PMC5903128_01
The edge of a tumorous mass is found at the lower margin of the upper eyelid. There is no loss of eye lashes (a). On lid eversion, there is a yellowish multilobulated papillary tumor behind the lid. The tumor is pedunculated from the tarsal palpebral conjunctiva (b).
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F1
On examination, a yellowish mass appeared to be located on the palpebral conjunctiva in her left upper eyelid, but neither abnormal findings on the surface of the lid skin nor loss of eyelashes was observed (Fig. 1a). Lid eversion revealed a yellowish multilobulatd papillary mass that was pedunculated from the palpebral tarsal conjunctiva (Fig. 1b).
A histopathologic section (hematoxylin-eosin, original magnification x200) from the biopsied specimen shows that the tumor consists of proliferative atypical vacuolated cells with slight basophilic cytoplasms and atypical nuclei associated with hyperchromatic nucleoli (a). A histopathologic section (hematoxylin-eosin, original magnification x12.5) from the resected specimen shows that the tumor demonstrated papillary and pedunculated exophytic growth from the palpebral conjunctiva (b). Greater magnification of the black square (hematoxylin-eosin, original magnification x100) reveals slight invasion into the tarsus (c). T, tumor; TA, tarsus.
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F2
The histopathologic diagnosis of a biopsied specimen was sebaceous carcinoma (Fig. 2a). A histopathologic examination revealed that the tumor consisted of proliferative atypical vacuolated cells with slight basophilic cytoplasms and atypical nuclei associated with distinct hyperchromatic nucleoli (Fig. 2a). On low magnification, the tumor demonstrated papillary and pedunculated exophytic growth from the palpebral conjunctiva (Fig. 2b). Although a small portion of invasion into the tarsus was found, the tarsal glands were not occupied by carcinoma cells (Fig. 2c).
The postoperative appearance of the left upper eyelid 2 weeks after the separation procedure for the switched flap from the lower eyelid (a). A Bowenoid proliferation of the recurrent sebaceous carcinoma in the middle third of the tarsal palpebral conjunctiva (b). The postoperative appearance of the tarsal palpebral conjunctiva 3 months after the resection of the re-recurrent tumor combined with mitomycin C and cryotherapy as well as simple resection (c).
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F3
The defected upper eyelid was reconstructed by a switch-flap from the ipsilateral lower eyelid (Fig. 3a). Nine months after the surgery, a Bowen-like abnormal epithelial lesion with a finely vascularized surface was observed on the middle third of the left superior palpebral tarsal conjunctiva (Fig. 3b). No recurrence occurred after this, and the resected surface was completely covered by the intact conjunctival epithelium (Fig. 3c) for at least 1 year after the third surgery.