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ARTICLE
Year : 1962  |  Volume : 10  |  Issue : 3  |  Page : 73-75

A case of carcinoma of both upper lids


Departments of Ophthalmology and Pathology, S. N. Medical College, Agra, India

Date of Web Publication18-Mar-2008

Correspondence Address:
K N Mathur
Departments of Ophthalmology and Pathology, S. N. Medical College, Agra
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Mathur K N, Kehar U, Wahi P N, Agarwal T P. A case of carcinoma of both upper lids. Indian J Ophthalmol 1962;10:73-5

How to cite this URL:
Mathur K N, Kehar U, Wahi P N, Agarwal T P. A case of carcinoma of both upper lids. Indian J Ophthalmol [serial online] 1962 [cited 2019 Nov 20];10:73-5. Available from: http://www.ijo.in/text.asp?1962/10/3/73/39564

Carcinoma of the lids as a single independent tumour is commonly seen constituting about 42% (Duke­-Elder) of all the malignant growths of the eye. Histologically basal­cell carcinoma is the commonest, next being the squamous-cell carcinoma, the baso-squamous be­ing the least common (Birge). Rarely multiple independent car­cinomatous tumours may be present in both the eyes of the same patient (Cochram and Robinson). It is ex­tremely rare, to have multiple independent tumours of different histological nature in one individual. A case showing two different histo­logical patterns of tumours in two lids is therefore reported.


  Case Report Top


Patient named B. A., aged 30 years, Hindu female was admitted in this hospital on 3rd April, 1960 with the complaints of gradually in­creasing swelling of both the upper lids, more so of the left eye and a notch in the right upper lid, for the last three months. During this period, she developed generalised weakness of the body and lost a good amount of weight. For the last one month she was having occasional bleeding from the under surface of the left upper lid and occasional purulent discharge from the ulcer on the skin surface of that lid.

She was a young villager of average build, fair, with normal pulse, temperature and blood pres­sure.

The right eye [Figure - 1] shows the presence of a notch in the right upper lid extending horizontally a little away from the punctum upto the junction of the middle and the outer third of the lid margin. The margins of the notch are pigment­ed, bluish in colour, raised above the surface level and non-tender. The swelling extends diffusely in the whole upper lid, restricting the active movements slightly. The re­maining eye lashes are matted and mild conjunctival congestion is present. Rest of the eye is normal.

The left eye [Figure - 1],[Figure - 2] shows a prominent, diffuse swelling involv­ing the whole thickness of the left upper lid measuring about 3.5 x 2.5 x 2.5 cms. and is triangular in shape with the base at orbital margin. Pro­minent veins can be seen on the skin surface. The skin is fixed with the growth. There is an ulcer present on the skin measuring about 1 x 1 cm. with irregular hard margins and the floor covered by slough. The palpebral surface is much hypertro­phied, where bleeding points could be seen. Active movements of the lids were restricted because of the heavy weight of the growth, but passively, it was freely mobile. The cornea could be seen only after lift­ing the lid mechanically. Clinically there was no involvement of any of the lymph nodes.

Histological examination of the tumour in the right eye revealed solid masses of darkly staining cells extending into the dermis as seen in [Figure - 3]. All the cells are of the same type as the basal cells of the epidermis and the nuclei take up an in­tensely dark blue stain with haematoxylin. The cells at the periphery of these solid masses show a typical palisading arrange­ment. A high power study of this tumour showed few abnormal mitotic figures. There is no evid­ence of keratinization or formation of cell nests. The inter-cellular matrix consists of bundles of adult connective tissue sparsely infiltrated by mononuclear cells.

The tumour in the left eye con­sisted of groups and sheets of malignant epithelial cells growing down into the dermis as seen in [Figure - 4]. In the centre of these masses of malignant epithelial cells the process of keratinization can be re­cognized forming epithelial pearls. Most of the malignant cells are polygonal, while others are enlarg­ed. Presence of inter-cellular keratin bridges can be recognized at a num­ber of places. About 2 to 4 abnormal mitotic figures can be seen per high power of the field. The inter-cellular matrix consists of loose vascularised connective tissue containing focal and diffuse collection of lymphocyt­es.

Involvement of the orbit and metastases in the lungs was exclud­ed by X-ray. Blood picture showed slight microcytic hypochromic anaemia.


  Comment Top


The percentage of carcinoma of the eye lids in all its different cutaneous forms (Basal-cell, Squam­ous-cell and Baso-squamous-cell) is commonly seen as single independ­ent tumour constituting about 42% of all the neoplasms of the eye and about 12% of all facial cancers. It is rare to find multiple independent tumours Cochrum and Robinson found a squamous-cell epithelioma on the right lower lid. which was ap­parently adequately treated by radium. Twenty-six months later similar tumours appeared on left eye ball and right conjunctiva.

The commonest age for carcinoma lids is 60-70 years (Duke-Elder), 50-55 years (Reese). Before 40 years and after 80 years, it is rare though cases of younger and older age groups have been reported varying from 3½ years to 85 years. Males are more commonly affected than females 65 : 35 (males : females) The site, which is most frequently effected is near the margin of the lower lid towards the inner canthus. The percentage for the involvement of different sites of the eye as re­ported in the literature are lower lid 51-54 per cent; upper lid 10-13 per cent; internal canthus 28-32 per cent; and external canthus 5-7 per cent. Basal cell Carcinoma is more com­mon than the Epidermoid Car­cinoma.[3]


  Summary Top


A case of Carcinoma lids is being reported in a lady of thirty years of age with independent carcinomatous tumours of different histological nature in the two sides; the left upper lid having Epidermoid Car­cinoma Grade II and the right upper lid having Basal-cell Carcinoma.

 
  References Top

1.
Cochrani and Robinson : (1922). A de derm. Sypb. iii : 385.  Back to cited text no. 1
    
2.
Duke-Elder, W. S. : (1962). Text book of Ophthalmology. V5. P. 5037 , Henry Kimpton, London.  Back to cited text no. 2
    
3.
Reese, A. B.: (1951) . Tumours of the Eye. p. i Paul B, Hoeber. Inc.  Back to cited text no. 3
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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