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Year : 2014  |  Volume : 57  |  Issue : 2  |  Page : 351-352
Recurrent mucoepidermoid carcinoma of the left lower eyelid: A common tumor in a rare site

Department of Pathology, Rohilkhand Medical College Hospital, Bareilly, Uttar Pradesh, India

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Date of Web Publication19-Jun-2014

How to cite this article:
Agrawal R, Kumar P, Varshney R. Recurrent mucoepidermoid carcinoma of the left lower eyelid: A common tumor in a rare site. Indian J Pathol Microbiol 2014;57:351-2

How to cite this URL:
Agrawal R, Kumar P, Varshney R. Recurrent mucoepidermoid carcinoma of the left lower eyelid: A common tumor in a rare site. Indian J Pathol Microbiol [serial online] 2014 [cited 2023 Sep 26];57:351-2. Available from:


A 55-year-old man developed a painless, indurated nodule in the left lower eyelid for 5 years and skin ulceration for a year. The patient was operated 5 years back at a local center following similar lesion. However, the biopsy report was not available with him. The present ulcer recurred at the same site. There was no history of pain, redness, or watering. Both eyes had normal visual acuity, extra ocular movements, intraocular tension, fundus, and punctum.

On examination, there was an ulcerated lesion in the left lower eyelid measuring 4 4 cm with undermined edges. The margins were irregular and sinus cavity was visible.

Histopathology showed variable degrees of acanthosis of the epithelium with intact basement membrane [Figure 1]. There were multiple islands of epithelial lobules comprising of both glandular and squamous cells [Figure 2]. Diastase resistant periodic acid-Schiff and cytokeratin were positive. The margins were clear. It was reported as low grade mucoepidermoid carcinoma (MEC). In view of the lesion developing at the same site it was considered to be a recurrent tumor.
Figure 1: Low power photomicrograph showing an outer eyelid epithelium, beneath which nests of tumor cells are present (H and E, ×40)

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Figure 2: Photomicrograph showing an outer capsule, with squamous and glandular components along with interspersed inflammatory infiltrate and mucin pools (H and E, ×400)

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Mucoepidermoid carcinoma is the most common malignancy of salivary glands although they have also been reported in the upper respiratory tract, nasal mucosa, esophagus, maxilla, mandible, liver, cervix, penis, and anus. [1],[2],[3] Of the various ocular structures, conjunctiva is most commonly involved followed by the lacrimal glands. The most common presentation is conjunctival mass with redness and irritation. In a study by Ni et al. the duration of symptoms ranged from 3 months to 3 years. [2] In contrast to previous reports, our case is quite unusual presenting as painless lid swelling for 5 years.

Histologically, there is an admixture of squamous epithelial cells and mucous-producing goblet cells in variable proportions. Goblet cells predominate in well-differentiated tumors and squamous epithelium in poorly-differentiated neoplasms. Histochemical stains for mucin help in the diagnosis.

It is postulated that MEC may arise from either the lacrimal sac mural serous gland epithelium or goblet cells in conjunctival columnar epithelium. [2] The epithelium becomes stratified squamous near the sclerocolumnar limbus and the mucocutaneous junction near the lid margin and so a neoplastic differentiation in both directions may result in MEC. [1] A three-grade scheme has been shown to be reproducible and predictive of the patient's outcome. Based on these parameters and scoring, the present case was assigned as low grade tumor. [3]

Although conjunctival MEC is rare, it should be recognized and differentiated from other tumors in this site, especially squamous cell and basal cell carcinomas, which have a different biologic behavior and relatively low malignant potential. [4],[5] Following early recurrences and local invasion, MEC are treated by a wide local excision and enucleation or exenteration due to involvement of intraocular structures and/or orbit. The margins should be carefully examined for residual tumors and patients should be followed-up frequently.

It is difficult to diagnose and grade MEC precisely by fine-needle aspiration cytology or preoperative biopsy so are often misdiagnosed as a benign tumor and removed without appropriate margins resulting in a poor prognosis. [3],[4],[5]

   References Top

1.Biswas J, Datta M, Subramaniam N. Mucoepidermoid carcinoma of the conjunctiva of the lower lid - Report of a case. Indian J Ophthalmol 1996;44:231-3.  Back to cited text no. 1
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2.Ni C, Wagoner MD, Wang WJ, Albert DM, Fan CO, Robinson N. Mucoepidermoid carcinomas of the lacrimal sac. Arch Ophthalmol 1983;101:1572-4.  Back to cited text no. 2
3.Goode RK, El-Naggar AK. Mucoepidermoid carcinoma. WHO Organization Classification of Tumours. Pathology and Genetics of Head and Neck Tumours. Lyon: IARC Press; 2005. p. 219-20.  Back to cited text no. 3
4.Irfan M, Wong CY, Fariza HN, Maha K, Hayati ON. Synchronous mucoepidermoid carcinoma of the right upper eyelid and right parotid gland in a young patient. Malays J Med Health Sci 2011;7:61-4.  Back to cited text no. 4
5.Hui-jing Y, Hua-sheng Y, Ping Z. Clinical analysis and pathology for mucoepidermoid carcinoma of the eyelid. Chin J Pract Ophthalmol 2010;28:1077-79  Back to cited text no. 5

Correspondence Address:
Ranjan Agrawal
Department of Pathology, Rohilkhand Medical College Hospital, Pilibhit Bypass Road, Bareilly - 243 006, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.134752

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  [Figure 1], [Figure 2]

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