A 73-year-old man presented to his physician with right eyelid swelling without pain or discharge. His medical history and a review of systems were otherwise noncontributory. Physical examination showed swelling and induration of the right lower eyelid, without tenderness. The ipsilateral parotid gland and cervical lymph nodes appeared normal. Magnetic resonance imaging of the patient's face and neck showed an enhancing soft-tissue mass along the inferior right eyelid, without underlying bony abnormality or extension into the orbit (Figure 1). A biopsy specimen obtained at an outside hospital was positive for carcinoma. The patient was referred to our institution for treatment.
There was no evidence of distant disease on metastatic workup. Surgical resection of the lower eyelid and a 1-cm strip of adjoining malar skin and soft tissue was performed. Frozen-section consultation revealed diffusely infiltrating malignant single cells at all surgical margins. Some cells had a signet ring appearance (Figure 2). Additional margins were obtained and submitted as permanent sections, and the procedure was terminated. Four of the 8 additional skin margins, as well as periorbital fat, showed involvement by tumor. Immunohistochemical staining showed strong tumor cell expression of cytokeratin (CK) 7, E-cadherin, and gross cystic disease fluid protein 15 (Figure 3) and no expression of CK20, CD34, melan-A, or p63. Orbital exenteration was performed as a second-stage procedure, given the involvement of deep soft tissues. Adjuvant external beam radiation therapy was administered to the primary site and the nodal drainage basin because of concern for locoregional recurrence.
What is your diagnosis?
Thank you for submitting a comment on this article. It will be reviewed by JAMA Otolaryngology–Head & Neck Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.