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Case Study: May 2007
History
A 45-year man presented to the ophthalmologists with a 1 year history of an expanding mass on the right lower lid.
A full thickness lower lid excision was performed.
Histology showed an expansile lesion, composed of a glandular elements. Nuclear pleomorphism and mitotic activity were identified. The cells were eosinophilic and showed bubbly to granular cytoplasm.
Fig1-low power of full thickness lid excision. Fat black arrow=tarsal conjunctiva. Thinner black arrow is skin.
Fig 2-Higher power of lesion.
Fig 3-the lesion was strongly positive for GCDFP-15 (as shown), CK-7 and EMA.
Questions
What is the diagnosis?
This is a primary apocrine adenocarcinoma of the eyelid. It has probably arisen from the Moll glands that are a type of apocrine gland. The strong GCDFP-15 staining corroborates the histological findings nicely.
In a woman, it is important to exclude metastatic breast carcinoma with apocrine differentiation, before entertaining a diagnosis of primary eyelid apocrine carcinoma.
References
Barker-Griffith AE, Streeten BW, Charles NC. Moll gland neoplasms of the eyelid: a clinical and pathological spectrum in 5 cases. Arch Ophthalmol. 2006 Nov;124(11):1645-9.
Shintaku M, Tsuta K, Yoshida H, Tsubura A, Nakashima Y, Noda K. Apocrine adenocarcinoma of the eyelid with aggressive biological behavior: report of a case.Pathol Int. 2002 Feb;52(2):169-73.
Seregard S. Apocrine adenocarcinoma arising in Moll gland cystadenoma.
Ophthalmology. 1993 Nov;100(11):1716-9.
Thomson SJ, Tanner NS. Carcinoma of the apocrine glands at the base of eyelashes; a case report and discussion of histological diagnostic criteria.
Br J Plast Surg. 1989 Sep;42(5):598-602.
