Alexander C Rokohl1, Heike Löser2, Joel M Mor3, Niklas Loreck3, Konrad R Koch3, Ludwig M Heindl3,4. 1. Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland. alexander.rokohl@uk-koeln.de. 2. Institut für Pathologie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland. 3. Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland. 4. Centrum für Integrierte Onkologie (CIO) Aachen - Köln - Bonn - Düsseldorf, Köln, Deutschland.
Abstract
BACKGROUND: A space-occupying lesion of the eyelid in young adults is often a sign of an inflammation, a trauma or a benign neoplasm. The aim of this case report is to demonstrate a rare basal cell carcinoma, which presumably already arose in adolescence without further high-risk factors. METHODS: A 28-year-old male patient presented for a second opinion on a painless swelling of the right lower eyelid. According to the patient's history the swelling had been present since the age of 16 years and originally resembled a molluscum contagiosum. An ophthalmologist in private practice made the diagnosis of a suspected trichoepithelioma. The extended patient history revealed a blood coagulation disorder. The clinical ophthalmological examination revealed a nodular space-occupying lesion with a border wall and telangiectasia. The further ophthalmological examination was bilaterally inconspicuous. Due to the suspicion of a malignant process, an operation was promptly carried out using local anesthesia with complete tumor excision and pedicled flap plasty as well as a histopathological investigation to confirm the diagnosis. RESULTS: The histopathological investigation revealed underlying infiltrates of a basaloid tumor with bale-shaped trabecular growth, sometimes with peripheral palisading of the cells. The cells were predominantly monomorphic with isolated pleomorphic nuclei and sometimes enclosed mitoses. Immunohistochemically the cells were strongly positive for BerEP4 and negative for epithelial membrane antigen (EMA). The diagnosis of a nodular basal cell carcinoma of the right lower eyelid was made. All incision margins were free of tumor cells (R0 resection). In the dermatological screening no further manifestations were detected. CONCLUSION: Despite the occurrence of a space-occupying lesion of the eyelid in a young adult patient and also with no further risk factors, in addition to an inflammatory event and a benign tumor, a malignant disease, such as a basal cell carcinoma should also be taken into consideration. A tissue biopsy or complete excision with subsequent histological examination including an immunohistochemical analysis are essential for differentiation from other tumor entities.
BACKGROUND: A space-occupying lesion of the eyelid in young adults is often a sign of an inflammation, a trauma or a benign neoplasm. The aim of this case report is to demonstrate a rare basal cell carcinoma, which presumably already arose in adolescence without further high-risk factors. METHODS: A 28-year-old male patient presented for a second opinion on a painless swelling of the right lower eyelid. According to the patient's history the swelling had been present since the age of 16 years and originally resembled a molluscum contagiosum. An ophthalmologist in private practice made the diagnosis of a suspected trichoepithelioma. The extended patient history revealed a blood coagulation disorder. The clinical ophthalmological examination revealed a nodular space-occupying lesion with a border wall and telangiectasia. The further ophthalmological examination was bilaterally inconspicuous. Due to the suspicion of a malignant process, an operation was promptly carried out using local anesthesia with complete tumor excision and pedicled flap plasty as well as a histopathological investigation to confirm the diagnosis. RESULTS: The histopathological investigation revealed underlying infiltrates of a basaloid tumor with bale-shaped trabecular growth, sometimes with peripheral palisading of the cells. The cells were predominantly monomorphic with isolated pleomorphic nuclei and sometimes enclosed mitoses. Immunohistochemically the cells were strongly positive for BerEP4 and negative for epithelial membrane antigen (EMA). The diagnosis of a nodular basal cell carcinoma of the right lower eyelid was made. All incision margins were free of tumor cells (R0 resection). In the dermatological screening no further manifestations were detected. CONCLUSION: Despite the occurrence of a space-occupying lesion of the eyelid in a young adult patient and also with no further risk factors, in addition to an inflammatory event and a benign tumor, a malignant disease, such as a basal cell carcinoma should also be taken into consideration. A tissue biopsy or complete excision with subsequent histological examination including an immunohistochemical analysis are essential for differentiation from other tumor entities.
Authors: V Kakkassery; K U Loeffler; M Sand; K R Koch; A M Lentzsch; A C Nick; I A Adamietz; L M Heindl Journal: Ophthalmologe Date: 2017-03 Impact factor: 1.059
Authors: Berenice M Lang; Panagiotis Balermpas; Andrea Bauer; Andreas Blum; G Felix Brölsch; Thomas Dirschka; Markus Follmann; Jorge Frank; Bernhard Frerich; Klaus Fritz; Axel Hauschild; Ludwig M Heindl; Hans-Peter Howaldt; Stephan Ihrler; Vinodh Kakkassery; Bernhard Klumpp; Albrecht Krause-Bergmann; Christoph Löser; Markus Meissner; Michael M Sachse; Max Schlaak; Michael P Schön; Lutz Tischendorf; Michael Tronnier; Dirk Vordermark; Julia Welzel; Michael Weichenthal; Susanne Wiegand; Roland Kaufmann; Stephan Grabbe Journal: J Dtsch Dermatol Ges Date: 2018-12-28 Impact factor: 5.584
Authors: Vinodh Kakkassery; Steffen Emmert; Irenäus A Adamietz; György Kovács; Anselm M Jünemann; Caroline Otte; Michael Zimbelmann; Anton Brosig; Salvatore Grisanti; Ludwig M Heindl Journal: Ophthalmologe Date: 2020-02 Impact factor: 1.059