Korean J Ophthalmol.  2009 Dec;23(4):301-305. 10.3341/kjo.2009.23.4.301.

Trichilemmal Carcinoma of the Upper Eyelid: A Case Report

• Lee JH
• Shin YW
• Oh YH
• Lee YJ

• KMID: 754768
• DOI: http://doi.org/10.3341/kjo.2009.23.4.301

Abstract

We report a very rare case of trichilemmal carcinoma (TLC) involving the upper eyelid. To the best of our knowledge, this is the first report of trichilemmal carcinoma of the upper eyelid in Korea. A 51-year-old man presented to our hospital complaining of a bloody discharge from his left upper eyelid. He had a soft and lobulated mass on the palpebral conjunctiva. An incisional biopsy revealed trabecular growth of tumor cells with clear cytoplasm, prominent nucleoli, frequent mitoses, and foci of trichilemmal keratinization. Immunohistochemically, the lesion was positive for p53 and negative for CD 34. A diagnosis of TLC was made, and total excision of the mass and reconstruction of the eyelid were performed. Trichilemmal carcinoma is a rare malignant tumor, though it appears to be an indolent neoplasm with no metastatic potential. The treatment of choice for trichilemmal carcinoma of the eyelid is complete excision with tumor-free margins due to the locally invasive nature of the lesion.

Keyword

Eyelid; Trichilemmal carcinoma

MeSH Terms

Carcinoma, Skin Appendage/*pathology/surgery
Diagnosis, Differential
Eyelid Neoplasms/*pathology/surgery
Follow-Up Studies
*Hair
Humans
Male
Middle Aged
Mohs Surgery
Skin Neoplasms/*pathology/surgery

Figure

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  Fig. 1 The patient had a swelling of the upper eyelid and a palpable, nontender, movable mass on the left eyelid.

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  Fig. 2 A yellowish, soft, multi-lobulated mass is shown. The mass protrudes through the lateral end of the left upper palpebral conjunctiva. (A) Gross view. (B) Slit-lamp view.

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  Fig. 3 Histology of the mass. (A) The section revealed a trabecular growth pattern of tumor cell nests (H&E, ×40). (B, C) The cells were characterized by clear cytoplasm, prominent nucleoli, frequent mitoses, few atypical tripolar mitoses, and focal necrosis. There were also foci of trichilemmal keratinization (black arrow) (B: H&E, ×100; C: H&E, ×400).

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  Fig. 4 Immunohistochemical staining of the mass. (A) Negative staining for CD 34. (B) Strongly positive staining for p53.

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  Fig. 5 Mass excision and reconstruction of the defect. (A) Complete mass excision using a pentagonal shape. Tumor-free margins were confirmed by frozen section biopsy. (B) Reconstruction of the posterior lamella with a tarsoconjunctival sling. (C) Reconstruction of the anterior lamella with a myocutaneous advancement flap. (D) Complete closure of the defect.

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