About MEAJO | Editorial board | Search | Ahead of print | Current Issue | Archives | Instructions to authors | Online submission | Subscribe | Advertise | Contact | Login 
Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
Users Online: 584   Home Print this page Email this page Small font sizeDefault font sizeIncrease font size


 
  Table of Contents 
ORIGINAL ARTICLE
Year : 2022  |  Volume : 29  |  Issue : 1  |  Page : 15-18  

Clinicopathological study of meibomian carcinoma of eyelids – An experience of two years in a tertiary care center


Department of Pathology, Medical College, Kolkata, West Bengal, India

Date of Submission16-Nov-2021
Date of Acceptance24-Apr-2022
Date of Web Publication23-Nov-2022

Correspondence Address:
Dr. Senjuti Dasgupta
Department of Pathology, Medical College, Kolkata, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/meajo.meajo_298_21

Rights and Permissions
   Abstract 


PURPOSE: Meibomian carcinoma is a rare and aggressive malignant neoplasm of the eyelids. The clinical presentation often mimics benign conditions thereby making the diagnosis challenging. The aim of the study was to analyze cases of meibomian carcinoma, the specimens of which were received, in the past 2 years in the pathology department.
METHODS: This retrospective observational study was undertaken for 2 years and included 9 patients of meibomian carcinoma. For each case, detailed history and clinical findings were retrieved from the hospital records. Histopathological examination was undertaken in all cases after preparing hematoxylin and eosin-stained slides from tissue blocks preserved in the department.
RESULTS: The mean age of the patients was 55 ± 15 years. Six (66.7%) patients were females, and the other three (33.3%) were male. Following surgery, gross examination of the specimens revealed that the mean size of the excised tumors was 2.45 ± 1.45 cm. The tumors were classified based on histopathological features according to growth pattern, cell type, and cytoarchitecture. Most cases had lobular growth pattern (5, 55.6% cases), consisted of epidermoid cells (5, 55.6% cases), and exhibited infiltrative cytoarchitecture (8, 88.9% cases).
CONCLUSION: Early diagnosis of meibomian carcinoma is important to reduce mortality from the aggressive tumor. The knowledge of clinicopathological aspects of the tumors that were biopsied in the department of pathology in the past 2 years will help in diagnosis and management of such tumors in future.

Keywords: Clinicopathological features, histopathological classification, meibomian carcinoma


How to cite this article:
Dasgupta S, Jain P, Bhattacharyya NK, Khatoon R. Clinicopathological study of meibomian carcinoma of eyelids – An experience of two years in a tertiary care center. Middle East Afr J Ophthalmol 2022;29:15-8

How to cite this URL:
Dasgupta S, Jain P, Bhattacharyya NK, Khatoon R. Clinicopathological study of meibomian carcinoma of eyelids – An experience of two years in a tertiary care center. Middle East Afr J Ophthalmol [serial online] 2022 [cited 2022 Nov 26];29:15-8. Available from: http://www.meajo.org/text.asp?2022/29/1/15/361875




   Introduction Top


Meibomian carcinoma is an aggressive tumor of the eyelids. It may arise from meibomian glands of the tarsal plate, caruncle, periocular skin, or glands of Zeiss. The incidence of meibomian carcinoma is only 1%–1.5%.[1] Although rare worldwide, meibomian carcinoma is now the third most common malignant tumor of eyelids after basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). SCC is on the rise and might be considered to be the second most common eyelid malignancies in some countries and the most common in others, like India.[2] Early diagnosis of meibomian carcinoma is often challenging since the clinical appearance often mimics benign conditions of eyelids such as chalazion and blepharoconjunctivitis.[3]

It is largely unknown why this carcinoma occurs commonly in the ocular adnexal structures.[4],[5] Even though the etiology of meibomian carcinoma has not been elucidated completely, an association with sunlight and radiation exposure has been reported.[3] Although it was previously believed that this disease is predominantly prevalent among Asians, not very long ago, greater incidence among Whites than Pacific Islanders or Asians has also been reported.[6] Muir–Torre syndrome has been known to predispose the development of sebaceous tumors due to the inactivation of genes MLH1 or MSH2.[7] p53 and RB are the other genes implicated in its pathogenesis.[8],[9] The association of meibomian carcinoma with Human Immunodeficiency Virus has been noted.[10]

It is absolutely essential to recognize the early symptoms and signs of meibomian carcinoma so that timely recognition of the tumor may save the patient's life. The present study was undertaken to highlight the clinicopathological characteristics of meibomian carcinoma cases encountered in the past 2 years in a tertiary care center of eastern India. This would help in diagnosis and management of similar cases in future.


