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 Table of Contents  
PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 182-183

A red little lid lump


1 Aayush Eye Clinic, A Unit of Dr. Agarwal's Eye Hospital; Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, Maharashtra, India
2 Aayush Eye Clinic, A Unit of Dr. Agarwal's Eye Hospital, Mumbai, Maharashtra, India
3 Temple University, Philadelphia, PA, USA
4 Clinico Path Labs, Mumbai, Maharashtra, India
5 Metropolis Healthcare Ltd, Mumbai, Maharashtra, India

Date of Submission10-Aug-2020
Date of Acceptance15-Oct-2020
Date of Web Publication01-Apr-2021

Correspondence Address:
Dr. Akshay Gopinathan Nair
Aayush Eye Clinic, A Unit of Dr. Agarwal's Eye Hospital, Road 20, Chembur, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2595_20

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  Abstract 


Keywords: Eyelid tumour, frozen section, merkel cell carcinoma, sebaceous gland carcinoma


How to cite this article:
Nair AG, Shah NA, Narayanan N, Gopinathan I, Murthy A. A red little lid lump. Indian J Ophthalmol Case Rep 2021;1:182-3

How to cite this URL:
Nair AG, Shah NA, Narayanan N, Gopinathan I, Murthy A. A red little lid lump. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Apr 14];1:182-3. Available from: https://www.ijoreports.in/text.asp?2021/1/2/182/312385




  Case Report Top


A 52-year-old immunocompetent female presented with an eyelid mass that was rapidly increasing in size. On examination, the mass appeared red, vascular and involved nearly 70% of the left upper eyelid. There was distortion of the lid margin and multiple prominent blood vessels were seen on the surface of the mass [Figure 1]. There was no ulceration, loss of lashes or regional lymphadenopathy. Based on the clinical appearance and the suspicion of a malignant tumor, a wide excision was performed with 4 mm clearance and reconstruction was completed in two stages using a Cutler-Beard flap. On histopathological examination of the excised mass, a well-delineated tumor was identified [Figure 2]a with uniform tumor cells which were arranged in sheets and cords. The tumor cells showed hyperchromatic nuclei, scant cytoplasm, and multiple small nucleoli [Figure 2]b. The margins were tumor free. Immunohistochemical studies showed that the tumor cells stained strongly for CK20. Based on the histological appearance, a diagnosis of Merkel Cell Carcinoma (MCC) was made. A PET-CT scan showed no metastatic lesions and the AJCC staging was designated as T2N0M0. Following excision and reconstruction, the patient underwent received 60 Gy of radiotherapy where the field included the lower lid – since a lid sharing procedure had been performed. At 6 month follow-up, there was no recurrence.
Figure 1: External photograph showing the upper eyelid mass with tortuous and prominent surface vessels. Observe the intact eyelashes and absence of ulceration; which are typically not seen in MCC. (Slit lamp-mounted iPhone 11 Pro)

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Figure 2: Scanner view of the mass (a; Hematoxylin-Eosin, 4×) shows a well-delineated mass in the lower part of the eyelid. The tumor cells are arranged in sheets and cords (b; Hematoxylin-Eosin, 40×). The tumor cells appear uniform with hyperchromatic nuclei, scant cytoplasm, and multiple small nucleoli

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  Discussion Top


MCC is a rare but lethal cancer of neuroendocrine origin with the highest case-by-case fatality rate among all skin cancers.[1] It is prevalent in regions with a high exposure to ultraviolet light and in the elderly.[2] Immunosuppression increases the risk of developing MCC. There is growing evidence to suggest that a previously unknown polyomavirus - Merkel cell polyomavirus may be a contributing factor in the pathogenesis of MCC with up to 80% of cancers being associated with the virus.[1],[3] Over 95% of published cases of MCC have occurred in Caucasians with the incidence in other ethnicities being very low.[4] There have been only two previously reported cases of eyelid MCC from the Indian subcontinent.[5],[6] As was seen in our case, MCC typically presents as a violaceous, solitary mass. Periocular MCCs are usually found on the upper lid near the margin. They commonly distort the normal eyelid architecture and are associated with skin ulceration and madarosis.[2],[4]

An incisional biopsy to confirm the diagnosis followed by excision with margin clearance is usually successful in establishing control of the primary eyelid tumor. Radiotherapy and surgery were found to control regional tumoral growth, as well as contribute to disease-free survival after treatment.[4] Chemotherapy has not yet shown a definite impact; however, it is reserved for metastatic disease.[4] The mortality rate reaches up to 40%, with patients over 70 years of age having the poorest prognosis.

In conclusion, MCC involving the eyelid is extremely rare in the Indian subcontinent. Once diagnosed, it should be aggressively treated with surgery and adjuvant radiotherapy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sunshine JC, Jahchan NS, Sage J, Choi J. Are there multiple cells of origin of Merkel cell carcinoma? Oncogene 2018;37:1409-16.  Back to cited text no. 1
    
2.
North VS, Habib LA, Yoon MK. Merkel cell carcinoma of the eyelid: A review. Surv Ophthalmol 2019;64:659-67.  Back to cited text no. 2
    
3.
Feng H. Shuda M, Chang Y, Moore PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science 2008;319:1096-1100.  Back to cited text no. 3
    
4.
Merritt H, Sniegowski MC, Esmaeli B. Merkel cell carcinoma of the eyelid and periocular region. Cancers (Basel) 2014;6(2):1128–1137.  Back to cited text no. 4
    
5.
Kaliki S, Bothra N, Bejjanki KM, Nayak A, Ramappa G, Mohamed A, et al. Malignant eyelid tumors in India: A study of 536 Asian Indian patients. Ocul Oncol Pathol 2019;5:210-19.  Back to cited text no. 5
    
6.
Singh M, Singh S, Singh U, Zadeng Z. Merkel cell carcinoma of eyelid: A rare clinical presentation and diagnostic challenge. Open J Ophthalmol 2013;3:16-8.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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