Monai Natsuki, Tanabu Reiko, Gonome Takayuki, Yokoi Katsunori, Urushidate Satoshi, Morohashi Satoko, Hirai Hideaki, Kurose Akira, Nakazawa Mitsuru
Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Plastic and Reconstructive Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Case Rep Ophthalmol. 2018 Mar 22;9(1):221-226. doi: 10.1159/000487704. eCollection 2018 Jan-Apr.
To report a case of recurrent conjunctival papillary sebaceous carcinoma that was successfully treated by a combination of surgical resection, intraoperative topical mitomycin C application, and cryotherapy.
A woman in her 80s developed a yellowish papillary tumor pedunculated from the surface of the upper palpebral tarsal conjunctiva in her left eye. She was histopathologically diagnosed as having sebaceous carcinoma by an excisional biopsy. We performed en bloc resection of the lateral one-third of the posterior lamella including the cutaneous margin of the upper eyelid as well as reconstruction of the defected portion by a switch-flap from the ipsilateral lower eyelid. Histopathologically, because the tumor was restricted to the epithelial region with minimal invasion into the tarsus, we diagnosed the patient to have conjunctival papillary sebaceous carcinoma. Nine months after the surgery, the tumor recurred and was resected and treated by intraoperative mitomycin C. Four months later, the tumor regrew at the resected margins and was treated by resection combined with mitomycin C and cryotherapy. After these combination treatments, the tumor did not recur for at least 1 year postoperatively.
Although sebaceous carcinoma usually originates from the meibomian gland cells or less frequently from the Zeis or Moll gland cells, it rarely occurs from bulbar or palpebral conjunctival cells. Because sebaceous carcinoma sometimes shows a pagetoid growth pattern, it can recur even after en bloc resection with a negative study for tumor cells at the surgical margins. The recurrent sebaceous carcinoma cells showed an intraepithelial growth pattern. Considering this superficial growth property, it may be effective to apply intraoperative mitomycin C and cryotherapy treatment combined with surgical resection to reduce the possibility of recurrence of presumed conjunctival papillary sebaceous carcinoma, although mitomycin C alone seems to be insufficient as an adjunctive treatment.
报告一例复发性结膜乳头状皮脂腺癌，通过手术切除、术中局部应用丝裂霉素C和冷冻疗法联合治疗成功。
一名80多岁的女性左眼上睑睑板结膜表面出现一个带蒂的淡黄色乳头状肿瘤。经切除活检，组织病理学诊断为皮脂腺癌。我们对后层外侧三分之一进行了整块切除，包括上睑皮肤边缘，并通过同侧下睑的转位皮瓣修复缺损部分。组织病理学检查显示，肿瘤局限于上皮区域，对睑板的侵犯极小，因此我们诊断该患者为结膜乳头状皮脂腺癌。手术后9个月，肿瘤复发，进行了切除并术中应用丝裂霉素C治疗。4个月后，肿瘤在切除边缘再次生长，采用切除联合丝裂霉素C和冷冻疗法治疗。经过这些联合治疗后，肿瘤术后至少1年未复发。
皮脂腺癌通常起源于睑板腺细胞，较少起源于蔡司腺或莫尔腺细胞，很少起源于球结膜或睑结膜细胞。由于皮脂腺癌有时表现为派杰样生长模式，即使在手术切缘肿瘤细胞检查为阴性的整块切除后仍可能复发。复发性皮脂腺癌细胞呈上皮内生长模式。考虑到这种浅表生长特性，术中应用丝裂霉素C和冷冻疗法联合手术切除可能有效降低结膜乳头状皮脂腺癌的复发可能性，尽管单独使用丝裂霉素C作为辅助治疗似乎不足。