   Methods Top


A retrospective observational study was carried out for 2 years. Patients with meibomian carcinoma of eyelids who had submitted their specimens in the department of pathology, following surgery, for histopathological examination (HPE), during that time were included in the study. A total of 369 specimens of eyelid tumors were submitted to the department of pathology in the span of 2 years, among which only 9 cases were diagnosed as meibomian carcinoma. Out of these nine patients, 7 were considered to be under good prognostic criteria while poor prognostic criteria were found in two patients The clinical features which constitute poor prognostic criteria include duration of symptoms more than 6 months, tumors exceeding 10 mm in diameter, simultaneous involvement of both upper and lower eyelids and presence of orbital invasion.[11] Patients with any type of lesion of eyelids, other than meibomian carcinoma, were excluded from the study.

For each case, detailed history and clinical findings were retrieved from the hospital records. The contact information available in the records was used to obtain consent and also to follow-up the patients. The tissue blocks of meibomian carcinoma of eyelids which have been preserved over the last 2 years, were then retrieved. Hematoxylin and eosin (H and E) stained slides were prepared from the tissue blocks, and HPE was undertaken in each case. All data were meticulously recorded.


   Results Top


The present study included 9 patients over a period of 2 years. The age of the patients ranged between 24 and 75 years with a mean of 55 ± 15 years. Six (66.7%) of the patients were female and the other three (33.3%) were male. The male-to-female ratio was 0.5:1.

All the patients presented with upper eyelid lesions. Six (66.7%) of the lesions were right sided and the rest (3, 33.3%) left sided. In five of the cases, the clinical suspicion was that of meibomian carcinoma from the onset. However, clinically, two cases were considered to be vascular lesions, one lacrimal gland neoplasm, and another melanoma.

Upper lid mass excision was done under general anesthesia with Cutler–Beard procedure in all but one case. The right orbit exenteration with forehead flap reconstruction was undertaken in that case. This aggressive procedure was done since a previous incisional biopsy report was available in this case, which was dated 3 months back. A differential diagnoses of meibomian carcinoma and SCC was rendered in that report. Later, a (contrast-enhanced computed tomography [CECT]) was done and it showed homogeneously enhancing mass lesion at superolateral quadrant of right orbit and lacrimal gland region measuring 3.6 cm × 3.1 cm × 7.1 cm. The lesion was found to protrude out to the globes. On the basis of these reports (incisional biopsy and CECT), a decision of the right orbit exenteration with forehead flap reconstruction was undertaken. In another case, small-sized masses were excised from the same site on three prior occasions, and each time the mass was histopathologically diagnosed to be sebaceous adenoma.

Following surgery, the specimens were sent to the department of pathology in 10% neutral buffered formalin. Gross examination of the specimens revealed that the size of the excised tumors ranged between 0.8 and 4.5 cm with a mean of 2.45 ± 1.45 cm. The histopathological diagnoses of the cases were rendered as meibomian carcinoma. Microscopic examination revealed that the growth pattern of the cases was trabecular in 3 (33.3%) cases, lobular in 5 (55.6%) and BCC like in 1 (11.1%) case. The tumor cell type was basaloid in 1 (11.1%) case, basosquamous in 3 (33.3%), and epidermoid in 5 (55.6%) cases. The cytoarchitecture was infiltrative in 8 (88.9%) cases and nodular in 1 (11.1%) case [Figure 1].
Figure 1: Meibomian carcinoma with lobular arrangement of epidermoid cells and infiltrative growth pattern (H and E, ×400). Inset shows scanner view of the tumor (H and E, ×100)

Click here to view


Immunohistochemical analysis was undertaken in the case where there was clinical suspicion of melanoma. The tumor cells were found to be EMA positive and S100 negative. Accordingly, the case was finally diagnosed as a case of meibomian carcinoma.

