Rokohl Alexander C, Löser Heike, Mor Joel M, Loreck Niklas, Koch Konrad R, Heindl Ludwig M
Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland.
Institut für Pathologie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland.
Ophthalmologe. 2020 Jan;117(1):73-77. doi: 10.1007/s00347-019-00948-y.
A space-occupying lesion of the eyelid in young adults is often a sign of an inflammation, a trauma or a benign neoplasm. The aim of this case report is to demonstrate a rare basal cell carcinoma, which presumably already arose in adolescence without further high-risk factors.
A 28-year-old male patient presented for a second opinion on a painless swelling of the right lower eyelid. According to the patient's history the swelling had been present since the age of 16 years and originally resembled a molluscum contagiosum. An ophthalmologist in private practice made the diagnosis of a suspected trichoepithelioma. The extended patient history revealed a blood coagulation disorder. The clinical ophthalmological examination revealed a nodular space-occupying lesion with a border wall and telangiectasia. The further ophthalmological examination was bilaterally inconspicuous. Due to the suspicion of a malignant process, an operation was promptly carried out using local anesthesia with complete tumor excision and pedicled flap plasty as well as a histopathological investigation to confirm the diagnosis.
The histopathological investigation revealed underlying infiltrates of a basaloid tumor with bale-shaped trabecular growth, sometimes with peripheral palisading of the cells. The cells were predominantly monomorphic with isolated pleomorphic nuclei and sometimes enclosed mitoses. Immunohistochemically the cells were strongly positive for BerEP4 and negative for epithelial membrane antigen (EMA). The diagnosis of a nodular basal cell carcinoma of the right lower eyelid was made. All incision margins were free of tumor cells (R0 resection). In the dermatological screening no further manifestations were detected.
Despite the occurrence of a space-occupying lesion of the eyelid in a young adult patient and also with no further risk factors, in addition to an inflammatory event and a benign tumor, a malignant disease, such as a basal cell carcinoma should also be taken into consideration. A tissue biopsy or complete excision with subsequent histological examination including an immunohistochemical analysis are essential for differentiation from other tumor entities.
年轻成年人眼睑的占位性病变通常是炎症、创伤或良性肿瘤的迹象。本病例报告的目的是展示一例罕见的基底细胞癌，其可能在青春期就已出现，且无其他高危因素。
一名28岁男性患者因右下眼睑无痛性肿胀前来寻求第二种意见。根据患者病史，肿胀自16岁起就已存在，最初类似传染性软疣。一名私人执业眼科医生诊断为疑似毛发上皮瘤。进一步询问患者病史发现有凝血障碍。临床眼科检查发现一个有边界壁和毛细血管扩张的结节状占位性病变。双侧进一步的眼科检查未发现异常。由于怀疑是恶性病变，遂立即进行局部麻醉下的手术，完整切除肿瘤并进行带蒂皮瓣成形术，同时进行组织病理学检查以确诊。
组织病理学检查显示为基底样肿瘤的浸润，呈束状小梁生长，有时细胞周边呈栅栏状排列。细胞主要为单形性，有孤立的多形性核，有时可见核分裂。免疫组化显示细胞对BerEP4呈强阳性，对上皮膜抗原（EMA）呈阴性。诊断为右下眼睑结节性基底细胞癌。所有切缘均无肿瘤细胞（R0切除）。皮肤科筛查未发现其他病变。
尽管年轻成年患者出现了眼睑占位性病变，且无其他危险因素，但除了炎症性病变和良性肿瘤外，也应考虑恶性疾病，如基底细胞癌。组织活检或完整切除后进行包括免疫组化分析在内的组织学检查对于与其他肿瘤实体的鉴别至关重要。
