Skin adnexal carcinoma of the eyelid: A case report

Abstract

Skin adnexal carcinomas (SACs) represent a diverse range of cancerous growths originating from the appendages of the skin. SACs are exceedingly rare malignancies that primarily manifest in individuals with fair skin and predominantly affect the head and neck. In the present study, a 70-year-old male presented with swelling and redness around the right eye, accompanied by skin desquamation. A tissue biopsy from the lesion showed a poorly differentiated SAC. Magnetic resonance imaging (MRI) of the neck and base of the skull revealed the presence of a large, well-defined heterogeneous mass involving the right orbit and periorbital tissue, measuring 62×38×43 mm. The patient declined wide local excision of the tumor. Eventually, the patient received a combination of chemotherapy and radiotherapy, followed by additional cycles of chemotherapy. Then, 1 month after the final chemotherapy, an MRI showed a small, linear lesion (8×4 mm) in the lower right orbital cavity, reduced by 90% from its original size. The scan also revealed diffuse volume loss and irregularity in the right eye, likely due to radiation, leading to vision loss in the affected eye. At present, the exact cause of SACs remains largely unidentified. While SACs frequently develop spontaneously, some may originate from precursor lesions or preexisting benign counterparts. The incidence of SAC is exceedingly rare, particularly when it is found in the eyelid. A combination of chemotherapy and radiotherapy followed by additional cycles of chemotherapy may be an effective therapeutic modality in shrinking the tumor.

Keywords: chemotherapy; eyelid; radiotherapy; skin adnexal carcinoma.

Figure 1.

Skin adnexal carcinoma affecting the right eye (pre-treatment appearance).

Figure 2.

Hematoxylin and eosin-stained images of the tumor biopsy. (A) The tumor cells were arranged in sheets and nests underneath the ulcerated epidermis (magnification, ×40). (B) Sheets and nests of large tumor cells infiltrated deeply around the benign adnexal structures (magnification, ×40). (C) The tumor cells were arranged in nests and had an abundant lightly eosinophilic to clear cytoplasm with markedly pleomorphic, large nuclei that had vesicular chromatin, prominent eosinophilic nucleoli and irregular nuclear outlines. There was brisk mitosis with atypical (tripolar) mitotic figures (magnification, ×400). (D) The tumor cells were predominantly arranged in nests with occasional pseudoglandular structures (magnification, ×400).

Figure 3.

Pre-treatment imaging revealing a significant right periorbital mass. (A) An axial contrast-enhanced computed tomography scan of the face and skull exhibited a large, well-defined mass (arrow) and the optic nerve (arrowhead). (B) A sagittal T2-weighted image revealed a large cystic-solid lesion (yellow arrow) with orbital (white arrow), periorbital and intraorbital extension. The optic nerve appeared free of any invasion (yellow arrowhead). (C) Post-contrast axial T1 fast suppression imaging showed a large, enhanced lesion (arrow) with foci of cystic degeneration represented by non-enhancing areas and the optic nerve (arrowhead). (D) Pre-treatment axial fat-suppressed T1-weighted images revealed two oval-shaped lymph nodes within the parotid gland, exhibiting peripheral enhancement and central necrosis (yellow and red arrows).

Figure 4.

A coronal reformatted computed tomography scan revealed a large, thick-walled subcapsular cystic lesion (arrows) with multiple thin internal septations (arrowhead), located at the liver dome just beneath the right hemidiaphragm.

Figure 5.

Decreased swelling and ulceration around the affected eye during treatment.

Figure 6.

Post-treatment results after combining chemotherapy and radiotherapy, followed by additional chemotherapy cycles. A notable reduction in tumor size was observed, shrinking from an initial 62 to 8 mm in diameter.

Figure 7.

Post-treatment magnetic resonance imaging showing a significant reduction (~90%) in the tumor size. (A) A sagittal T2-weighted image showing a shrunken intraorbital mass (arrow) with atrophy of the right orbit, resulting in phthisis bulbi, which contained a hemorrhagic component (arrowhead). (B) A sagittal post-contrast fat-suppression T1-weighted image showing an infraorbital linear enhancing component measuring 8×4 mm, with the intraorbital homogenous component appearing hyperintense (arrowhead). (C) A sagittal subtraction sequence showing an enhancing infraorbital linear focus (arrow), representing residual tumor after chemotherapy, with the intraorbital hemorrhagic component showing no post-contrast enhancement (arrowhead). (D) Post-treatment axial fat-suppressed T1-weighted images demonstrated a significant reduction in the size of both lymph nodes (yellow and red arrows).