system, which can be particularly difficult to detect and repair, is specifically emphasized and explored.

Clinicopathological analysis of 5146 eyelid tumours and tumour-like lesions in an eye centre in South China, 2000-2018: a retrospective cohort study

OBJECTIVES

To describe the clinicopathological characteristics of patients with eyelid tumours and tumour-like lesions in South China, investigate possible factors affecting tumour constitution.

DESIGN

Retrospective cohort study.

SETTING

All patients diagnosed with eyelid tumours were included from a high-volume tertiary eye care centre from South China which caring for over 2000 patients per day. All biopsied specimens were reviewed by two senior pathologists and were classified according to the fourth edition of the WHO Classification of Skin Tumours.

PARTICIPANT

A total of 5146 cases of eyelid lesions were reviewed from 2000 to 2018, being classified by histogenesis and pathologic diagnosis, being compared with data from previous literature containing different races.

MAIN OUTCOME MEASURES

Age-specific and gender-specific incidence constitutions, time trends, tumour location, distribution in different age groups and relationship with Sociodmographic Index (SDI) were calculated.

RESULTS

Benign tumours accounted for 85.08% (4378) of all cases, among which, nevus was most common (33.07%). Eight of top 10 benign lesions had higher occurrence in upper eyelids. The R² value of linear regression in patient annual number of benign lesions were 0.946 (p<0.01) for male and 0.914 (p<0.01) for female. More than 33.60% (1471/4378) were made up by patients younger than 40 years. The number of patients undergoing removal of benign lesions decreased with age. Among the malignant lesions, basal cell carcinoma (BCC) was most prevalent (48.70%), followed by sebaceous gland carcinoma (34.24%) and majority (81.8%) occurred in patients above 60 years.

CONCLUSIONS

Over the past 19 years, most eyelid tumours occurred at our centre were benign lesions. The number of patients presenting with benign lesions increased in both genders, especially among young females who were more likely to request surgeries. Among malignant lesions, BCC remains the most common type, appears a higher incidence in countries with higher SDI.

Analysis of Tumour Related Data and Clinical Features of Eyelid Carcinomas

Almost 10% of worldwide skin cancers are located at the eyelid level. In European countries, malign eyelid tumours are mostly represented by basal and squamous cell carcinomas, and usually affect elderly patients. In order to study the clinical features of eyelid tumours, and potential correlations between tumour parameters, we have enrolled a cohort of 98 subjects from a south-western region of Romania. Our study confirmed the majority of results from other European studies, as basal cell carcinoma was the most frequent malign form, being diagnosed for more than 85% of patients with declared prolonged sun exposure; tumours were mostly located on the superior eyelid, especially for males, and may present slow progression rates. We have identified significant correlations only between the tumour stage and symptoms' duration, and also between the tumour stage and smoking habit, for females.

Histopathological Features of the Eyelid Basal Cell Carcinomas

Basal cell carcinomas (BCC) make up about 90% of malignant tumors of the eyelids. Although they are generally slow-growing tumors, in the periocular region can cause significant morbidity due to orbital invasion. In the present study we followed the associations between the various types of BCC with the depth of invasion, respectively the Breslow stage (BS) and with the pT category. The study included a number of 92 cases of eyelid BCC from the Plastic Surgery and Ophthalmology Departments of the Craiova County Emergency Clinical Hospital which were processed and diagnosed in the Pathological Laboratory of the same hospital. Histopathological analysis of the 92 BCCs indicated that in 72 cases the tumors were composed of a single growth pattern, and in 20 cases they were composite, associating two or more growth patterns. The cases with a single growth pattern corresponded in 53 cases of nodular BCC, in 9 cases of infiltrative BCC, in 2 cases of superficial BCC and in 8 cases of micronodular BCC. The composite types corresponded in 10 cases to the association of the nodular type with the micronodular one, in 8 cases to the association of the nodular type with the infiltrative one and in 2 cases to the association of the infiltrative type with the micronodular one. Statistical analysis indicated significant associations between BS, pTa and the histopathological type of tumors, the mixed types being frequently present in cases with high SB and advanced pT.

MR and CT Imaging of the Normal Eyelid and its Application in Eyelid Tumors

T-staging of most eyelid malignancies includes the assessment of the integrity of the tarsal plate and orbital septum, which are not clinically accessible. Given the contribution of MRI in the characterization of orbital tumors and establishing their relations to nearby structures, we assessed its value in identifying different eyelid structures in 38 normal eyelids and evaluating tumor extension in three cases of eyelid tumors. As not all patients can receive an MRI, we evaluated those same structures on CT and compared both results. All eyelid structures were identified on MRI and CT, except for the conjunctiva on both techniques and for the tarsal muscles on CT. Histopathology confirmed the MRI findings of orbital septum invasion in one patient, and the MRI findings of intact tarsus and orbital septum in another patient. Histopathology could not confirm or exclude tarsal invasion seen on MRI on two patients. Although imaging the eyelid is challenging, the identification of most eyelid structures is possible with MRI and, to a lesser extent, with CT and can, therefore, have an important contribution to the T-staging of eyelid tumors, which may improve treatment planning and outcome.