All the nine cases have been followed up for between 6 and 18 months. So far, all patients are doing well.


   Discussion Top


Meibomian carcinoma has a poor prognosis. Shields et al. reported that only 32% of cases of meibomian carcinoma were appropriately diagnosed during the first clinical examination. Further, on initial histopathologic analysis, only 50% of cases were correctly diagnosed.[12] Cicinelli and Kaliki were of the opinion that timely diagnosis and therapeutic intervention may improve the prognosis of this dismal disease.[2]

It has been emphasized that the varied clinical presentations of mebomian carcinoma and its histopathologic mimics must be appreciated to achieve the objective of appropriate diagnosis and management of the lesion.[4] In the early stage of the disease, pagetoid spread of meibomian carcinoma without tumefaction may lead to its resemblance with blepharoconjunctivitis. Chalazion is also a common misdiagnosis of this tumor. The histopathologic differentials include BCC and Merkel cell carcinoma.[3] In the present study, vascular lesion, lacrimal gland neoplasm, and melanoma were the differentials on clinical examination. In cases where the posterior extent of the tumor could not be delineated on clinical examination, CECT of the orbit was undertaken. Fine-needle aspiration cytology of lymph nodes was performed in those cases where local lymph nodes were found to be palpable. Systemic metastases were ruled out in all cases by the following investigations – chest X-ray, ultrasound of the whole abdomen and liver function tests. Immunohistochemical analysis was required to rule out the possibility of melanoma in one case.

Cicinelli and Kaliki classified meibomian carcinoma based on histopathological features according to growth pattern, cell type, and cytoarchitecture.[2] The same system of classification has been used in the present study.

Meibomian carcinoma occurs commonly in the elderly with the mean age of incidence being 73 years.[6] Even though the maximum age found in the present study was 75 years, the mean age was 55 years. Etiology could not be delineated in any of the cases. According to Sung et al. this aggressive malignant lesion can occur even in the absence of any prior history of radiation therapy, occurrence of retinoblastoma or syndrome association.[3]

Meibomian carcinoma has a high recurrence rate ranging between 9% and 36%.[13] It also has a significant metastatic potential. The regional spread has been reported to structures such as nasolacrimal duct, lacrimal sac, and also the regional lymph nodes (both preauricular and submandibular). Rarely, the distant spread may occur to lungs, liver, bones, and brain.[1]

In institutes where facilities for intraoperative frozen section are available, the technique helps to ensure clean surgical margins during the excision of malignant eyelid lesions. Meibomian carcinoma is notorious for recurrence, especially if resection margins are not free of tumor. Hence, the frozen section technique helps to prevent recurrence. However, the use of frozen section prolongs the time of surgery, increases the expenses and also requires the presence of an experienced pathologist at the center.[14]

The most common treatment of meibomian carcinoma is Mohs micrographic surgery, which is also most effective. Some cases however require more radical approach including orbital exenteration. The success of other modalities of treatment is rather limited.[15] The factors which impart a worse prognosis in this tumor include involvement of both upper and lower eyelids, a large tumor size (≥10 mm), persistence of symptoms for more than 6 months, poorly differentiated morphology on histopathologic examination, lymphovascular invasion, multicentric origin, extension into the orbit and pagetoid spread of tumor cells.[16] Till date, the follow-up of patients included in the present study has not shown any evidence of recurrence. But further follow-up for a longer period is crucial so as to detect any recurrence at its earliest.


