Eyelid Metastatic Thyroid Papillary Carcinoma

Abstract

Purpose: The aim of this study was to report the clinical and histopathological features of an eyelid metastasis in a 70-year-old male with no prior medical history.

Methods: A 70-year-male presented with a painless, hard, red nodular growth in his left lower medial eyelid of 6 months duration, involving the canaliculus and punctum. He did not complain of any other ocular or systemic abnormality. The clinical differential diagnosis included lymphoma or a primary adnexal tumour. The lesion was excised under local anaesthetic cover and sent for routine histopathological analysis.

Results: The histology revealed a carcinoma involving the posterior and anterior lamella of the lower lid. It was composed of papillary and follicular areas. The tumour nuclei were optically clear, overlapping, had nuclear grooves and were associated with eosinophilic colloid material. The tumour cells were strongly positive for nuclear thyroid transcription factor-1 and thyroglobulin (which also stained some of the eosinophilic colloid material). The histological and immunohistochemical features were those of metastatic papillary carcinoma of the thyroid. Unfortunately, the patient's thyroid has yet to be examined because of loss to follow-up.

Conclusion: To the best of our knowledge, this is the first report of thyroid papillary carcinoma metastasizing to the eyelid as the presenting feature of the disease. A review of the literature of metastatic thyroid carcinoma to the eyelids is presented, to place the findings of this case report in context.

Keywords: Eyelid; Metastasis; Papillary carcinoma; Thyroid carcinoma.

Fig. 1

a Reddish nodular lesion at the medial aspect of the left lower eyelid, involving the punctum and canaliculus. b Scanning power image of the histological section (HE). c Higher-power image, showing papillary areas of the tumour (HE; black arrows). d Another part of the tumour, showing follicular areas with distinct eosinophilic colloid material (HE; black arrows). e Higher-power image, illustrating the nuclear features of the tumour (HE). f Higher-power image, showing the nuclear grooves (HE; black arrow). g Nuclear TTF-1 immunohistochemical positivity of the tumour. h Cytoplasmic tumour-cell positivity with antibody to thyroglobulin (white arrow). i Colloid staining positively with thyroglobulin (white arrow).