Department of Pathology, Sir Salimulla Medical College, Mitford, Dhaka, Bangladesh
Department of Ophthalmology, Sir Salimulla Medical College, Mitford, Dhaka, Bangladesh
Background and objective: Eyelid
growth is a common clinical condition presented to ophthalmologists. Accurate
diagnosis of eyelid tumors is necessary to guide ophthalmologists to design
optimal management. We carried out the study to assess the histopathological
types of different eyelid growth in tertiarycare hospitals of Dhaka city.
Methods: This is a cross sectional study performed at
the Department of Pathology of Sir Salimullah Medical College
(SSMC), Dhaka, Bangladesh. Samples were collected from hospitals of SSMC and
National Institute of Ophthalmology (NIO), Dhaka, Bangladesh. Study period was
from January 2012 to December 2013. A total of 93 cases with eyelid growth of
both sex were enrolled in the study. After obtaining informed written consent,
tumors were excised by the ophthalmologist and the specimens were collected in
10% formalin for histopathological examination.
total of 93 cases of eyelid lesions were examined. The most common age group
affected was between 26-50yrs (50.54%). Mean age was 43.22±17.42 (range 19 – 90
years). Gender distribution of the patients was almost equal (male 51.6%,
female 48.4%). Neoplastic lesions were found in 86 cases (92.47%) and non
neoplastic growth was present in 7 (7.53%) cases. Benign, pre-malignant and
malignant tumors were found in 52 (55.91%), 01(1.08%) and 33(35.48%) cases
respectively. Among the malignant lesions,
basal cell carcinoma was the most common malignant tumor (36.4%) followed by sebaceous gland and squamous cell
carcinoma (27.3%). Nevus was the most common benign lesions (26.9%) followed by sudoriferous
cyst (19.2%) and haemangioma (15.4%).
the eyelid lesions removed surgically should be examined histopathologically to
establish the correct diagnosis. Accurate diagnosis of
specific tumors is important for proper treatment and favorable prognosis.
IMC J Med Sci 2017; 11(1): 5-10
Address for Correspondence:Dr.
Rita Paul, Assistant Professor, Department of Pathology, Ibrahim Medical
College, 122 Kazi Nazrul Islam Avenue, Shahbag, Dhaka, Bangladesh. E-mail:
growth is a common clinical condition presented to ophthalmologists . The
eyelid is rich in glandular tissue which includes sweat glands of the eyelid
skin, lacrimal gland of Krause and Wolfring, the apocrine gland of Moll, meibomian
and the glands of Zeiss . Pathologic conditions affecting the eyelid may be
inflammatory or neoplastic. It has been reported that 90% of skin cancers
occurs in head and neck region and 10% of them are located at eyelid level .
Benign epithelial lesions, cystic lesions, and benign melanocytic lesions of
eyelid are very common .Among the benign lesions, squamous cell
papilloma, seborrheic keratosis, melanocytic nevus are common. Most common
malignant tumors of eyelid are basal cell carcinoma, squamous cell carcinoma
and sebaceous carcinoma. Other less common malignant tumours include merkel
cell carcinoma, lymphoma and secondary metastatic carcinoma .
Most of the
eyelid tumors are of cutaneous origin, mostly epidermal, which can be divided
into epithelial and melanocytic tumors. Basal cell carcinoma, benign epithelial
lesions, cystic lesions, and melanocytic lesions represent about 85% of all
eyelid tumors . Inflammatory and infectious lesions simulating neoplasm are
also common. Basal cell carcinoma is the most common malignancy of eyelid. It
occurs most frequently in lower eye-lid, followed by medial canthus, upper
eye-lid and lateral canthus . Squamous cell carcinoma usually involves the
lower lid margin in elderly fair-skinned persons. It most commonly arises from
premalignant lesions like actinic keratosis, Bowen's disease, xeroderma
pigmentosa and radiation dermatitis .
malignancies are completely treatable if detected early. Early diagnosis of
eyelid growth is thus of extreme importance to avoid high morbidity and mortality.
eyelid lesions are common in clinical practice, no systematic study has yet
been performed in Bangladesh. Therefore, the present study was conducted to determine
the histological types of eyelid lesions among the patients attending teaching
hospitals of Dhaka city.
