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| CLINICAL QUIZ |
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| Year : 2013 | Volume
: 6
| Issue : 1 | Page : 63 |
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It is not chalazion
Abdullah Al-Mujaini1, Buthaina Sabt1, Ibrahim Al-Hadabi2
1 Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
2 Department of Pathology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| Date of Web Publication | 15-May-2013 |
Correspondence Address:
Abdullah Al-Mujaini
Department of Ophthalmology, Sultan Qaboos University Hospital, PO- 38, PC-123, Muscat
Sultanate of Oman
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-620X.111933
How to cite this article:
Al-Mujaini A, Sabt B, Al-Hadabi I. It is not chalazion. Oman J Ophthalmol 2013;6:63 |
A 65-year- old woman, Omani patient, presented with a foriegn body sensation and a painless right upper lid swelling [Figure 1] for over 6 months. Findings on everting the upper lid are as seen in [Figure 2].
 Questions | |  |
- What is the most likely diagnosis? Describe the clinical and histopathologic features [Figure 3] and [Figure 4] in support of your diagnosis.
- What are the prognostic indicators in this condition?
 View Answer
| Answers | | |
Diagnosis1. Sebaceous cell carcinoma, clinical [Figure 2] and histopathologic features of pagetoid spread [Figure 3], high lipid content [Figure 4], and multifocal skip lesions support the diagnosis. 2. 1 Poor prognostic indicators:
- Delay in diagnosis for over 6 months.
- Size >10 mm.
- Simultaneous upper and lower eyelid involvement.
- Multicentric origin.
- Poor differentiation.
- Highly infiltrative pattern.
• Vascular, lymphatic, orbital, and pagetoid spread. 2 Good prognostic indicators:
- Zeiss gland better than mebomein gland origin.
- Lower lid involvement alone.
| Discussion | | |
- Sebaceous cell carcinoma accounts for 1%-5% of all eyelid malignancies. Features mainly in 50 years and above age group, with a slight preponderance for females and Asians with the upper eyelid being the most common location. It presents as a painless, firm, slowly enlarging mass simulating a chalazion [Figure 1], may masquerade as unilateral blepheroconjunctivitis, as a result misdiagnosis is reported in upto 50% both clinically and histopathologically. Sebaceous cell carcinoma is considered as an aggressive tumor with local versus metastatic spread.
Mortality rate is usually within 20% but increases dramatically to 59% when pagetoid extension exits. Treatment of choice for this type of cancer varies, but the most acceptable modality nowadays is Moh's micrographic surgical procedure. It significantly lowers local and distant recurrence rates. Advanced cases will require exenteration, and in some cases palliative treatment with radiotherapy or chemotherapy may be required.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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