|Year : 1966 | Volume
| Issue : 3 | Page : 144-145
Adenocarcinoma of Meibomian glands -report of 2 cases
Ophthalmic Dept.. Sardar Patel Medical College, Bikaner, India
|Date of Web Publication||16-Jan-2008|
S D Sharma
Ophthalmic Dept.. Sardar Patel Medical College, Bikaner
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma S D. Adenocarcinoma of Meibomian glands -report of 2 cases. Indian J Ophthalmol 1966;14:144-5
Carcinomata of the sebaceous glands of the skin are extremely rare. Meibomian glands are modified sebaceous lands. There is a lot of difference in views about the occurrence of adeno-carcinoma in Meibomian glands. Although such cases were reported by Allaire (1891) Panas (1894) Parsons (1904), some authors, such as V. Michel (1908) and Schreiber (1924) expressed doubts as to the existence of such tumours.
The view of Morax (1926) that all Meibomian neoplasms were carcinomatous is also not absolutely correct, at least for age groups under 40 years.
Meibomian carcinoma, usually occurs in women, of middle age and over. It is met with in both lids. Its progress is insidious and painless. It is invariably mistaken for chalazion, especially if the patient happens to seek advice early. If the patient comes only when it is of a fairly big size then the doubt of a neoplasm creeps up. If there is history of recurrence, then the question of malignancy arises otherwise a routine biopsy in at least an elderly patient with a chalazion like swelling is a safe and correct approach.
When this growth is mistaken for chalazion, and is incised and curetted, the growth rapidly recurs, with involvement of tarsal conjunctiva and lid margins, there is spread to preauricular or other regional lymphnodes and later on, distant multiple metastases may prove fatal.
| Case No. 1|| |
A 54 year old Hindu lady, otherwise healthy, came with a swelling in the middle of right upper lid, which had started 2 years back. The swelling was incised in a dispensary 6 months back, but it recurred after a month. It was once again incised by the doctor of another dispensary 4 months back, after which it has been continuously increasing, to reach the present size. She has also noticed a swelling one month back, in front of her right ear. On examination, it was found that the whole of the right upper lid was involved in the tumor mass. The size of the tumor was 2½ x 1 x 1 in., the preauricular glands on right side were enlarged to the size of an almond. The diagnosis of adenocarcinoma of Meibomian gland was made. The patient was advised to have a complete resection of right upper lid and of the right preauricular swelling followed by a plastic repair and deep X-ray irradiation. As she was unwilling for any further surgical treatment, the two previous operations having failed, only a biopsy was taken before starting deep X-ray therapy. The histological report suggested the diagnosis of adenocarcinoma of Meibomian gland.
Deep X-ray therapy was started on the right upper lid, with a protective shield for the right eye and on the right preauricular region, but she left after 10 days as she did not notice any appreciable improvement in her condition.
After 3 months, the patient again visited the hospital: now she had enlargement of submaxillary and clavicular lymph nodes. After six months or so, we learnt from her relation, that she had expired, probably from distant metastases in abdomen or mediastinuin.
| Case No. 2|| |
A 50 year old Hindu female, otherwise healthy, came with a swelling in the right lower lid, which had started one year back. There was rapid increase in the swelling for the last two months. [Figure - 1]
The present size of the growth was 2 x 1 x 1 in. in the lateral 2/3 of the right lower lid. It was firm in consistency and was not tender. The right preauricular gland was enlarged and firm in consistency.
| Treatment|| |
The growth was removed, with resection of nearly ¾ of right lower lid and of the lymph nodes in the preauricular area. Later on, prophylactic deep X-ray therapy was given, after the plastic repair of the part.
The histological report was: Adeno-carcinoma of meibomian gland. [Figure - 2]. No recurrence has been reported after six months.
| Discussion|| |
Adenocarcinoma of the Meibomian gland does not seem to be very rare. The incidence appears to be definitely more than is thought to be. The lack of histological survey of all chalazia, might be responsible for this very low percentage. In the cases reported here, both were females, one had it in the upper lid and the other in the lower one. Both the patients were over 50 years of age. The mode of onset was insidious and the growths were painless. In the first case, its quicker spread and distant metastases could be explained due to its getting irritated by insufficient surgery.
| Summary|| |
Two case-reports of Meibomian carcinoma both in females and both over the age of 50 have been reported.
It is emphasised that chalazia in elderly patients or where there has been recurrence after incision and curretting must be invariably examined histologically to exclude malignancy.
Acknowledgements : I am thankful to Dr. B. C. Singhal, M.D. for the histopathological examination and for the microphotograph.
| References|| |
Das S. P. (1962). J. All India Oph. Society. 10: 36-38.
Duke Elder (1952), Text-book of Oph. Vol. 5 Henry Kimpton, London, p. 5065. For Refs. Allaire (1891). Morax (1926). Panas (1894). Parsons (1904). Schreiber (1924) and V. Michel (1908).
Jain B. S. Am. J. Oph. 1964. 57: 1050-1052.
Kennedy R. J.. Am. J. Oph. (1954), 37: 250-260.
Spaeth, E. B. (1951). Archives of Oph. 46:421-423.
[Figure - 1], [Figure - 2]