Haymete Maedot A, Delans Kristen, Varghese Paul, Ramey Nicholas, Grider Douglas J
Virginia Tech Carilion School of Medicine, Virginia Polytechnic Institute and State University, Roanoke, Virginia, USA.
Division of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
Case Rep Ophthalmol Med. 2025 Sep 19;2025:5565300. doi: 10.1155/crop/5565300. eCollection 2025.
Sebaceous carcinoma, an uncommon malignant neoplasm, often arises de novo from periocular sebaceous glands. Commonly manifesting as diffuse eyelid thickening, sebaceous carcinoma can mimic other inflammatory processes such as persistent chalazion or blepharitis. Delayed diagnosis often complicates the disease course due to its indolent presentation. Described is a rare case of sebaceous carcinoma entirely confined to the conjunctival epithelium of the upper eyelid. An 80-year-old female presented for evaluation of bothersome "cysts" under her left upper lid as well as blurry vision in her left eye. The patient was repeatedly re-evaluated over the next few months and found to have Meibomian gland dysfunction of the upper and lower left eyelids as well as 3+ diffuse spongy papillary injection of the tarsal conjunctiva in the left upper lid, with large papillae and conjunctival thickening in the left inferior fornix. A conjunctival biopsy was eventually performed when appropriate management of presumed conjunctivitis failed to alleviate the patient's symptoms. Pathological examination of the left upper eyelid tarsal conjunctiva showed epithelium largely replaced by pagetoid spread of intraepithelial sebaceous carcinoma, with an underlying band-like lymphocytic infiltrate. The carcinoma was strongly adipophilin positive with variable EMA, PRAME, and Factor XIIIa positivity, confirming intraepithelial sebaceous carcinoma. The nuclei of the carcinoma had a smudged, salt-and-pepper appearance; however, CK20, INSM-1, and synaptophysin were negative, excluding Merkel cell carcinoma. A sebaceous carcinoma limited to conjunctival epithelium is rare. However, given its potential aggressive nature, it should be included in the differential diagnosis of "nonhealing conjunctivitis" or persistent unilateral irritation of the eyelid.
皮脂腺癌是一种罕见的恶性肿瘤，常起源于眼周皮脂腺。皮脂腺癌通常表现为眼睑弥漫性增厚，可类似其他炎症性病变，如持续性睑板腺囊肿或睑缘炎。由于其临床表现隐匿，诊断延迟常使病程复杂化。本文描述了一例罕见的皮脂腺癌，肿瘤完全局限于上睑结膜上皮。一名80岁女性因左上睑出现令人不适的“囊肿”以及左眼视力模糊前来就诊。在接下来的几个月里，该患者接受了多次复查，发现左上、下睑睑板腺功能障碍，左上睑睑结膜有3级弥漫性海绵状乳头充血，伴有大乳头，左下穹窿结膜增厚。在对疑似结膜炎进行适当治疗未能缓解患者症状后，最终进行了结膜活检。左上睑睑结膜病理检查显示上皮大部分被上皮内皮脂腺癌的派杰样扩散取代，其下有带状淋巴细胞浸润。肿瘤嗜脂素染色强阳性，上皮膜抗原、黑色素瘤相关抗原和凝血因子ⅩⅢa染色呈不同程度阳性，确诊为上皮内皮脂腺癌。癌细胞核呈模糊的椒盐样外观；然而，细胞角蛋白20、胰岛淀粉样多肽1和突触素染色均为阴性，可排除默克尔细胞癌。局限于结膜上皮的皮脂腺癌罕见。然而，鉴于其潜在的侵袭性，在“不愈性结膜炎”或持续性单侧眼睑刺激的鉴别诊断中应考虑该病。