Materials and Methods
This was a cross sectional study conducted at the Department of Pathology
of Sir Salimullah Medical College, Dhaka,
Bangladesh. Samples were collected form hospitals of SSMC and NIO. Study period was from January 2012 to December 2013. The study protocol was approved
by the ethical committee of Sir Salimullah Medical College, Dhaka. Ref: Memo. No / SSMC /294. Date: 06/09/ 2012.
Collection and processing of samples: A total of 93 patients
with clinically diagnosed eyelid growth of
both sex were enrolled in the study. All the patients presented with eyelid
growth were examined by an ophthalmologist and complaints were recorded. After obtaining
informed written consent, tumors were excised by the ophthalmologist and the
specimens were collected by researcher for histopathology examination. The
surgically excised specimens were preserved in 10% formalin solution. Size,
shape and consistency of each specimen were recorded. Large specimens were cut
sagitally into pieces and the very small ones were embedded as such and wrapped
in wrapping paper and kept in cassettes and then placed in 10% formalin for
overnight fixation. Following over night fixation in 10% formalin the tissue
blocks were gradually dehydrated in ascending concentration of ethyl alcohol.
The blocks were then cleared in xylene, impregnated in paraffin and then
embedded in proper orientation in malted paraffin. Tissue sections of 5-7 um
thick were prepared and stained with haematoxylin and eosin (H&E) stains as
described elsewhere .
A total of 93 cases
with eyelid growths attending the outpatient department of NIOH and SSMC
hospital were included in the present study. Out of total 93 cases, males and females were almost equally distributed
(51.6% vs. 48.4%). The mean age of the study population was 43.2±17.4
years (range 19 - 90 years). There was no significant difference (p>0.05) of
mean age of male and female cases.
Out of total 93 eyelid
growth, 55.9% were benign lesions while 35.5% and 7.5% were malignant and
non-neoplastic lesions respectively (Table-1). Benign lesions of the eyelid was
significantly higher (p<0.05) than that of malignant lesions. There was only
one case of premalignant lesion in a 65 years old male. The most common
location of the eyelid lesions was upper eyelid (51.8%) while lower eyelids had
Of the malignant lesions, basal cell carcinoma was 12 (36.4%) followed
by sebaceous gland carcinoma 9 (27.27%) and squamous cell carcinoma
9 (27.27%). Less common were non-Hodgkin’s lymphoma 2 (6.06%) and small cell
carcinoma 1 (3.03%).
Among 52 benign lesions, nevus was the most common (14/26.9%), followed by
sudoriferous cyst (10/19.23%), haemangioma (8/15.38%), squamous papilloma (5/9.6%) and dermoid cyst (5/9.6%). Other less common lesions were
epidermal inclusion cysts in 3 cases (5.77%), and sebaceous cysts in 2 cases
(3.85%), fibroepithelial polyp 2
(3.85%). adenoma 1(1.92%), lipoma 1(1.92%), neurofibroma 1(1.92%). There
were 2 cases of rhinosporodiosis among non-neoplastic lesions. Detail
distribution of histopthologically diagnosed eyelid growths is shown in
The present study was
conducted with an aim to assess the histopathological types of eyelid growths.
It was a hospital based cross sectional study which enrolled 93 clinically
suspected eyelid growths. Out of them 86 were neoplastic and 7 were non-
neoplastic growth. In our series we found 35.5% malignant and 55.9% benign
growth. There was only one case of premalignant lesion. A study from Japan in
2012 has reported that out of 118 eyelid tumors that were removed and examined,
106 (89.8%) were benign and 12 (10.2%) were malignant . Previous
study in a tertiary care hospital in Thailand, has reported that out of 212
cases of eyelid tumor, 71.4% were benign and 10.8% were malignant . We found
a higher percentage of malignant growths. This might be due to the delay in
seeking treatment because of lack of awareness, education and treatment facilities
in rural areas, low socioeconomic status and less cosmetic concern.