Clinicopathological features of cystic lesions in the eyelid

The aim of the present study was to investigate the clinicopathological features of cystic lesions in the eyelid. Clinicopathological profiles were retrospectively searched based on medical records of 35 patients with cystic lesions of the eyelids, which were surgically resected from January 2003 to June 2016. The cohort consisted of 16 men and 19 women. The mean age of the patients was 57±24 years. The main locations of the cysts were the upper eyelid in 22 patients, followed by the lower eyelid in 5 patients. Eyelid skin and its appendages were the most common as the origin of cysts, followed by the tarsus, palpebral conjunctiva and lacrimal gland. The histopathological diagnoses were 16 epidermal cysts, 5 intratarsal keratinous cysts, 3 conjunctival cysts, 2 trichilemmal cysts, 1 dermoid cyst, 1 apocrine hidrocystoma, 1 lacrimal gland cyst and 6 unclassifiable cysts. All cysts did not recur following resection. In summary, cystic lesions of the eyelid were frequently observed in the upper eyelid. The most frequent diagnoses were epidermal cysts, followed by intratarsal keratinous cysts, while a definitive diagnosis in some cysts could not be pathologically determined, as they lacked epithelia and/or the contents or they resembled apocrine hidrocystoma and intratarsal keratinous cysts with atypical findings. The results of the current study indicate that the incidence and differential diagnosis of eyelid cystic lesions may contribute to the application of appropriate treatment for patients with eyelid tumors.

Periocular inverted follicular keratosis: a retrospective series over 17 years

PURPOSE

To evaluate the demographic, clinical, and histopathologic characteristics of periocular inverted follicular keratosis (IFK), a very rare lesion with poorly defined characteristics.

STUDY DESIGN

Retrospective case series.

METHODS

We evaluated 11 patients with clinically diagnosed IFK confirmed by histologic analysis. Data were collected on the patients' demographics, clinical presentation and course of the disease, signs and symptoms, location of the lesion, and outcomes of treatment.

RESULTS

The patients' mean age was 71 years (range, 32-91 years). Seven (64%) of the patients were female. Eight of the patients (72.7%) had no symptoms, two (18.2%) reported itching, and one (9.1%) had edema and bleeding of the lesion. The lesion affected the upper eyelid in 4 of the patients (36%), the lower lid in 3 of the patients (27%), and the inner canthus in 4 of the patients (36%).

CONCLUSIONS

IFK has no specific clinical characteristic and thus requires histologic confirmation for its diagnosis and appropriate management.

The clinical significance of CD133, MACC1, and KAI1 expression in sebaceous gland carcinoma of the eyelid

BACKGROUND AND PURPOSE

CD133, which is considered a useful biomarker for the prediction of metastasis and prognosis for various cancers, is a biomarker of cancer stem cells (CSCs). Metastasis-associated in colon cancer 1 (MACC1) has been considered an oncogene that promotes invasion and metastasis in many solid tumors. KAI1 is a suppressor gene of metastasis and is also considered a valuable biomarker for the prediction of tumor invasion and metastasis. The purpose of this study is to investigate the expression of CD133, MACC1, and KAI1 in sebaceous gland carcinoma of the eyelid (SGCE) and to analyze their respective associations with clinicopathologic characteristics and survival in SGCE.

METHODS

Positive expression of CD133, MACC1, and KAI1 in 77 whole SGCE tissues and the corresponding normal tissues were detected by immunohistochemistry. Patient demographics, clinical data, and follow-up data were collected.

RESULTS

The positive expression of CD133 and MACC1 was significantly higher and KAI1 significantly lower in SGCE tissues compared to the control tissues. The Positive expression of CD133 and MACC1 was positively associated with local invasion, lymph node metastasis (LNM), and TNM stages. KAI1 expression was inversely associated with tumor grade, local invasion, LNM, and TNM stages. A Kaplan-Meier survival analysis demonstrated that CD133+ or MACC1+ patients had a significantly lower overall survival (OS) time when compared with CD133- or MACC1- patients. And KAI1+ patients had a significantly longer OS time compared with KAI1- patients. Multivariate analysis showed that positive expression of CD133, MACC1, and KAI1, as well as the TNM stages were independent prognostic factors in SGCE patients.

CONCLUSION

The expression of CD133, MACC1, and KAI1 should be considered promising biomarkers for invasion, metastasis, and prognosis, as well as potential therapeutic targets for SGCE.

