34 Malignant Tumors
RHABDOMYOSARCOMA |
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METASTATIC EYELID CARCINOMA |
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Rhabdomyosarcoma consists of three histological types: pleomorphic, embryonal, and alveolar. Embryonal rhabdomyosarcoma is the most common malignant orbital tumor in young children. Although the usual presentation is within the orbit, the tumor can present as a lid or subconjunctival mass. In its early stages, it presents as a firm mass which enlarges significantly within several weeks.
Currently, the preferred method of treatment is a combination of radiation therapy and chemotherapy. This combination achieves a 70–80% five-year survival rate, which is significantly better than the five-year survival rate of 30–40% that was accomplished with orbital exenteration.72
Carcinoma metastatic to the eyelid is a rare occurrence. The primary site is usually in the breast or lung (9). However, tumors from the stomach, the parotid gland, kidney, trachea, and colon have also been reported. Cutaneous malignant melanoma metastastic to the eyelid is extremely rare. Metastatic tumors usually present as a painless eyelid nodule or an ulcerated lesion. Some tumors may also present as an acutely inflamed, tender nodule (102).73–75 A case report described a 71-year-old female who presented with what was clinically diagnosed as a chalazion. Further history revealed that she had had a melanoma removed from her back three years previously. A biopsy showed malignant melanoma and further systemic evaluation uncovered extensive metastatic disease.76
When tumors metastasize to the eyelids, they often spread to other areas of the body, including the orbit. In some cases, however, the first evidence of carcinoma in the body is the eyelid tumor. Therefore, treatment should begin with the diagnostic biopsy unless it is known that other metastases are present. Further care would then have to be coordinated with proper systemic evaluation.
102
102 Metastatic carcinoma.This patient had a lesion in the right upper lid incised and drained as a chalazion.This tissue was not examined histologically. Six months later, she presented with a recurrence of the lesion that a biopsy showed to be metastatic adrenal carcinoma.The patient had other evidence of extensive metastasis and lived only six months after the diagnosis was made.
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