   Conclusion Top


Early diagnosis of meibomian carcinoma is essential to reduce mortality from the aggressive tumor. Studies like the present one are necessary for meticulous analysis of clinicopathological aspects of meibomian carcinoma which in turn will help in diagnosis and management of such tumors in future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Devi B, Das RK, Medhi S. Case report of a rare case of meibomian gland carcinoma of the lower eyelid. Int J Res Med Sci 2016;4:3629-31.  Back to cited text no. 1
    
2.
Cicinelli MV, Kaliki S. Ocular sebaceous gland carcinoma: An update of the literature. Int Ophthalmol 2019;39:1187-97.  Back to cited text no. 2
    
3.
Sung D, Kaltreider SA, Gonzalez-Fernandez F. Early onset sebaceous carcinoma. Diagn Pathol 2011;6:81.  Back to cited text no. 3
    
4.
Shields JA, Demirci H, Marr BP, Eagle RC Jr., Shields CL. Sebaceous carcinoma of the ocular region: A review. Surv Ophthalmol 2005;50:103-22.  Back to cited text no. 4
    
5.
Yoon JS, Kim SH, Lee CS, Lew H, Lee SY. Clinicopathological analysis of periocular sebaceous gland carcinoma. Ophthalmologica 2007;221:331-9.  Back to cited text no. 5
    
6.
Dasgupta T, Wilson LD, Yu JB. A retrospective review of 1349 cases of sebaceous carcinoma. Cancer 2009;115:158-65.  Back to cited text no. 6
    
7.
Abbas O, Mahalingam M. Cutaneous sebaceous neoplasms as markers of Muir-Torre syndrome: A diagnostic algorithm. J Cutan Pathol 2009;36:613-9.  Back to cited text no. 7
    
8.
Kiyosaki K, Nakada C, Hijiya N, Tsukamoto Y, Matsuura K, Nakatsuka K, et al. Analysis of p53 mutations and the expression of p53 and p21WAF1/CIP1 protein in 15 cases of sebaceous carcinoma of the eyelid. Invest Ophthalmol Vis Sci 2010;51:7-11.  Back to cited text no. 8
    
9.
Kivelä T, Asko-Seljavaara S, Pihkala U, Hovi L, Heikkonen J. Sebaceous carcinoma of the eyelid associated with retinoblastoma. Ophthalmology 2001;108:1124-8.  Back to cited text no. 9
    
10.
Yen MT, Tse DT. Sebaceous cell carcinoma of the eyelid and the human immunodeficiency virus. Ophthalmic Plast Reconstr Surg 2000;16:206-10.  Back to cited text no. 10
    
11.
Kaliki S, Ayyar A, Dave TV, Ali MJ, Mishra DK, Naik MN. Sebaceous gland carcinoma of the eyelid: Clinicopathological features and outcome in Asian Indians. Eye (Lond) 2015;29:958-63.  Back to cited text no. 11
    
12.
Shields JA, Demirci H, Marr BP, Eagle RC Jr, Shields CL. Sebaceous carcinoma of the eyelids: Personal experience with 60 cases. Ophthalmology 2004;111:2151-7.  Back to cited text no. 12
    
13.
Song A, Carter KD, Syed NA, Song J, Nerad JA. Sebaceous cell carcinoma of the ocular adnexa: clinical presentations, histopathology, and outcomes. Ophthalmic Plast Reconstr Surg 2008;24:194-200.  Back to cited text no. 13
    
14.
Şahan B, Çiftçi F, Özkan F, Öztürk V. The importance of frozen section-controlled excision in recurrent basal cell carcinoma of the eyelids. Turk J Ophthalmol 2016;46:277-81.  Back to cited text no. 14
    
15.
Nanda L, Sanjana SM, Srivastava VK, Shivakumar M, Dsouza JR. Meibomian gland carcinoma of the eyelid: A rare case report. Int J Sci Stud 2015;3:140-2.  Back to cited text no. 15
    
16.
Wali UK, Al-Mujaini A. Sebaceous gland carcinoma of the eyelid. Oman J Ophthalmol 2010;3:117-21.  Back to cited text no. 16
[PUBMED]  [Full text]  


    Figures

  [Figure 1]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Methods
   Results
   Discussion
   Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed156    
    Printed0    
    Emailed0    
    PDF Downloaded16    
    Comments [Add]    

Recommend this journal