Characteristics and Factors Related to Eyelid Basal Cell Carcinoma in Saudi Arabia

PURPOSE:

Data on basal cell carcinoma (BCC) from the Middle East are deficient. We present the features and management outcomes for BCC over the last 36 years in Saudi Arabia.

SUBJECTS AND METHODS:

This retrospective chart review included BCC patients diagnosed and treated at Saudi Arabia between 1980 and 2016. Data were collected on patient demographics, clinical and histopathological characteristics of the lesions, management, and follow-up.

RESULTS:

One hundred and twenty-six patients with BCC were included in this study. The incidence of BCC in Saudi Arabia is 0.8 cases a year. The median age of the patients was 71 years. BCC affected 58.9% of males. The lower lid was the most common site of occurrence (52.7%). Clinically, BCC was most commonly recognized as a mixed lesion (41.1%) and 50.4% were histologically nodular. Risk factors for poor prognosis included tumor localization in the medial aspect of the lid, tumor size > 5 mm, histological subtype being ulcerative or morphea forms, affected margins, and recurrent lesions.

CONCLUSION:

BCC is a rare condition in Saudi Arabia. The clinical features and histopathology of BCC in Saudi Arabia are similar to the patterns observed in other regions of the world. Early detection and timely management mitigates the extensive destructive ocular/orbital damage due to BCC and results in better patient outcomes.

Updates on the clinical diagnosis and management of ocular sebaceous carcinoma: a brief review of the literature

Ocular sebaceous carcinoma (SC) is an exceedingly rare but aggressive malignancy that can impair patients’ visual acuity or even cause tumor-specific mortality. This tumor usually mimics chronic benign eyelid lesions, thus leading to delayed diagnosis, thereby causing high recurrence and metastasis. Ophthalmologists should be more aware of SC in order to offer correct diagnosis and treatment at the onset of symptoms. Prompt surgical excision with frozen section margin control is the mainstay of SC management after patient evaluation and accurate biopsy. Mohs micrographic surgery has been associated with better tumor control outcomes than wide local excision. Radiation therapy should be considered as adjuvant treatment for locally advanced (stage T3a or higher) or high-risk (pagetoid spread) SC, nodal metastasis, or palliative care. Cryotherapy and topical chemotherapy are used for pagetoid spread. Targeted therapy has an emerging role in more complicated cases. For lymph node and distant metastasis, combination treatments should be provided, including lymph node and neck dissection, radiation therapy, systemic chemotherapy, and even orbital exenteration. The rarity of ocular SC precludes a comprehensive perspective on standard treatment. This paper offers a brief review of recent advances in the clinical diagnosis and management of ocular SC based on current scientific literature.

Lacrimal Caruncle Nevus with Papilloma

Purpose

The aim of this article is to report a case of lacrimal caruncle nevus with papilloma.

Methods

This is a case report of a 39-year-old female with a progressively enlarging pigmented lesion on the left lacrimal caruncle. She had been aware of a raised whitish wart on the top of this pigmented lesion for several months before her initial visit. Slit lamp examination revealed a papillomatous lesion over a well-circumscribed, pigmented lesion on the left lacrimal caruncle.

Results

The histopathological examination of the excised tumor disclosed 2 characteristic findings, which include nests of nevus cells within the dermis and papillomatous structures which had fibrovascular cores overlying squamous cell epithelia with variable levels of acanthosis. The findings were consistent with an intradermal nevus and a papilloma arising from the conjunctival epithelium of the nevus.

Conclusion

This is the first case report of a lacrimal caruncle nevus with papilloma. The clinical history and pathological findings of this case underscore the fact that an intradermal nevus primarily occurred on the lacrimal caruncle, after which a papilloma arose from the epithelium of the nevus as a consequence of human papillomavirus autoinoculation.

Immunohistochemical expression of X-linked inhibitor of apoptosis in eyelid sebaceous gland carcinoma predicts a worse prognosis

Purpose:

Overexpression of the inhibitors of apoptosis proteins have been demonstrated in a variety and of solid tumors including melanomas and nonmelanomas skin cancers. X-linked inhibitor of apoptosis protein (XIAP) is an inhibitor of apoptosis which prevents apoptosis by inhibiting caspases 9, 7, and 3. The prognostic value of XIAP in sebaceous gland carcinoma (SGC) remains unexplored.

Methods:

The immunohistochemical expression of XIAP was evaluated in 29 SGC cases.

Results:

The cytoplasmic overexpression of XIAP was detected in 62% SGC cases. XIAP expression was found to be significantly associated with advanced age, large tumor size, and with reduced disease-free survival (P = 0.0174). XIAP expression and advance tumor Grade III emerged as significant risk factors on univariate analysis. On stepwise multivariate analysis, both increased cytoplasmic XIAP expression and high tumor grade were found to be significantly associated with recurrence. Patients with low XIAP immunoexpression had a longer disease-specific survival than those with high expression in the 5-year follow-up.

