Atypical Case of Trichilemmal Carcinoma of the Eyelid

眼瞼惡性毛囊癌之非典型病例報告

吳映萱(Ying-Hsuen Wu) ； 江鈞綺(Chun-Chi Chiang) ； 蔡宜佑(Yi-Yu Tsai)

《中華民國眼科醫學會雜誌》 50卷2期 (2011/06) Pp. 328-332

https://doi.org/10.30048/ACTASOS.201106.0017

摘要

目的：眼瞼惡性毛囊癌之非典型病例報告。方法：病例報告。結果：一位六十六歲的女性因右上眼瞼復發性腫瘤而轉至本院，檢查發現右上眼瞼一表面粗糙且邊界不明顯之腫瘤，合併有多顆較小之腫瘤分布於四週，完全切除後病理報告顯示為嚴重分化不良之皮膚細胞。約一個半月後，相同位置又可見一乳突狀腫瘤，完全切除後病理報告顯示為惡性毛囊癌，此病人於後續十七個月的門診追蹤過程中，並沒有復發或轉移之情形。結論：惡行毛囊癌應列入眼瞼腫瘤之鑑別診斷，其緩慢病程及多變的表現常造成診斷上的困難，本篇之病例可見皮膚之分化不良出現於惡性毛囊癌之前，有多種假設可以解釋這種現象，即使復發或移轉之情形並不常見，完全切除腫瘤及密切追蹤仍是重要的。

並列摘要

Purpose: To describe a rare case of trichilemmal carcinoma (TLC) of the upper eyelid, which was previously presented as skin dysplasia and later as a papillary tumor.Method: Current study is an observational case report.Results: A 66-year-old female had a recurrent tumor on the right upper eyelid. She had received excision of the tumor at a local clinic the first time. Several weeks later, recurrence was noted, so she came to our outpatient department for further evaluation. The tumor had an indefinite margin with a pink, coarse appearance resembling a healed ulcer and was diffusely surrounded by several small nodules. After excision, the pathology revealed severe dysplasia of the skin. The base and margins were free of tumor cells. About one and a half months later, she had a similar lesion in the same area but with a papillary appearance. Excisional biopsy revealed solid tumor with plate-like growth of clear cells surrounded by palisading and central keratinization. In addition, stromal invasion was observed. The immunohistochemical stain was positive for cytokeratin (CK) and negative for CK7, CK20, and S-100. The margins and base were free of tumor cells. All these features are compatible with TLC. No recurrence or metastasis was noted during the 17-month follow-up.Conclusion: TLC should be considered in the differential diagnosis of an eyelid mass despite its rarity. It has an indolent clinical course and variable appearance that make the diagnosis more challenging. As in our case, skin dysplasia developed before TLC and many hypotheses could explain this atypical presentation. Although TLC is malignant in nature, it does not metastasize or recur. However, it is still important to perform a complete excision of the tumor and to offer careful follow-up to all patients.

並列關鍵字

trichilemmal carcinoma ； eyelid tumor