|Year : 1973 | Volume
| Issue : 4 | Page : 200-203
Primary tumours of eye-lid
PP Banait, NK Patoria, KD Sharma
Department of Pathology, Medical College, Nagpur, India
P P Banait
Department of Pathology, Medical College, Nagpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Banait P P, Patoria N K, Sharma K D. Primary tumours of eye-lid. Indian J Ophthalmol 1973;21:200-3
Eyelid tumours present peculiar problems regarding their excision which will necessitate plastic repair, otherwise irradiation will endanger the eyesight. In addition the tumours, particularly carcinomas are destructive lesions and might invade the orbital cavity. From this point of view a careful histopathological diagnosis is very important in view of the damage that may be caused to the eyes by the lesion itself or by its treatment.
This short communication analyses the distribution of various lid tumours observed in the Department of Pathology, Medical College Hospital, Nagpur, during the last twenty-five years.
| Materials and Methods|| |
During the twenty-five years period, 36 cases of primary eyelid neoplasms were studied and reviewed histopathologically. Wherever necessary special staining methods were applied. Tumours metastatic into the eyelid or infiltrating from the surrounding tissues were excluded. Similarly other orbital tumours were also excluded. Particular care was taken to make a detailed study of tumour-like lesions (Reese  ) which were not included in this study.
| Observations|| |
In the present study, 36 cases of primary eyelid neoplasms were studied and they were classified histologically [Table - 1]. Basal cell carcinomas formed a predominant group (33.3%) followed by squamous cell carcinoma (22.2%).
These tumours involved lower lid (69.5%) much more as compared to the upper lid (30.5%). The distribution of basal cell carcinoma was equal on both the lids (6 : 6), while all the cases of squamous cell carcinoma (8) were located over the lower lid:
Malignant tumours were more common in middle aged and old persons while benign neoplasms were observed in younger persons. Basal cell carcinomas were found in 31-70 years group while a few cases of squamous cell carcinoma were seen a decade earlier (21-60 years range).
In the present study, it was observed that males were affected nearly twice as often, compared to females [Table - 2]. Basal cell carcinomas were equally distributed in both the sexes.
| Discussion|| |
In the present work, 36 cases of primary lid neoplasms were studied and their histological classification is given in [Table - 1]. The maximum number of cases (33.3 percent) were basal cell carcinomas. REESE  also reported that the most common neoplasm of eyelid was basal cell carcinoma. MARTIN  estimated that it comprised 85 percent of all carcinomas of the eyelid. HOGAN AND ZIMMERMAN  observed its incidence as 90 per cent of all malignant neoplasms of the lid. Both the authors observed this malignant neoplasm commonly in the lower lid and least in the upper lid; but in the present analysis the distribution was equal in both the upper and lower lids.
Squamous cell carcinoma cases were 22.2 per cent. It was stated to be less common (MARTIN  ). KwITKO et al  found the ratio of basal cell to squamous cell carcinoma to be 39 to 1. We have taken -every care not to confuse squamous cell carcinoma with various types of keratoses, keratoacanthoma, pseudo-epitheliomatous hyperplasis, Bowen's disease, adnexal carcinoma adenoacanthoma, etc. (KWITKO et al  ) .
All the cases of squamous cell carcinoma were located over the lower lid. Taking basal cell and squamous cell carcinoma together, they involved lower lid much more than upper lid (14 : 6 REESE).
Benign naevi occur frequently on the surface of the lid or the lid margin (HOGAN AND ZIMMERMAN). They may be pigmented or non-pigmented. Only four cases were observed in this study. All of them were pigmented and papillary. There is every likelihood of confusing the pigmented naevus with an early pigmented basal cell carcinoma and melano-acanthoma (a pigmented seborrheic papilloma). When non-pigmented, it should be differentiated from neurofibroma, fibroma, xanthoma, senile keratosis, papilloma, histocytoma etc. (REESE).
Nearly two-thirds of all haemangiomas occur in the head and neck and the lids are not infrequently affected. Lid lesions sometimes occur in conjunction with angiomas primary in the conjunctiva or orbit. Of 50 haemangiomas of the lid, verified histologically, more than half were of capillary and angioblastic type (REESE). In the present work five cases of haemangiomas were observed, out of which three were capillary and one each of cavernous and sclerosing type.
Haemangio-pericytoma is a very rare tumour of the eyelids. We had one such case which was benign in nature. This was seen in a 45 years old male clinically diagnosed as sebaceous cyst. STOUT reported on 285 such tumours occurring in the soft tissues over the body, of which six were orbital.
There was one case of solitary neurofibroma seen in a seven year old female child. It occurred in the upper lid. Neurofibroma is a less common neoplasm in the eye, but may be an accompaniment of generalised von Recklinghausen's disease. A lid granuloma, cicatrix or keloid may simulate neurofibroma.
Sebaceous adenoma is also an infrequent neoplasm. There was only one case in a eighteen year old male occurring in the upper lid clinically diagnosed to be amyloid deposit.
There were two cases of keratoacanthoma involving the lower lid. Papillomas are common tumours of the lid.
Lipomas are benign tumours found in lids, conjunctiva and orbit. They may be congenital and are sometimes associated with dermoid or dermolipoma. FRIEDNWALD et al.  True lipomas have capsule should be differentiated from orbital fat. In a female child of 5 years a tumour was present since birth and was found to be a fibrolipoma.
Malignant melanomas are uncommon as compared to other eyelid tumours. Only one case of malignant melonoma was seen in a male of 64 years in the present study.
Primary neoplasms of eyelids showed more or less similar age incidence as the skin tumours in general. Benign tumours were commonly observed in childhood and early adult life, while malignant were present in middle and old age.
Basal cell carcinoma cases were noted in the age group of 31 to 70 years. This is more or less similar to the involvement of the skin over the face. In the case of squamous cell carcinoma few cases were seen a decade earlier than the basal cell carcinoma.
Males (23 cases) were more affected than females (13 cases) in case of eyelid tumours [Table - 2]. REESE  also observed a somewhat higher incidence in males than females.
| Summary|| |
The present paper emphasises on histopathological study of eyelid' tumours. The material comprised of such tumours seen over a period of twenty-five years. Their incidence with regards to location, age and sex disposition have been studied and commented pen upon.
| References|| |
Friedenwald, J. S.; Wilder, H. C.; Maumene_ e, A, E.; Sanders, T. E.; Keyes, J. E.; Hogan, M. J. Owens, W. E. V. and Owens, W. C.: Ophthalmic Pathology. Philadelphia, W. B. Saunders, 1957. p. 413.
Hogan, M. J. and Zimmerman. L. E.: Ophthalmic Pathology; 2nd Edn. Philadelphia, W. B. Saunders, 1962. p. 212.
Kwitko, M. L.; Beniuk, M. and Zimmerman, L. E.: Eyelid Tumours with special reference to lesions confused with squamous cell carcinoma. Arch. Ophth. 69: 693-97, 1963.
Martin, H. E.: Cancer of the Eyelids. Arch. Ophthal. 22: 1-20, 1939.
Reese, A. B.: Tumours of the Eye; 2nd Edn; New York, Harper and Row, publishers 1963. p. 2.
Ibid., p. 325.
Reese, A. B.: Tumour of the eye and Adnexa-Atlas of Tumour Pathology. Washington, Armed Forces Institute of athology, Fasc. 38: 1956. p. 163.
Stout, A. P.: Haemangio-pericytoma. Cancer, 2: 1027-54, 1949.
[Table - 1], [Table - 2]