Conclusion:

The present study demonstrates at the immunohistochemical level that XIAP is overexpressed in SGC and that high expression could be of biological significance in the development of eyelid SGC. Our finding suggests that up-regulation of XIAP may aggravate tumor metastasis in SGC.

Case report repairing orbital skin defects using composite flaps after giant eyelid-derived tumor excision and orbital exenteration

RATIONALE

Though giant malignant tumors arising in the eyelid are rare, they often require extensive surgery for removal along with orbital exenteration. Because of this, repairing orbital defects is an important factor in the surgical strategy.

PATIENT CONCERNS

Case 1 was a 78-year-old nomad man who presented in the Department of Ophthalmology with a giant tumor in his right eyelid, which had developed over three years. Clinical examination revealed a huge pigmented, nonhealing ulcerated lesion, approximately 52×44×40 mm in size. Case 2 was a 52-year old rural male complaining of a huge tumor in the right eyelid. Patient medical history revealed that the mass was initially the size of a soybean and gradually grew over 3 years to the size of a fist.

DIAGNOSES

Histopathological examination of the tumors revealed that one was a basal cell carcinoma and the other a sebaceous gland carcinoma.

INTERVENTIONS

The two cases of giant malignant eyelid tumors were surgically excised using rapid frozen section margin control. Different pedicle myocutaneous flaps were used to repair the orbital skin defects.

OUTCOMES

Postoperative follow-up showed perfect healing of the pedicle flaps and good patient compliance. The results of these cases indicate that covering exposed orbital cavities with composite pedicle mycuaneous flaps is a simple and practical strategy for orbital reconstruction. Not only does this help maintain orbital stability, but it also provides opportunities for patients to return to normal lives.

LESSONS

Although surgical management is often the first option for treatment of giant eyelid tumors, recurrence and mortality due to the tumors is still high after long-term follow-up. Therefore, early discovery and treatment is the best way to control the progression of giant eyelid tumors and enhance survivability.

Solitary neurofibroma of eyelid masquerading as chalazion

Neurofibroma, a benign peripheral nerve sheath tumor, usually appears together with café-au-lait spots, iris nodules, and other tumors within the scope of neurofibromatosis von Recklinghausen type 1 tumors. A solitary neurofibroma of the eyelid is relatively rare. In this case report, we present a 39-year-old woman who had a lesion on the eyelid crease, previously treated as a chalazion. Due to persistent wound crusting, the lesion was excised above the tarsus. Pathological examination revealed a solitary neurofibroma. The patient did not have other clinical symptoms of neurofibromatosis, and there was no recurrence of the nodule during the 1-year follow-up.

Eyelid Malignancies- Always Quite Challenging

The diagnosis and management of eyelid cancers are quite challenging. Eyelid tumours are relatively rare diverse group of diseases varied in their presentation and extent. Many benign tumours and inflammatory conditions quite frequently masquerade eyelid cancers. Eyelid cancers are not single entity but comprise a wide range of tumours with extremes of tumour biology from indolent to very aggressive histopathologic types. Compromise on aesthetics and eyelids' indispensable function of protecting the eyes during management, may lead to untoward cosmetic disfigurement and loss of vision. On the other hand, inadequate cancer clearance will also be vision threatening and life threatening due to loco regional recurrence and metastasis. To strike an optimal balance is a challenging task, to achieve 'cancer cure' with maximum preservation of function and cosmetics. In addition, the integration of other modalities of treatment, judicious selection and their sequencing require multidisciplinary discussion and joint management by different specialists. We are presenting four case scenarios, we met with in our teaching hospital with reference to literature review to emphasize that eyelid malignancies are not always simple with respect to diagnosis and management.

Fibrosarcoma of the eyelid in two sibling Czech wolfdogs

Most canine tumors of the eyelid are tumors generally encountered in the skin. They are most commonly of epithelial origin and benign. In this report, we describe the cases of two sibling Czech wolfdogs presented, one year apart, with a subcutaneous mass involving the left eyelid. Both lesions were histologically consistent with a diagnosis of subcutaneous fibrosarcoma. Immunohistochemical analyses of the tumors revealed a mild positivity for vimentin and negativity for GFAP, desmin, αSMA, myoglobin, S100, PNL2 and calponin, excluding all differential diagnosis (i.e. peripheral nerve sheath tumor, melanoma, perivascular sarcoma, myofibroblastic sarcoma, rhabdomyosarcoma). To the best of authors’ knowledge, this is the first report of canine eyelid fibrosarcoma. Since this rare tumor has been observed in two full siblings, we could speculate the existence of some genetic predisposition to sarcoma, however the present data did not allow any definite conclusion on the etiopathogenesis or genetic basis of these tumors.