|Year : 1962 | Volume
| Issue : 2 | Page : 36-38
Adenocarcinoma of Meibomian glands
Institute of Ophthalmology, Calcutta, India
|Date of Web Publication||29-Mar-2008|
S P Das
Institute of Ophthalmology, Calcutta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Das S P. Adenocarcinoma of Meibomian glands. Indian J Ophthalmol 1962;10:36-8
Tumour of the Meibomian gland was described first by Baldauf in 1870 and its malignant character was reported first by Allaire in 1891 and then by Sourdille in 1894.
Adenocarcinoma of the Meibomian gland has a tendency for recurrence and metastasis. Metastasis occurs by the lymphatic path and orbit etc. Fatal cases were reported by Snell, Knapp, Cavara, Riva etc.
The usual method of treatment is wide excision of the tumour, followed by irridiation in advanced cases. If there is a gap, plastic repair is to be done.
During the period of last 12 years, 170 cases of tumours of the lids were sent to the Pathology department of the Institute of Ophthalmology for histopathological examinations. Among these cases and during this period, 5 cases of tumours of the Meibomian glands were detected and 4 of them were adenocarcinoma of the Meibomian glands.
| Case Reports|| |
Case No. 1
A. M., 45 years, male patient, came to the Institute of Ophthalmology, Calcutta, on 3rd September, 1957. He presented a tumour in the middle of the lower eyelid of right eye. The present complaint started in 1947 as a small mass at the same site and in the same eye which was then operated for chalazion, and again in 1956. But the swelling was increasing again after the second operation and had attained the present condition.
On examination the tumour extended from the fornix to lid margin and was hard, well-defined, not tender and mobile. It measured ½ x ¼ x ¼. The mass was adherent to the skin of the lid margin. Pre-auricular and other lymph nodes were not palpable and no metastasis could be detected anywhere in the body. The eyeballs were normal and no abnormality could be detected in the fundi of both eyes. Vision in both the eyes was 6/6. General condition was fair. Blood and urine examinations did not reveal any abnormality. The Clinical diagnosis was carcinoma of Meibomian gland.
Case No. 2:
Male patient, aged 50 years, attended the Institute of Ophthalmology first on 30-12-58 and complained of swelling almost in the middle of the lower eyelid of lefteye. The condition started one year and 10 months back with a small nodule and for the last 3 months it was increasing with moderate rapidity. Nothing particular was noted in the family and personal history. There was no history of the occurrence of chalazion beforehand.
On examination, the tumour was firm, irregular, mobile, not tender, well-defined and pyramidal in shape. The swelling measured ¾ x ½ x ½. The mass was adherent to the skin of the lid margin. Except the tumour in the left lower eyelid and lental sclerosis in both eyes, the both eyeballs were otherwise healthy. Lymph nodes were not palpable and there was no sign of other metastasis. Blood and urine examinations showed no abnormality. The clinical diagnosis was carcinoma of the left lower eyelid.
Case No. 3.
N-D., aged 60 years came to the hospital with the complaint of a swelling in upper lid of right eye with the duration of 9 months. He gave a past history of chalazion operation in the same eye and at the same site. The growth was almond shaped and of firm consistency. No other abnormality could be found out. The clinical diagnosis was carcinoma of Meibomian gland.
Case No. 4.
A male patient of 40 years age was admitted into the hospital with the clinical diagnosis of carcinoma of right lower eyelid. On examination, a hard mass of 1" x ½ x ½ was found in right lower eyelid. There was no enlargement of lymph nodes and no other abnormality was found.
| Pathology|| |
The specimens were yellowish in colour and had nodular surfaces. On section the cut surfaces showed yellowish colouration and contained minute yellow areas.
The removed tumour masses in the four cases were put in 10 per cent formol, embedded in paraffin, sectioned and stained with hematoxylin and eosin.
Histologically they were glandular carcinoma. Two types of acini were seen. One was of Meibomian gland type of normal size and the other variety was much bigger in size with evidence of proliferation. The acini were separated from each other by connective tissue rich in capillaries. The regular arrangement of the cells was lost and there was less orderly cell differentiation. Mitosis was found throughout the neoplastic cells. The less differentiated cells were observed mainly at the periphery and the more vacuolated cytoplasmic cells were at the centre of the acini.
Meibomian glands are modified sebaceous glands, so their secretion sebum is rich in fat, fatty acids and cholesterol. Many vacuoles were present in the cytoplasm giving the cells the appearance of round empty spaces. These empty spaces were nothing but fat globules removed during the preparation of the histological slides. There were little signs of inflammation.
Adenocarcinoma of the Meibomian gland is definitely rare. But true incidence is difficult to determine since there is no constant histological survey of all chalazia removed and clinically it is most often impossible to differentiate it from chalazion.
The upper eyelid is said to be more affected than the lower, but in the present four cases lower eye-lids were involved in three cases.
Sex has no special prediclaction and both sexes are equally affected. It occurs usually above 40 years of age, although it has been noted at the age of 3½ years by Knapp, at the age of 11 years by Allaire and at the age of 35 years by Imatomi. The mode of onset is insidious and the progress is variable from months to years.
All the four present tumours were removed under local anaesthesia and the resulting gaps were sutured. Considering the recurrence of the tumour, all cases were subjected to deep X-ray therapy and the patients are doing well at present, although the followup period of the fourth patient is less than six months.
Adenocarcinoma of the Meibomian gland usually starts as a small tumour and simulates a chalazion in every way. So it is very difficult or rather impossible to diagnose the true condition until biopsy is done. It is to be remembered that the recurrence of a chalazion after surgical removal should lead one to think of the possibility of adenocarcinoma of the Meibomian gland and biopsy is essential in these cases.
Four cases of adenocarcinoma of Meibomian glands with a histological diagnosis are reported.
| References|| |
Allaire (1881). These de Paris. (Ref. Brit. J. Ophth., 1930, 15, 588).
Cavara (1920), Arch. per le Sci. Med., 43, I (Ref. Arch. of Ophthal. 1934, 12, 850).
Duke-Elder (1952), Text Book of Ophthalmology, Vol. 5, Henry Kimpton, London, P. 5065.
Imatomi (1920), Chuo Ganka-Iho, 12,171. (Ref. Brit. J. Ophth., 1930, 15, 588).
Knapp (1936). J. Am. Med. As, 107, 933.
Lazarescu, Lazarescu and Ionescu (1930), Brit. J. Ophth., 14, 588.
Riva (1922), Arch, di Ottal., 29, 261 (Ret. Amer. J. Ophth., 1935, 18, 552).
Sourdille (1894), A. d'o, 14, 179.
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