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  Table of Contents    
LETTERS TO EDITOR  
Year : 2019  |  Volume : 62  |  Issue : 4  |  Page : 635-636
Carancular mass- Always take with a pinch of salt!


1 Department of Oculoplasty, Oculoplasty and Cataract Services, Anand Eye Institute, 7-147/1, Nagendranagar, Habsiguda, Hyderabad, India
2 Glaucoma and Cataract Services, Sita Lakshmi Glaucoma Center, Anand Eye Institutue, Habsiguda, India
3 Ocular Oncology and Pathology Services, Centre for Sight, Banjara Hills, India

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Date of Web Publication14-Oct-2019
 

How to cite this article:
Basa D, Balijepalli P, Mulay K. Carancular mass- Always take with a pinch of salt!. Indian J Pathol Microbiol 2019;62:635-6

How to cite this URL:
Basa D, Balijepalli P, Mulay K. Carancular mass- Always take with a pinch of salt!. Indian J Pathol Microbiol [serial online] 2019 [cited 2019 Nov 21];62:635-6. Available from: http://www.ijpmonline.org/text.asp?2019/62/4/635/269056




Editor,

We would like to report a rare case of Sebaceous carcinoma of caruncle. Caruncular masses have a wide variety of presentations and the diagnosis remains a surprise until the histopathology confirms it.[1] Most of caruncular tumors reported are benign, as malignant tumors are rarely reported. The common malignant tumors of the caruncle are basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma, malignant melanoma, lymphoma, malignant fibrous histiocytoma, and oncocytoma.[2]

Sebaceous carcinoma in the eyelid originates usually from the meibomian glands of tarsus and cilia (zeis glands), and only a small proportion originates from the sebaceous glands of the caruncle.[3] Very few cases are reported till now.[4],[5],[6]

A 57-year-old female noticed swelling in her left eye since one month. It was largely painless but gradually increasing in size. She had no systemic ailments. Her best corrected visual acuity in both the eyes was 20/20 N6. LE examination showed enlarged caruncle which is about 5*5 mm in size, with smooth surface with no signs of inflammation.

On palpation, its firm to hard in consistency, and not freely mobile. Rest of the anterior and posterior segment examination was within normal limits in both the eyes. The systemic examination was normal. A wide excision of the mass in toto was done and sent for Histopathological examination (HPE). HPE showed tumor cells which were compactly organized with abundant cytoplasm and a vesicular nuclei which was suggestive of malignant tumor with a strong suspicion of sebaceous carcinoma [Figure 1]a and [Figure 1]b. For further confirmation, immunohistochemistry was done which showed that the tumor cells were positive for pan- cytokeratin (CK), epithelial membrane antigen (EMA) and adipophilin [Figure 2]. So, a diagnosis of sebaceous carcinoma of the caruncle was made and the margins were free of tumor cells. She was referred to a higher center, where she underwent map biopsy which was found to be free of tumor cells.
Figure 1: (a and b) Well defined solid sheets or lobules of atypical epithelial cells, including large, pale or clear cells with coarsely vacuolated cytoplasm

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Figure 2: The tumor cells were positive for pan-cytokeratin (CK), epithelial membrane antigen (EMA) and adipophilin

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Figure 3: Adipophilin Image – Tumour cells were positive for adipophilin

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   Discussion Top


Sebaceous carcinoma, a malignant neoplasm most commonly arises from the eyelid than any other parts of the body. In the eyelid, it usually arises from the meibomian glands of the tarsus and less often from the Zeis glands in association with cilia, but rarely from the caruncle.[3] Sebaceous gland hyperplasia and adenoma are the benign lesions of the caruncle which are seldom seen, but sebaceous gland carcinoma rarely arises.[2]

Zhang et al.[5] reported a case of sebaceous carcinoma of caruncle, for which a map biopsy was combined with excision biopsy in view of high clinical suspicion of malignancy due to its yellow multi nodular appearance. Similarly, Shield et al.[4] reported a case of caruncular mass which was elsewhere reported to be squamous cell carcinoma, but excision biopsy with double freeze thaw cryotherapy was done due to its clinical appearance.

In our case, we suspected a benign lesion. However, to our surprise, it was reported to be a malignant tumor and the margins were free of tumor cells. As we did not suspect a malignancy, clinical photographs pre operatively were not taken, which proved to be a limitation in our case report. The patient later underwent map biopsy elsewhere, which turned out to be free of tumor cells.

Caruncular masses can always give a surprise as it is difficult to diagnose by clinical appearance. Histopathology plays an important role in the diagnosis. Even if the clinical suspicion of malignancy is low, a wide excision of the mass has to be performed with cryotherapy of the margins. Close follow-up of these patients after excision is warranted to detect recurrence.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Solari HP, Ventura MP, Orellana ME, Novais GA, Cheema DP, Burnier MN. Histopathological study of lesions of the caruncle: A 15-year single center review. Diagn Pathol 2009; 4:29.  Back to cited text no. 1
    
2.
Levy J, Ilsar M, Deckel Y, Maly A, Pe'er J. Lesions of the caruncle: A description of 42 cases and a review of the literature. Eye 2009;23:1004.  Back to cited text no. 2
    
3.
Shields JA, Demirci H, Marr BP, Eagle RC Jr, Shields CL. Sebaceous carcinoma of the eyelids: Personal experience with 60 cases. Ophthalmology 2004;111:2151-7.  Back to cited text no. 3
    
4.
Shields JA, Shields CL, Marr BP, Eagle RC Jr. Sebaceous carcinoma of the caruncle. Cornea 2006;25:858-9.  Back to cited text no. 4
    
5.
Zhang Z, Sun S. Sebaceous carcinoma of lacrimal caruncle in a Chinese patient. Optom Vis Sci 2014;91:e72-5.  Back to cited text no. 5
    
6.
Kaliki S, Ayyar A, Dave TV, Ali MJ, Mishra DK, Naik MN. Sebaceous gland carcinoma of the eyelid: Clinicopathological features and outcome in Asian Indians. Eye 2015;29:958.  Back to cited text no. 6
    

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Correspondence Address:
Divya Basa
Oculoplasty and Cataract Services, Anand Eye Institute, 7-147/1, Nagendranagar, Habsiguda, Hyderabad
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_103_19

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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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