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Tumours of the Moll's Glands

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Tumours of the Moll's Glands Br J Ophthalmol: first published as 10.1136/bjo.68.7.502 on 1 July 1984. Downloaded from British Journal of Ophthalmology, 1984, 68, 502-506 Tumours of the Moll's glands CHUO NI,'* MICHAEL WAGONER,'2 SHALOM KIEVAL,2 AND DANIEL M. ALBERT" From the 'Eye Research Institute of Retina Foundation, Boston, and the 2Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, USA SUMMARY Four cases of tumours arising from Moll's glands, two benign mixed tumours of the skin (chondroid syringomas) and two adenocarcinomas, are reported. Three of the patients were over 40 years old. Contrary to the common assumption that malignant Moll's gland tumours are of low-grade malignancy, the two adenocarcinomas described here were highly malignant. Despite vigorous treatment, including orbital exenteration and lymph node resection, one was rapidly fatal and the other recurred with extensive involvement of the paranasal sinuses. Tumours originating in sweat glands are rare.' 2 In consisting of small spindle cells, is thought to the eyelids they may arise from eccrine or apocrine represent the myoepithelium of the normal gland. glands. Moll's glands are apocrine sweat glands at the Low malignancy and slow invasiveness have been lid margin from which both benign and malignant considered characteristic of Moll's gland carci- tumours may occur.' 2 Although cysts of Moll's glands noma.45 This study, however, shows that the tumour are common, true neoplasms are rare.' The Moll's may be highly malignant and may metastasise. glands open into follicles of the cilia, the duct of the Zeis or on to the lid They Case reports glands, directly margin. http://bjo.bmj.com/ differ from eccrine sweat glands in that they are larger, contain eosinophilic cytoplasm, and show decapita- CASE I tion secretion of apical cytoplasmic processes. A 21-year-old man whose chief complaint was a Most tumours of Moll's glands are small and growth on his right upper lid of five months' duration asymptomatic. Clinically they are often mis- was examined at the Massachusetts Eye and Ear diagnosed as cysts, papillomas, fibromas, molluscum Infirmary (MEEI). A small cystic lesion was seen at contagiosum, seborrhoeic keratosis, or other benign the lid margin, but other findings in the ophthalmo- lesions. Many histological varieties of apocrine logical examination were normal. An excisional on September 29, 2021 by guest. Protected copyright. tumours have been described, including adenoma, biopsy was performed. The specimen measured pleomorphic adenoma, hydrocystoma, cystadenoma, 4x2x2 mm, had a well-demarcated, irregular sur- and adenocarcinoma.' Other authors have consid- face, and was not encapsulated. On histopathological ered papillary syringoma, papillary hidradenoma, examination the tumour was found to be composed and cylindroma to be of aprocrine origin.- of adenomatous tissue intermingled with loose, Tumours of the Moll's glands are apocrine gland myxoid stroma (Fig. 1). Duct-like structures filled tumours, and their histological features distinguish with cellular debris were lined with two layers of them from eccrine sweat gland tumours. Moll's gland cuboidal epithelial cells. The superficial cells con- tumours are generally made up of glandular tissue or tained granular eosinophilic cytoplasm and basal tubules that usually comprise two layers. The inner nuclei. Some of these cells had apical processes cells frequently retain the characteristic secretory showing decapitation secretion. The deeper layer appearance of apocrine sweat glands, though was closely connected with the spindle-shaped cells squamous metaplasia also occurs. The outer layer, that were preponderant in the mucoid stroma. Correspondencc to Dr C. Ni, c/lo Library, Eyc Rcscarch Institutc, 20 Anaplasia and mitotic figures were not seen. Normal Staniford Street, Boston, MA 02114, USA Moll's glands were seen near the tumour. A diagnosis *Present address: EENT Hospital, Shanghai, Pcoplc's Rcpublic of of mixed tumour (chondroid syringoma) of Moll's China. gland was made. 502 Br J Ophthalmol: first published as 10.1136/bjo.68.7.502 on 1 July 1984. Downloaded from Tumours ofthe Moll's glands 503 'W! ..e 4 tw Xv ",b& ..:Bz C>¢ Fig. I Mixed tumour (case 1) ofthe skin ofright upper Fig. 3 Adenocarcinoma ofMoll's gland ofleft lower lid eyelid arisingfrom Moll's gland shows adenomatous tissue (case 3) shows duct-like structures lined with double-layered intermingled with myxoid stroma. (Haematoxylin and eosin, epithelium with abundant cytoplasm and basal nucleus. x62). (Haematoxylin and eosin, x 90). CASE 2 frozen section control to ensure that all margins were A 58-year-old woman seen at the MEEI complained free of tumour. The specimen was a l(x5x5 mm of a growth on her right lower lid that had been cystic mass attached to a piece of lid tissue. Histo- enlarging slowly for three years. A basal cell carci- pathological examination showed a large, solitary, noma had