EPITHELIAL LESIONS
Squamous Carcinoma
Squamous carcinoma is the most common paranasal sinus tumor to invade the orbit. [
52] The maxillary sinus is the original site of the carcinoma in the majority of cases. The patients with this tumor may present predominantly with orbital signs. In these cases, destruction of the orbital floor is usually seen on CT scan (Figure 10-31).
Fine needle aspiration reveals abundant malignant cells. The key to the diagnosis is the discovery of squamous differentiation. Frequently, the tumors will have a spindle-cell appearance (Figure 10-32). Some of these tumors may arise from inverted papillomas (Figure 10-33). Patients with squamous carcinoma from a sinus involving the orbit in general, have a poor prognosis.
Sebaceous Carcinoma
Sebaceous carcinoma originates from meibomian glands and glands of Zeis in the eyelid. It may present clinically in different forms, a small yellow nodule, a diffuse thickening of the eyelid, or a mass in the lacrimal fossa. [53] As a small yellow nodule, it is frequently misdiagnosed as a chalazion. As a diffuse thickening of the eyelid, it may be misdiagnosed as blepharitis (Figure 10-34). As an orbital mass, it may be misdiagnosed as a primary lacrimal gland tumor (Figure 10-35). [54]
Fine needle aspiration of sebaceous carcinoma has been reported in numerous cases for eyelid tumors. [43, 55] Fine needle aspiration is generally done when an orbital mass is the predominant presenting feature or if the abnormalities of conjunctiva and eyelid are overlooked. Fine needle aspiration shows abundant material with large cells and numerous lipid vacuoles (Figure 10-36). As a result of fine needle aspiration, the surgeon may plan to do multiple eyelid and conjunctiva biopsies to determine the extent of the tumor because independent foci of sebaceous carcinoma in the eyelid have been noted in up to 10% cases (Figure 10-37). [
56,
57]
Basal-cell Carcinoma
Basal-cell carcinoma is the most common malignant epithelial tumor if the eyelid. [58] Fine needle aspiration is unnecessary to diagnose most primary lesions because skin biopsy is so easily performed. Occasionally, recurrent deep orbital lesions present as orbital masses. Fine needle aspiration of basal-cell carcinoma shows tight clusters of small epithelial cells with atypical nuclei and occasional palisading (Figure 10-38). There is a high rate of negative and insufficient biopsies with basal cell carcinoma.
Metastatic Carcinoma
A variety of metastatic carcinoma initially presents with orbital manifestations. [
59] Metastatic breast, renal cell, transitional cell, and prostate carcinomas have all been specifically identified by orbital fine needle aspiration, but most are only identified as adenocarcinoma. Immunocytochemical studies may be helpful in specifying some sources of origin, such as prostate. [
60]
References
52.
Johnson LN, et al. Sinus tumors invading the orbit. Opthalmology, 1984. 53. Shield JA, Font RL, Meibomian gland carcinoma presenting as a lacrimal gland tumor. Arch Opthalmology 1974;92:304-306.
54. Shield JA, Font RL, Meibomian gland carcinoma presenting as a lacrimal gland tumor. Arch Opthalmology 1974;92:304-306.
55. Das KK, Das J, Natarajan R.m Chachra KL, Chacchra KL, et al. Meibomian gland carcinoma initially identified by cytology. Diagn Cytopathol 1986;2:154-156.
56.
Boniuk M, et al. Sebaceous carcinoma of the eyelid, eyebrow, caruncle, and orbit. Trans Am Acad Ophthalmol Otolaryngol. 1968 Jul-Aug;72(4):619-42.57.
Rao NA, Sebaceous carcinomas of the ocular adnexa: A clinicopathologic study of 104 cases, with five-year follow-up data. Hum Pathol. 1982 Feb;13(2):113-22. 58. Aurora AL, Blodi FC. Lesions of the eyelids. A clinicopathologic study. Surv Opthalmol 1970;15:94-104.
59.
Goldberg RA, et al. Clinical characteristics of metastatic orbital tumors. Ophthalmology. 1990 May;97(5):620-4.60.
Kopelman JE, et al. A case of prostatic carcinoma metastatic to the orbit diagnosed by fine needle aspiration and immunoperoxidase staining for prostatic specific antigen. Ophthalmic Surg. 1987 Aug;18(8):599-603.
