Abstract
Sebaceous gland carcinoma (SGC) of the eyelid is a highly malignant neoplasm that arises from the meibomian glands, glands of Zeis, and sebaceous glands of the skin. The characteristics of this disease are high recurrence rate, significant metastatic potential, and notable mortality rate, which are quite different from basal cell carcinoma (BCC). We report the case of a 37-year-old woman with the history of left lower eyelid BCC (diagnosed 9 years ago), who had left parotid lymph nodes metastases and local recurrence twice. The chief complaint during visit was a left upper eyelid swelling mass noted for 3 months. She received salvage ablation surgery later. The final pathologic report is SGC. The diagnosis corresponds to the clinical presentation of this patient at last. The delay between initial examination and final diagnosis in this patient is about 9 years, but operation and concurrent chemotherapy and radiotherapy were performed after left parotid lymph nodes metastasis was noted. Although there was still local recurrence after concurrent chemotherapy and radiotherapy, the patient is still alive without distant metastasis. In this article, we would discuss the differences of the pathologic characters, treatment, and prognosis between SGC and BCC.
1
Introduction
Sebaceous gland carcinoma (SGC) of the eyelid is a highly malignant neoplasm that arises from the meibomian glands, glands of Zeis, and sebaceous glands of the skin. It is relatively rare, accounting for 1% to 5.5% of all eyelid cancers (the third most common) . Sebaceous gland carcinoma has a high recurrence rate, significant metastatic potential, and notable mortality rate . The disease can spread directly by orbital invasion, lymphatic spread to regional lymph nodes, and hematogenous spread to distant organs . It is female predominant, occurring on average at the sixth to seventh decade of life. Basal cell carcinoma (BCC) is different from SGC in epidemiology, treatment, clinical course, and prognosis ( Table 1 ). However, the initial clinical presentations of both may be the same as a nodule lesion. Thus, a full-thickness eyelid biopsy is the necessary approach to the diagnosis . Histopathology of SGC may show highly pleomorphic cells arranged in lobules or nests with hyperchromatic nuclei and vacuolated (foamy or frothy) cytoplasm. However, BCC consists of nests, lobules, cords of tumor cells with peripheral palisading of cells, and stromal retraction ( Table 2 ). Besides, they have different special stains, respectively. Although the pathologic characters of these 2 malignant tumors differ from each other, it is still difficult to distinguish them if poor sebaceous differentiation initially or even the coexistence of the both differentiated type . We presented a case of eyelid SGC with parotid lymph node metastasis and frequent local recurrence which was diagnosed as BCC initially.
| SGC | BCC |
|---|---|
| Firm, yellow nodule; plaque-like thickening; destruction of the eye structure; various manifestations | 5 basic types: nodular-ulcerative, pigmented, morphea or sclerosing, superficial, fibroepithelioma |
| Highly malignant | The most common eyelid cancer |
| From meibomian, Zeis, or sebaceous glands | From cells of the basal layer of the epidermis |
| Metastatic potential, notable mortality rate | Locally invasive, rarely metastasize |
| 60∼70 years old, female | Average age: 60 y |
| SGC | BCC |
|---|---|
| Pleomorphic cells arranged in lobules or nests, pagetoid superficial spread | Tumor cells arranged in nests, lobules, and cords |
| With hyperchromatic nuclei and vacuolated, more basophilic cytoplasm | With peripheral palisading of cells and stromal retraction |
| Special stain: EMA, oil red O, Sudan III, Sudan black, antiperilipin, and antiadipophilin stains | Special stain: BerEP4; CK20 (−) |
2
Case report
A 37-year-old woman complained a left upper eyelid swelling mass for 3 months. The history was left lower eyelid BCC diagnosed 9 years ago with left parotid lymph nodes metastases and local recurrence twice. In reviewing the history, it was noted that she came to our ophthalmology department for help due to a left lower eyelid mass 9 years ago. She received en bloc excision and tarsoconjunctival flap reconstruction. The pathologic report showed BCC with only regular follow-up suggested. Two years later, a left preauricular mass (3 × 4 cm) was noted. She came to our ENT department for help. Superficial parotidectomy was done with metastatic lymph nodes reported, and consequent concurrent chemotherapy and radiotherapy (CCRT) (intensity-modulated radiation therapy total 6000 cGy and 2 cycles of 5-FU + cisplatin) were performed. However, there was still local recurrence over left lower and even upper eyelid noted in October 2005 and March 2009. Excision and local salvage radiotherapy (total 5040 cGy) had been arranged, respectively. In November 2009, she came to our hospital again for a 1.5 × 1.5–cm, indurated, nontender, irregular surface mass on left upper eyelid ( Fig. 1 ). Computed tomographic scan showed a soft tissue mass lateral to the left eyeball ( Fig. 2 ). Composite resection with canthoplasty was then performed. The pathologic report ( Fig. 3 ) was altered to SGC this time. We kept undone salvage RT after wound healing. Now the patient is under regular follow-up, and we had added oral chemotherapeutic agents (tegafur/uracil and cyclophosphamide) as metronomic setting. There was no local recurrence or distant metastasis noted.
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