Ishikawa D, Azumi A, Ohbayashi C, Yamamoto M
Department of Ophthalmology, Kobe University School of Medicine, Japan.
Nippon Ganka Gakkai Zasshi. 1998 Apr;102(4):281-6.
A 73-year-old male presented with a slowly growing tumor in the right lower eyelid of one year's duration. The condition had been diagnosed elsewhere as poorly differentiated squamous cell carcinoma by biopsy. The residual tumor progressed rapidly and metastatized to the ipsilateral preauricular lymph nodes. We performed orbital evisceration and radical neck resection. Microscopically, the tumor showed small epithelial nests, cords, and ductal structure buried in abundant collagenous stroma. Besides focal squamous differentiation with keratinization in the surface area, the tumor showed, as cardinal features, ductal differentiation possessing comma-like extensions identical to syringoma. Cellular atypia, invasive growth pattern, and remarkable perineural invasion were suggestive of malignancy. These features led to the diagnosis of syringomatous carcinoma. Immunohistologically, the tumor showed positive staining for cytokeratine and epithelial membrane antigen (EMA). It was mostly negative for S-100 and carcinoembryonic antigen (CEA).
一名73岁男性，右眼下睑出现一个生长缓慢的肿瘤，病程为一年。该病例在其他地方经活检诊断为低分化鳞状细胞癌。残留肿瘤迅速进展并转移至同侧耳前淋巴结。我们进行了眼眶内容剜除术和根治性颈部切除术。显微镜下，肿瘤表现为小上皮巢、条索及导管结构，埋于丰富的胶原性间质中。除表面区域有局灶性鳞状分化伴角化外，肿瘤的主要特征为具有与汗管瘤相同的逗号样延伸的导管分化。细胞异型性、浸润性生长模式及显著的神经周围浸润提示为恶性。这些特征导致诊断为汗管癌。免疫组织化学检查显示，肿瘤细胞角蛋白和上皮膜抗原（EMA）染色阳性，S-100和癌胚抗原（CEA）大多为阴性。
