Primary Cribriform Carcinoma of the Eyelid With Neuroendocrine Features: A Case Report

February 2017 | Volume 16 | Issue 2 | Case Report | 173 | Copyright © 2017

Joshua D. Fox MD,a Sander R. Dubovy MD,b Sara T. Wester MD,c and Keyvan Nouri MDa

aDepartment of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL bFlorida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL cBascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL

Abstract

A variety of tumors may involve the eyelid, most of which are primary, but rarely can be metastatic. Previously reported eyelid primary carcinomas with neuroendocrine features include Merkel cell carcinoma, apocrine and eccrine gland carcinoma, sebaceous gland carcinoma, and one report of primary “well-differentiated neuroendocrine tumor.” Herein we report the first case of primary cribriform carcinoma of the eyelid with neuroendocrine features. The patient is a 75-year-old black man who presented to the clinic with a 5-year history of a slowly growing, non-painful, non-exudative lesion of his left lower eyelid. Examination disclosed a non-tender 8 mm by 9 mm ovoid, firm, euchromic subdermal non-adherent nodule involving the left lower eyelid with no madarosis or loss of lid margin architecture, but with overlying induration. An incisional biopsy demonstrated nodules and aggregates of tumor composed of cuboidal hyperchromatic basoloid cells with occasional mitotic figures within sheets in a mostly cribriform and occasionally papillary pattern. The tumor was diffusely positive for cytokeratin, Epithelial Membrane Antigen, and p40 and focally positive for synaptophysin. The tumor was negative with antibodies for Cytokeratin 20 (CK20), p63, CD10, Thyroid Transcription Factor-1, Cytokeratin 7, Prostate Specific Antigen, and Epithelial Specific Antigen. Oncologic evaluation was negative for metastases. The patient underwent a complete excision of his eyelid tumor with 5 mm margins using Mohs surgery, with subsequent reconstruction using a Hughes tarsoconjunctival flap, myocutaneous advancement flap, and lateral canthal tendon plication.

J Drugs Dermatol. 2017;16(2):173-174.

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CASE REPORT

A 75-year-old black male with a history of prostate cancer, hypertension, and cataracts presented to Bascom Palmer Eye Institute of the University of Miami Miller School of Medicine, Miami, Florida, with a 5-year history of a slowly growing, non-painful, non-exudative lesion of his left lower eyelid. The patient presented with a diagnosis of fragmented papillary carcinoma from a biopsy 8 months prior. Regarding the patient’s prostate cancer, he was diagnosed with adenocarcinoma of the prostate four years prior, and was status post-1 year of hormonal therapy and three years of active surveillance. The patient also had an atrial myxoma excised 3 months prior and a 25 pack per year smoking history. The review of systems was negative for fever, chills, or weight loss. Examination disclosed a non-tender 8 mm by 9 mm ovoid, firm, euchromic, subdermal non-adherent nodule involving the left lower eyelid with no madarosis or loss of lid margin architecture, but with overlying induration (Figure 1). The remainder of the physical exam was unremarkable, including negative lymphadenopathy. An incisional biopsy demonstrated nodules and aggregates of tumor composed of cuboidal hyperchromatic basoloid cells with occasional mitotic figures within sheets in a mostly cribriform and occasionally papillary pattern (Figures 2 and 3). The tumor was diffusely positive for cytokeratin, Epithelial Membrane Antigen (EMA), and p40 and focally positive for synaptophysin. The tumor was negative with antibodies for Cytokeratin 20 (CK20), p63, CD10, Thyroid Transcription Factor-1 (TTF-1), Cytokeratin 7 (CK7), Prostate Specific Antigen (PSA), and Epithelial Specific Antigen (ESA). Oncologic evaluation was negative for metastases, including a serum PSA that was within normal limits. Thus, the patient maintained his low risk prostate cancer clinical staging of T1cN0M0. The patient underwent a complete excision of his eyelid tumor with 5 mm margins using Mohs surgery, with subsequent reconstruction using a Hughes tarsoconjunctival flap, myocutaneous advancement flap, and lateral canthal tendon plication.A wide variety of tumors may involve the eyelid, most of which are primary, but in rare cases may be metastatic.1 Previously reported eyelid primary carcinomas with neuroendocrine features include Merkel cell carcinoma,2 apocrine, and eccrine gland carcinoma,1 sebaceous gland carcinoma,3 and one report of primary “well-differentiated neuroendocrine tumor.” We believe this to represent the first reported case of primary cribriform carcinoma of the eyelid with neuroendocrine features. The focally positive synaptophysin immunostain led us to classify the tumor as one “with neuroendocrine features.” The negative CK20, as well as the hematoxylin and eosin appearance are not consistent with Merkel cell carcinoma. The

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