eyelid sebaceous carcinoma
Introduction
Eyelid sebaceous gland cancer Sebaceousadenocarcinomaofeyelid is a tumor with a high degree of malignant eyelid, which is invasive and easy to metastasize. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: eye movement disorders
Cause
Causes of sebaceous gland cancer
(1) Causes of the disease
The reason is unknown.
(two) pathogenesis
Long-term stimuli such as chronic inflammation of the sebaceous glands of the eyelids can promote the formation of tumors. The tumors originate from the malignant transformation of normal cells of the glands, leading to changes in biological behavior, formation of autonomously growing new organisms, and tumorigenic factors. The changes in genetic material within the cell are related.
Prevention
Eyelid sebaceous gland cancer prevention
For long-term eyelid sebaceous gland inflammation, especially in middle-aged and elderly patients, local biopsy should be performed in time to achieve early detection and early treatment.
Complication
Eyelid sebaceous gland cancer complications Complications, eye movement disorders
Local spread invades the palpebral conjunctiva, the ocular fascia sac and even the surrounding bone wall, leading to eye movement disorders, etc., systemic metastasis to the lungs, liver and other parts can cause different clinical complications.
Symptom
Orbital sebaceous gland cancer symptoms Common symptoms Ankle defect or sacral defect Yellow nodular sacral cyst
The clinical manifestations of sebaceous gland cancer are diversified. The early stage of the disease is a tough small nodule in the orbit. Similar to the meibomian gland cyst, the lesion gradually enlarges, the tarsal plate is diffuse plaque-like thickening, and the palpebral conjunctiva has a yellow bulge. Most of them are single lesions, a few are multicentric, the lesions are small in the early stage, the painless induration is located in the tarsal or near the temporal margin, slowly grows, the skin is not ulcerated, and the genus from the Zeis gland is located at the margin of the iliac crest. Small yellow nodules in front of the line, similar to sputum granuloma, some cases of conjunctival visible yellow tumor tissue or cauliflower-like, followed by nodular swelling can be lobulated mass; in a few cases, thickening of the margin, ulceration, clinical resemblance of blepharitis or Conjunctivitis or papilloma and other cancers, such as from the sebaceous glands, yellow nodules on the rim of the rim, the surface of the skin is normal, the patient generally has no obvious symptoms, or only the eyelids are heavy, but when the palpebral conjunctiva is involved There may be obvious irritation symptoms, which are manifested as papillary conjunctivitis. Because the lesion is often misdiagnosed as meibomian gland cyst or conjunctivitis, the treatment is not timely and easy to relapse. The average course of disease is 1 year. Before transfer to the ear or submandibular lymph nodes, the patient can be transferred from about 5% liver, lung, mediastinum and other parts, may spread to the orbit.
Examine
Eyelid sebaceous gland cancer examination
Histopathological examination: Histologically, the tumor consists of lobular cells composed of cells of different degrees of differentiation. The differentiated tumor cells are sebaceously differentiated, rich in fine vacuolar cytoplasm, and the nucleus is located in the center or slightly displaced to the periphery. The well-differentiated region is often in the center of the tumor leaflet. The poorly differentiated tumor shows degenerative development. Most of the cells show polymorphic nucleus, obvious nucleoli, less cytoplasm, moderate mitotic activity, and mitosis. Typical, and odd-shaped, frozen section with oil red O for fat staining, very helpful to establish a clear diagnosis, differentiated cancer cells are large, polygonal, cytoplasm is foamy, nuclear vacuoles, visible nucleoli, differentiation Poor cells can be like basal-like cells or squamous cells. Nie is divided into 5 types: differentiated, squamous cell type, basal cell type, adenoid and spindle cell type. Spencer is divided into cell differentiation according to the degree of cell differentiation. Type 3:
1 highly differentiated type, many cells show sebocytes differentiation, cytoplasm rich, fine vacuoles are foamy, the nucleus is located in the center or slightly to the periphery of the cell;
2 moderately differentiated type, only the differentiated sebaceous gland cells, most of the tumor cells contained in the core are deeply stained, and the nucleoli are abundant and rich in basophilic cytoplasm;
3 poor differentiation, most of the nuclear nucleus, nucleoli, cytoplasm, and moderate mitotic figures.
Tumors can have 4 histological images:
1 lobular, the formation of tumor cells is clear, and in some areas, the cytoplasm is characterized by the differentiation of foamy sebaceous cells;
2 acne type, characterized by significant necrosis in the center of the cell mass, cells viable in the lobule and central necrotic cells, fat staining is often strongly positive;
3 papilloma type, similar to conjunctival squamous cell papilloma or carcinoma, careful examination revealed focal sebaceous cell differentiation;
4 mixed type, the lesions have lobular and acne-like, and may also have a mixture of papillary and acne.
The tumor can be diffused intraepithelially, invading the surface epithelium as a single cell or small cell nest, lacking an intercellular bridge, squeezing adjacent epithelial cells, spreading as Paget-like, and another type replacing the surface epithelium by the thickness of the whole layer of tumor cells.
Imaging examination: direct ultrasound examination showed that the shape of the lesion was irregular, the internal echo was medium, the distribution was uneven, and there was a block echo. CT showed irregular high-density shadows of the eyelids. The posterior boundary was clear and the range was clear. The imaging examination could also be Assessment of the transfer of distant organs.
Diagnosis
Diagnosis and differentiation of orbital sebaceous gland cancer
According to the medical history and clinical manifestations, the disease can be suspected, but the diagnosis requires histopathological examination. If the sebaceous gland cancer is suspected, the fresh tissue should be taken, frozen and sliced, and stained with Sudan III. The positive person can help the diagnosis.
Differential diagnosis
The disease should be clinically identified with the following eye diseases:
1 sputum granuloma, common in children or young people, the conjunctiva surface is purple-red, not yellow granular tissue;
2 Stye, the course of the disease is very short, there are acute inflammation, red, pain and other symptoms, usually in a few days to wear pus;
3 general blepharoconjunctivitis, conjunctival hyperplasia, infiltration is not obvious, no granule-like tissue on the conjunctiva surface, sebaceous gland cancer can cause unilateral chronic conjunctivitis, so the middle, the elderly, orbital nodules or atypical In the case of blepharoconjunctivitis, biopsy should be removed promptly.
The pathological diagnosis should be identified as:
1 squamous cell carcinoma, well differentiated, visible intercellular bridge, keratinized cells and horn beads, no sebaceous adenoid cells;
2 basal cell carcinoma, basal-like cells originating from the epidermis, no sebaceous adenoid cells, less atypia, less nuclear division;
3 carcinoma in situ, originating from the spine cells in the epidermis, not sebaceous cells.
