Chalazion-mimicked eyelid angiosarcoma in a young Asian with good prognosis: a case report

Abstract

Background: Angiosarcoma is an extremely rare malignant tumor. So far, only about 42 cases of angiosarcoma involving the eyelids have been reported. Eyelid angiosarcoma occurs more frequently in elderly Caucasian males and is prone to misdiagnosis. We present a case report in a young Asian male patient with eyelid angiosarcoma that was misdiagnosed as a chalazion.

Case presentation: A 46-year-old South Korean male with no underlying disease had a right lower lid mass. The lesion was initially misdiagnosed as a chalazion at a local clinic, but a diagnosis of eyelid angiosarcoma was made after the first biopsy trial. PET-CT was performed to ensure that there was no metastasis in the whole body. Surgical excision with enough surgical margin was used alone for treatment and reconstruction was performed with a tarsoconjunctival advancement flap (modified Hughes procedure), which helped ensure good cosmesis. No recurrence was observed 4 years and 5 months after the surgery.

Conclusions: The current study presents the first case of chalazion-mimicked eyelid angiosarcoma in a young Asian male aged under 50 years. This case shows that even if a benign eyelid disease is suspected in a young patient, an incisional biopsy must be performed to confirm whether the lesion is malignant. Since the prognosis is good for the case of eyelid angiosarcoma, if there is no clear evidence of distal metastasis, surgical resection should be performed with an enough safety margin.

Keywords: Angiosarcoma; Chalazion; Eyelid; Misdiagnosis; Surgical excision.

Fig. 1

Photographs of our patient. A, nodular lesion appearing like a ruptured chalazion in the mid-lower lid margin at the first visit. B, after surgical excision with a safety margin of 5 mm and 7 negative frozen biopsies, the incision line was designed at the upper conjunctiva for a tarsoconjunctival advancement flap (modified Hughes procedure) with a green corneal protector. C, the tarsoconjunctival advancement flap reconstruction for the posterior lamella and myocutaneous advancement for anterior lamella reconstruction were performed. D, no recurrence was observed 4 years and 5 months after the surgery

Fig. 2

Pathologic findings of angiosarcoma. A, atypical endothelial cells showing sheet-like growth and scanty slit-like vascular structures filled with some RBCs and invading skeletal muscle bundles (hematoxylin and eosin, 100x). B, atypical endothelial cells lined by vascular structures filled with RBC (arrow)(hematoxylin and eosin, 400x). C, positive expression for CD31 (immunohistochemistry, 200x). D, high Ki-67 index of 95% (immunohistochemistry, 400x)

Fig. 3

Age and sex distribution of eyelid angiosarcoma. Forty-two cases reported in the paper by Hwang et al. [3] and our current study case were included. * Current study case