present study, the majority of the patients (47 out of 93) were in the 26 to 50
years age group. Mean age of the study population in the present study was 43.2
years. Most of the malignant eyelid lesions were in patients above 51 years of
age and benign growths were within the age group 26-50 years. Mean age of the
patients with malignant lesions was 56.3
years and those with benign was 35.9 years. Both benign and malignant
lesions of the eyelid were most commonly seen in patients in their forties and
fifties . Studies from Thailand, Taiwan and Japan have reported the mean
age of diagnosis of eyelid cancers was between 52.4 to 72 years [12,13,14]. However,
malignant tumors like squamous and basal cell carcinoma of the eyelid have been
reported in patients below 25 years of age . In the present study, we found
squamous and basal cell carcinoma of eyelid in 21 and 22 years old patients.
Among the malignant
tumors in the present study, most common was basal cell carcinoma (36.4%)
followed by sebaceous gland (27.3%) and squamous cell carcinoma (27.3%). In western
countries, basal cell carcinoma is the most common among malignant eyelid
tumors, whereas in Japan and other parts of Asia, the frequency of sebaceous
gland carcinoma and squamous cell carcinoma are relatively high . Sebaceous gland
carcinoma tumor is more common in Asian countries, reportedly comprising 33% of
eyelid tumors and second behind basal cell carcinoma . The upper eyelid is involved 2
to 3 times more commonly than the lower eyelid.Women are affected more
than men. The etiology of sebaceous carcinoma is not entirely known. Human
papilloma virus and increased expression of TP53 gene has been implicated as
genetic factor in invasive sebaceous gland carcinoma [17,18]. In the present
study, sebaceous gland carcinoma was found in 27.3% cases with malignant
tumors. Females (6 out of 9) were affected more than male. In the present
study, squamous cell carcinoma was found in 27.3% malignant cases. Eyelid squamous
cell carcinoma is an invasive tumor arising from the squamous cell layer of the
skin epithelium and affects mainly elderly fair-skinned individuals. The most
common risk factor is exposure to ultraviolet light. Most commonly, it involves
the lower lid margin and inner canthus. It may arise de novo but often it may
arise from preexisting lesions such as actinic keratosis, xeroderma
pigmentosum, carcinoma in situ (Bowen's disease), or following radiotherapy .
present study, other less common malignant tumors were non-Hodgkin’s lymphoma (2 cases) and small cell carcinoma (1 case).
One case was histolologically diagnosed as actinic keratosis in the present
study. Actinic keratosis (solar keratosis) is the most common precancerous
cutaneous condition. It usually occurs in sun-exposed areas of the skin,
including eyelids, and is a result of damage of the epidermal cells by near
ultraviolet radiation. Actinic keratosis may transform to squamous cell
the benign lesions of eyelid, nevi were the most common in the present study.
Out of 52 benign lesions, nevus was the most common (26.9%), followed by
sudoriferous cyst (19.2%), haemangioma (15.4%), squamous papilloma (9.6%) and dermoid cyst (9.62%). Other less common lesions were epidermal
inclusion cysts, sebaceous cysts, fibro
epithelial polyp, adenoma, lipoma and
neurofibroma. Similar pattern of benign growth of eyelids were reported by
lesions namely, molluscum contagiosum, rhinosporodiosis, chalazion/and lipogranuloma
were found in the present study. Chalazion is a very common localized lipogranulomatous inflammatory lesion of the
sebaceous gland of the eyelid, most often of the meibomian gland. It usually
occurs spontaneously due to noninfectious obstruction of sebaceous gland ducts .
Molluscum contagiosum are common skin lesions, seen more in children, caused by
the pox virus that often affects the eyelid and the periocular skin . Rhinosporidiosis
caused by Rhinosporodium seberii presents
as a polypoidal and vascular mass. Conjunctiva, lacrimal sac, sclera and
eyelids are the most common ocular sites .
Eyelid is composed of heterogeneous tissue. Hence,
we tend to see a variety of tumor types and subtypes, both benign and malignant. The early diagnosis
of these tumors is essential for proper treatment and favorable prognosis. The present study has
showed the pattern of eyelid tumors in our population. The information is important
to ophthalmologists for accurate diagnosis of eyelid growths and its proper
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