|Year : 1981 | Volume
| Issue : 3 | Page : 289-291
Meibomian gland carcinoma
A Hussain, HN Gogoi
Department of Ophthalmology, Medical College, Gauhati, India
Department of Ophthalmology, Medical College, Gauhati
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Hussain A, Gogoi H N. Meibomian gland carcinoma. Indian J Ophthalmol 1981;29:289-91
The incidence of Meibomian gland carcinoma though appears to be rare yet it projects a perplexing clinical picture for its early diagnosis. Metastasis usually occurs to the regional lymphnodes and it metastatise to the distant organs are very slow.
Meibomian gland carcinoma simulates to a number of pathological conditions affecting the lids. Among these papilloma, keratoacanthoma, chalazion, seborrhic keratitis, benign calcifying epithelioma, inverted follicular eratitis need to be differentiated.
Four cases of meibomian carcinoma were studied and the important points in their management are discussed in this paper.
| Materials and methods|| |
Case No. I S.A. aged 50 years, male Muslim, complained of swelling of the upper eye lid of right eye for the last three years [Figure - 1]. The swelling was painless and gradually increasing in size. It was operated once but the swelling had recurred again. On examination a mass measuring ˝" X ˝" at the junction of medial 2/3rd and lateral 1/3rd of the lid presented with firm in consistency with irregularity of surface towards tarsal conjunctiva. Small blood vessels are seen running over the growth. Preauricular or submandibular lymphnodes were not enlarged. All other laboratory examinations were normal. The case has been labelled as Meibomian gland carcinoma and excission with plastic reconstruction of upper eye lids was done following Mustarde's technique. Post operative period was uneventful. He has been advised to come back for further treatment. Histopathological report of the excised mass was adenocarcinoma of meibomian gland.
Case No. 2 M.A. aged 60 years, male Muslim, attended OPD with a complaint of painless progressive swelling right upper lid, since 6 months. When the swelling was small, he was operated upon it about 6 months back and since then the swelling is increasing day by day. On examination a mass measuring 2x2 cm firm in consistency, with irregular surface could be seen. Vision was 6/18 in that eye. Excission of the growth with plastic reconstruction of upper eye lid as had been done in case 1 was done. Follow-up of 1 year showed no recurrence. Histopathological report was adenocarcinoma of Meibomian gland.
Case No. 3 K.B., female, aged 40 years Muslim, she gave the history of swelling in the right upper lid for the last 10 months. The swelling was painless, gradually increasing in size. On examination a firm lobular mass was felt. On eversion of the lid the surface of the growth towards tarsal conjunctiva was found to be irregular. No involvement of regional lymph-gland has been observed. Excission and reconstructive surgery of the upper lid following Mustarde's technique has been done. The histopathological section came out to be adenocarcinoma of Meibomian gland. [Figure - 2]
Case No. 4 P.B. aged 35 years female, muslim, complained of a swelling in left lower lid since I month. It is painless and rapidly progressing. On examination a firm mass, was felt in left lower lid, skin ever the mass was adherent. Towards the tarsal conjunctival face, the growth was having irregular fungating surface. Draining lymph glands were not enlarged. 2/3rd of the lower lid was excised and reconstruction of lower lid was done by mobilizing the tarsoconjunctival layer of upper lid (Hughe's operation). Histopathological report of the excised tissue came to be adenocarcinoma of meibomian gland. After 4 weeks she was again admitted and lash grafting was done taking the graft from eye brow. Again after 4 weeks, the lid has been splited and palpebral aperature was make opened. Follow up was satisfactory with out any recurrence.
Acinar arrangement of polygonal carcinomatous cells were found in the subepithelial connective tissue. The epidermis and hair follicles were free. Normal sebaceous gland elements were also noted. The adenocarcinomatous cells show necrotic centres of the acinous and vacuolated appearances and at places as solid cords.
| Discussion|| |
Meibomian gland carcinoma mistaken as Chalazion is a common occurrence and early diagnosis of this growth increases the cure and survival rate. Usually the growth occurs between 40 to 60 years involving either sex as has been noted by all workers and also tailing with our reported cases. Hence a painless growth in the lid in an aged person, persisting inspite of medication and once or twice operations should be viewed with suspicion. The cases reported above had the history of operations and recurrence of a swelling considered by eye specialists as chalazion Clinically, in all 4 cases the swelling gradually increased in size and showed irregular surfaces towards the terso conjunctival surface and are important for early diagnosis.
So far treatment is concerned besides saving life, due consideration is to be given for proper function and cosmetic appearance of the eye and therefore selection of method of treatment is important. In our 4 cases, radiation therapy has not been considered because the growth is in its early stage and within amnable limit without any evidence of secondary metastasis.
The method of Mustarde that have been followed in 3 of our cases proved to be best for early case of Meibomian gland carcinoma because it is less mutilating and less time consuming with excellent results. Only in one case we followed the Hughes reconstruction method of lower lid from upper lid tissue, and we got satisfactory result.
| Summary|| |
Early Meibomian gland carcinoma is usually mistaken as chalazion. Hence repeated occurrence of chalazion in the same place of the lid necessitate a thorough clinical and histopathological assessment. 4 cases of early Meibomian gland carcinoma have been described with their histopathological findings. Operation of early cases by Mustarde's method has been considered to be most suitable procedure.
| Acknowledgement|| |
I am grateful to Principal, J. Mahanta, of G.M.C. and Prof. 1.K.S.M. Barua of Department of Pathology and to my departmental colleagues for their help.
| References|| |
Cutler, N.L. and Beaid, C., 1955, Amer. J. Ophthalmol. 39:1.
Harts, P.H. A. 1955, J. Clin. Pathology 25:636.
Hogan, J.M. and Zimerman E.L. 1962, Ophthalmic pathology 2nd Ed., Page 214-216. W.B. Saunders Co. London.
Hughes, W.L. : in "Ophthalmic Plastic Surgery" 3rd L d. P. 196.198. Edited by Fox. S.A. Newyork, Gruine & stratta.
Kanedy and King, 1964. Amer. J. Ophihalmol. 37: 259.
Knapp, H., 1903, Tr. Am. Ophthalmol. Soc. 10: 57.
Mustarde, C.J., 1969, "Repair and Reconstruction in the Orbital Region" E.S. Livingston Ltd. London.
Murrah, W.R. 1951, Amer. J. Ophthalmol 34, 633.
Rice M.L., 1950, Amer. J. Ophthamol, 33, 1434.
Reese A.B., 1963, "Tumours of eye" P. 5-23.
Speath, E.B., 1951, A.M.A. Atch. Ophthalmol. 46 ; 421
Straatsma, B.R. 1956 : Arch. Ophthalmol. 56, 71.
Sweebe, E.C. and Cogan D.G, 1959, Arch. Ophthalmol, 61, 130.
[Figure - 1], [Figure - 2]