been excised from this lid five years prev- cystic lesion in the subepidermal layer of the eyelid iously. A cystic, translucent lesion with mottled margin (Fig. 2). The tumour was composed of tubules purple discoloration and prominent vessels was ofvarious sizes with two layers ofirregularly arranged, present on the lid margin over the temporal portion large columnar cells. The cells in the inner layer of the right lower lid, but there was no loss of cilia in contained eosinophilic cytoplasm and basal nuclei. In http://bjo.bmj.com/ the affected area. No other abnormal conditions some areas proliferating epithelium sent papillary were observed during the ophthalmological exami- projections into the cystic cavity. These projections nation. An excisional biopsy was performed, with contained solid nests of cells as well as microcytic spaces. In some areas the epithelial cells were con- tinuous with mucinous, myxoid stroma in the lumen of the cyst. A mixed tumour of Moll's gland arising from an apocrine cystademona was diagnosed. There on September 29, 2021 by guest. Protected copyright. was no evidence of recurrence during a five-month follow-up. CASE 3 A 66-year-old man came to the Eye, Ear, Nose, and Throat Hospital of the Shanghai First Medical Col- lege with a growth in his left lower lid of six months' duration. The growth appeared like a chalazion, but biopsy showed that it was an adenocarcinoma. A full-thickness lid resection was performed. Micro- ... scopic examination showed a glandular tumour in the deep subcutaneous tissue of the lid. Ducts of various sizes were lined with double-layered epithelium. Tall lower columnar cells with abundant eosionophilic cyto- Fig. 2 Mixed tumour (case 2) ofthe skin ofright and basal nuclei lined the lumen (Fig. 3). In eyelid arisingfrom an apocrine cystadenoma shows papillary plasm projections ofepithelial cellsfrom the wall ofa solitary cystic some areas these cells had proliferated to such a lesion. The epithelial cells are continuous with myxoid degree that they almost obliterated the lumen. The stroma. (Haematoxylin and eosin, x JO). outer cells were smaller with ill-defined contours and Br J Ophthalmol: first published as 10.1136/bjo.68.7.502 on 1 July 1984. Downloaded from 504 Chuo Ni, Michael Wagoner, Shalom Kieval, and Daniel M. Albert ~~~~~~~~~~~~~~~~~~~M .X eI I Fig. 4 Adenocarcinoma ofMoll's gland ofthe left lower lid Fig. 5 Adenocarcinoma ofMoll's gland of'lefi lower lid (case 3) shows perineural invasion by the tumour. (case 4) shows diffuse infiltrative tumour composed of (Haematoxylin and eosin, x 90). glandularstructure in some areas. (Haematoxylin and eosin, x 60). small, dark nuclei. Perineural invasion of the tumour biopsy the patient underwent an exenteration of the was striking (Fig. 4). One year later the tumour left orbital contents with subtotal maxillectomy and a recurred in the lateral portion of the lid margin. biopsy of the ethmoid mass. Histopathological exami- Enlarged preauricular and submandibular nodes were nation of the tumour, including the sinus mass, present. The patient underwent orbital exenteration revealed a deeply invasive adenocarcinoma contain- and dissection of the involved nodes. Histopatho- ing gland-like structures with irregularly shaped logical studies showed that the deeper orbital tissues lumina of various sizes. In some areas the columnar were diffusely infiltrated with tumour nodules. The cells lining the lumina contained abundant eosino- http://bjo.bmj.com/ patient died one year later from intracranial extension philic cytoplasm and basal nuclei (Fig. 5). Areas of of the tumour. A necropsy was not performed. decapitation secretion suggested an apocrine sweat CASE 4 A 50-year-old man was examined at the MEEI for gradual proptosis of the left eye. One year earlier he was found to have 7 mm of proptosis OS and a firm, rubbery mass below the left lower lid. He had refused on September 29, 2021 by guest. Protected copyright. further diagnostic studies. In the course of one year proptosis OS increased to 10 mm. The lids were oedematous, and a firm, rubbery mass was present in the left lower lid. Extraocular movement was slightly impaired in the left eye in all fields of gaze. Orbital resiliency was greatly reduced. Other findings of ophthalmological examination of both eyes were un- remarkable. Preauricular and submandibular nodes were enlarged and palpable. A biopsy of the lid mass was performed, and a diagnosis of adenocarcinoma of undetermined source was made. Skull and chest roentgenograms, an intravenous pyelogram, upper and lower gastrointestinal examinations, and liver function tests revealed no abnormalities. Radio- therapy (4000 R of deep x-ray in 29 days) to the orbit Fig. 6 Adenocarcinoma ofMoll's gland (case 4) shows decreased the tumour size slightly, but this reduction infiltration ofeyelid muscles by the tumour. (Haematoxylin was not sustained. Three months after the original and eosin, x 63). Br J Ophthalmol: first published as 10.1136/bjo.68.7.502 on 1 July 1984.
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