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OJHAS Vol. 9, Issue 3:
(Jul - Sep, 2010) |
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| Primary Cutaneous Low
Grade Mucinous Adenocarcinoma of Eyelid |
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Geethalakshmi U, Assistant Professor Department of Pathology,
Vijayshankar S Assistant Professor, Department of Pathology,
Abhishek MG, Assistant Professor, Department
of Pathology,
Indira CS, Tutor, Department
of Pathology,
Adichunchanagiri Institute of Medical Sciences, BG Nagara, Bellur cross, Mandya district, Karnataka, India. |
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Address For Correspondence |
Assistant Professor,
Department
of Pathology,
Adichunchanagiri Institute of Medical Sciences,
B.G.Nagara, Bellur cross,
Mandya district, Karnataka, India.
E-mail:
ugeeths_ganesh@yahoo.co.in |
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Geethalakshmi U, Vijayshankar S,
Abhishek MG, Indira CS. Primary Cutaneous Low
Grade Mucinous Adenocarcinoma of Eyelid. Online J Health Allied Scs.
2010;9(3):18 |
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Submitted: Jul 30 2010;
Accepted:
Sep 25, 2010; Published: Oct 15, 2010 |
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| Abstract: |
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Primary cutaneous mucinous adenocarcinoma is a rare adnexal neoplasm,
eyelid being the most common site of presentation. Clinically it is
mistaken for a benign / cystic lesion. Its morphologic similarity to
metastatic deposits from breast, gastrointestinal tract (GIT) or any
visceral sites adds to the diagnostic difficulty mandating the role
of ancillary techniques in precise diagnosis and hence planning the
management. We report a
case of primary cutaneous mucinous adenocarcinoma of eyelid with emphasis
on pathology along with a brief review of literature.
Key Words: Mucinous adenocarcinoma; Eyelid; Immunohistochemistry
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A 45 year old male presented for evaluation of a painless nodular lesion
over lateral aspect of right upper eyelid, slowly growing in size over
duration of five years. There was no lymphadenopathy. On examination
it was a skin colored nodule measuring 1x 0.5 x 0.5cm. The swelling
was fluctuant with positive transillumination test. Clinical diagnosis
of benign cystic lesion with a possibility of hydrocystoma was considered.
The mass was excised under local anaesthesia and sent for histopathological
examination.
Gross
examination revealed a grey tan subcutaneous nodule measuring 1x 0.5 x 0.5cms.
Cut section was solid and gelatinous with areas of haemorrhage (Figure
1). Microscopy showed a dermal tumour composed of epithelial cells in
nests (Figure 2), glandular, cribriform and micropapillary pattern surrounded
by lakes of mucin, divided into lobules by fibrovascular septa along
with foci of haemorrhage. Lateral margins were free from tumour while
deep resected margin was involved.
On histochemistry the mucin was PAS positive, diastase resistant, alcian
blue positive and hyaluronidase resistant at pH 2.5. Tumor cells immunohistochemically
expressed EMA and CK 7. Tumor was negative for CK20, CD10, p63 and TTFI.
Extensive search for primary mucinous carcinoma elsewhere was negative.
Thus a final diagnosis of primary cutaneous mucinous adenocarcinoma was made.
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Figure 1:
Gross appearance of the specimen |
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Figure 2:
Photomicrograph shows dermal tumour composed of epithelial cells in nests (Haematoxylin and Eosin, X 450). |
Primary cutaneous mucinous adenocarcinoma of eyelid is a rare neoplasm
believed to arise from eccrine type of sweat glands. It occurs commonly
in males in sixth decade of life. Head and neck are the most common
sites affected especially the eyelid.1 The other common
sites are scalp, face, axilla, rarely abdomen, groin, foot and vulva.
Clinically it appears as a solitary painless, slow growing nodule. As
a result malignancy is never considered as a possibility by the ophthalmologist,
when clinical appearance is considered.
Histopathologically tumour is subepithelial comprising of tumour cells
arranged in cohesive nests, glandular, cribriform and micropapillary
pattern surrounded by pools of mucin separated by thin fibrous septa.
Individual cells are cuboidal with moderate amount of eosinophilic cytoplasm.2 Microscopy
closely mimics colloid carcinoma breast. The differential diagnosis
of primary mucinous adenocarcinoma includes metastatic mucinous adenocarcinomas
from breast, GIT (mainly stomach, colon, pancreas and rectum), ovary,
prostate, bronchus and salivary glands.3
The distinction between primary and secondary mucinous carcinomas cannot
be done on histologic grounds alone. Mucin histochemistry is distinctive
and would allow a correct diagnosis.4,5 Mucin produced
in primary mucinous carcinoma is PAS positive, diastase resistant and
alcianblue positive, hyaluronidase resistant at pH 2.5. It also stains
positive for mucicarmine and colloidal iron. Mucin belongs to nonsulphated
sialomucin.
At immunohistochemistry EMA and CK 7 positivity confirms the primary
carcinoma.3,5,6 Additional studies like enzyme histochemistry
and electron microscopy help in confirming the sweat gland origin.
Enzyme histochemistry reveals eccrine enzymes commonly. Electron microscopy
shows two types of cells-dark cells and light cells. Dark cells are
responsible for secretion of sialomucin.
Primary mucinous carcinoma is a slow growing neoplasm with high recurrence
rate.7 Tumor is locally aggressive but metastasizes rarely.
Treatment is mainly surgical in the form of wide local excision. Chemotherapy
and radiotherapy have a limited role.
Primary cutaneous mucinous adenocarcinoma mimics a benign non neoplastic
lesion of the eyelid clinically and metastatic mucinous carcinoma histologically.
The present case underscores the importance of considering this in differential
diagnosis of any solid/cystic eyelid lesion. A close coordination between
a surgical pathologist and ophthalmologist is must for precise diagnosis
and appropriate management.
- Snow SN, Reizner
GT. Mucinous eccrine carcinoma of the eyelid. Cancer. 1992;70:2099-2104
- Mckee PH, Colonje
E, Granter SR. Primary mucinous carcinoma. Pathology of skin with clinical
correlation. 3rd Edition Elsevier, Mosby. 2005. pp1656-1659
- Randhwa NK, Wong
MTC. Primary mucinous carcinoma of the skin-a case report. Eur J Plast
Surg. 2009;32:315-317
- Schwartz RA, Weiderkehr
M, Lamber WC. Secondary mucinous carcinoma of skin – metastatic breast
carcinoma. Dermatol Surg. 2004;30:234-235
- Bellezza G, Sidoni
A, Bucciarelli E. Primary mucinous carcinoma of skin. Am J Dermatopathol.
2000;22:166-170
- Levy G, Finkelstein
A, McNiff JM. Immunohistochemical techniques to compare primary vs.
metastatic mucinous carcinoma of the skin. J Cutan Pathol. 2009;9:24
- Chauhan A, Ganguly
M, Takkar P, Dutta V. Primary mucimous carcinoma of eyelid: A rare clinical
entity. Indian J Ophthalmol. 2009;57:150-152
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