Regression of Sebaceous Carcinoma of the Eyelid after a Small Incisional Biopsy: Report of Two Cases

Abstract

Purpose: To report 2 cases of regression of sebaceous carcinoma of the eyelid after a small incisional biopsy.

Methods: Clinical, imaging, and histopathological findings are presented, with a literature review on regressing ocular tumors.

Results: Our first patient was a 79-year-old man who presented with a 10-month history of progressive left upper eyelid ptosis caused by an eyelid tumor with orbital involvement and confirmed on magnetic resonance imaging. Our second patient was a 70-year-old woman who presented with ptosis with a left upper eyelid mass. Both patients underwent a small incisional biopsy of their lesion. The histopathological diagnoses in both cases were consistent with sebaceous carcinoma. Both patients refused exenteration. Follow-up clinical examination and imaging disclosed total regression of the ptosis and of the neoplasm with no sign of recurrence in both patients over a 4-year period for Case 1 and a 7-year period for Case 2.

Conclusion: Regression following incisional biopsy of basal cell, squamous cell, and Merkel cell carcinoma, including of the eyelid, is well documented. To the best of our knowledge, our 2 cases of sebaceous carcinoma are the first to be reported with total involution clinically and on imaging of the tumor following partial incisional biopsy.

Keywords: Exenteration; Eyelid; Orbit; Ptosis; Sebaceous carcinoma; Small incisional biopsy; Spontaneous regression.

Fig. 1

a Our first case (Case 1) demonstrates marked ptosis and substantial fullness in the medial upper and lower eyelids of the left eye. b Magnetic resonance imaging (MRI) at initial presentation revealed a soft tissue mass involving the left eyelids, especially medially extending into the left anterior medial orbit. c 14 months after incisional biopsy of the medial eyelid with orbital extension, Case 1 shows complete clinical resolution of the lesions. d MRI 14 months after the small incisional biopsy shows no evidence of the prior tumor, which has undergone regression. e Case 2 has a large mass in the medial left upper eyelid, which shows ptosis. f Eversion of the eyelid reveals a massive lesion in the anterior medial eyelid. g Computed tomographic (CT) imaging of Case 2 exhibits a contrast-enhancing loculated lesion of the medial left upper eyelid. h, i There is complete resolution of the ptosis (h) and complete resolution of the tarsal lesion clinically (i) at 2.5 years after initial biopsy. j Follow-up CT scan 2.5 years after initial presentation discloses regression of the tumor.

Fig. 2

The findings in Case 1 are in the left column, while those from identical stains are shown in the right column side by side. a Biopsy specimen from Case 1 is comprised of glandular tissue with pleomorphic nuclei and focal foamy cytoplasm consistent with the findings in a sebaceous adenocarcinoma. Hematoxylin-eosin, original magnification ×400. b Biopsy specimen from Case 2 shows a lesion that contained cells with pleomorphic nuclei and foamy cytoplasm with focal chronic granulomatous inflammatory infiltrates (arrows). Hematoxylin-eosin, original magnification ×200. c, d Epithelial membrane antigen is strongly positive in the tumor cells. ×100. e, f BER-EP4 is positive, more so in Case 1. ×100. g, h The tumor cells are immunoreactive for adipophilin in both cases. ×100. i, j P16 is highly positive in both cases. ×100. k, l Ki67 is positive in 35% of the tumor cells in Case 1 and in 60% in Case 2. ×100. m, n Staining for androgen receptor is very positive in Case 1 but negative in Case 2. ×100.