Wollensak G, Witschel H, Böhm N
Department of Ophthalmology, University of Freiburg i. Br., Germany.
Ophthalmology. 1996 Nov;103(11):1788-93. doi: 10.1016/s0161-6420(96)30426-0.
Signet ring cell carcinoma of the eyelid is a rare variant of eccrine sweat gland carcinoma and has been reported previously in only five patients.
The authors report the clinical findings of a 55-year-old man with a signet ring cell carcinoma in the left eyelid as well as a clinical follow-up of 4.5 years. Several biopsies and the exenteration specimen were analyzed by routine light microscopy, electron microscopy, and comprehensive immunohistochemical stains on paraffin sections.
Histologically, the tumor was shown to be a rare type of eccrine sweat gland carcinoma with signet ring cells and Indian file growth pattern reminiscent of invasive lobular carcinoma of the breast. Estrogen and progesterone receptors were identified immunohistochemically. On electron microscopy, intracytoplasmic pseudolumina with microvilli were positive for anti-human milk fat globulin and the lectin peanut agglutinin. Clinically, the tumor followed a malignant course with orbital invasion and lymph node metastases.
Histologic recognition of this variant of eccrine sweat gland carcinoma is important because of its aggressive and malignant behavior and the wide range of differential diagnoses. Primarily, metastatic mammary carcinoma must be excluded. The treatment is primary excision with histologic control of the excision margins. In more advanced stages, radiation therapy, neck dissection, and anti-estrogen therapy should be considered.
眼睑印戒细胞癌是一种罕见的小汗腺癌变异型，此前仅报道过5例患者。
作者报告了一名55岁男性左眼睑印戒细胞癌的临床发现以及4.5年的临床随访情况。对多次活检组织和眼球摘除标本进行常规光学显微镜检查、电子显微镜检查以及石蜡切片的全面免疫组织化学染色。
组织学上，该肿瘤表现为一种罕见的伴有印戒细胞的小汗腺癌，呈印度排状生长模式，类似于乳腺浸润性小叶癌。免疫组织化学鉴定出雌激素和孕激素受体。电子显微镜下，带有微绒毛的胞质内假腔对抗人乳脂肪球蛋白和凝集素花生凝集素呈阳性反应。临床上，该肿瘤呈恶性病程，伴有眼眶侵犯和淋巴结转移。
由于这种小汗腺癌变异型具有侵袭性和恶性行为以及广泛的鉴别诊断范围，对其进行组织学识别很重要。首先，必须排除转移性乳腺癌。治疗方法是进行原发灶切除并对切除边缘进行组织学检查。在更晚期阶段，应考虑放射治疗、颈部淋巴结清扫和抗雌激素治疗。
