Meibomian gland carcinoma

ARTICLE

Auteur(s) : Hilke H. BETTEN, Jörg WENZEL, Thomas BIEBER, Monika-H. SCHMID-WENDTNER

Department of Dermatology University of Bonn, Sigmund-Freud-Str. 25 D-53105 Bonn Germany
<monika-hildegard.schmid-wendtner@ukb.uni-bonn.de>

A 64-year-old Caucasian male presented with a one cm inflamed crusted nodule on the right upper eyelid which had developed slowly over the last 18 months (figure 1A). The lesion had been initially diagnosed as allergic eczema and chronical blepharoconjunctivitis by general practitioneers and ophthalmologists, but numerous therapeutic efforts, including topical corticosteroids and antibiotics failed. Biopsy of the tumor revealed a nodular sebaceous gland carcinoma with central ulceration which originated from a meibomian gland (figure 1B). The tumor cells had prominent vacuoles and several mitoses (figure 1C). The tumor was excised with clear margins by an oculoplastic surgeon. During a follow-up period of sixteen months neither recurrence nor metastases have been observed.

Discussion

Meibomian gland carcinoma is a rare and aggressive malignant tumor derived from the Meibomian glands, which are modified sebaceous glands of the eyelid [1]. After basal cell carcinoma, squamous cell carcinoma and malignant melanoma it is the fourth most common eyelid malignancy and accounts for 10-30% of eyelid neoplasms. Undifferentiated tumors and tumors with dural or intracranial invasion have a poor prognosis. The non-specific clinical symptoms can resemble chronic unilateral blepharitis, granuloma and fibrous histiocytoma. Important differential diagnoses are the internal stye (hordeolum) and the chronic variant, a chalazion. In later stages, meibomian gland carcinomas present as firm nodules, which gradually enlarge and become ulcerated. In these cases, the tumors may be clinically indistinguishable from basal cell carcinomas, squamous cell carcinomas, eccrine duct carcinomas and metastatic carcinomas to the eyelid from visceral malignancies [2].
Histopathologically, meibomian gland carcinomas can vary considerably from an acinar pattern to a very undifferentiated pattern. A biopsy may show intraepidermal malignant clear cells leading to the misdiagnosis of a superficial spreading melanoma. Moreover, basal cell carcinomas with sebaceous differentiation have histopathological similarities to meibomian gland carcinoma [3]. It has been suggested that human telomerase RNA- and P53-expression may be useful markers in progression of Meibomian gland carcinomas but their reliability in routine clinical practice has yet to be investigated [4].
In conclusion, relapsing or infiltrated eyelid nodules with pigmentation or bleeding, especially in aged persons, should raise the suspicion of Meibomian gland carcinoma. This tumor requires extensive excision, usually followed by complete eyelid reconstruction. Long-term monitoring for recurrence, regional lymph involvement or distant metastases is necessary. n

1. Nelson BR, Hamlet KR, Gillard M, Railan D, Johnson TM. Sebaceous carcinoma. J Am Acad Dermatol 1995; 33: 1-15.

2. Piest KL. Malignant lesions of the eyelids. J Dermatol Surg Oncol 1992; 18: 1056-9.

3. Shields JA, Demirci H, Marr BP, Eagle RC Jr, Shields CL. Sebaceous carcinoma of the eyelids: personal experience with sixty cases. Ophthalmology 2004; 111: 2151-7.

4. Li B, Li N, Cheng G, et al. Correlation of the expression of telomerase RNA with risk factors for recurrence of sebaceous gland carcinoma. Graefes Arch Clin Exp Ophthalmol 2005; 25: 1-5.