Primary neuroendocrine carcinoma of ocular adnexa.

We present our findings in a case of primary neuroendocrine carcinoma (NEC) of the lacrimal gland and a case of primary Merkel cell carcinoma (MCC) of the eyelid. An 86-year-old man noticed a swelling of the left upper eyelid three months earlier. We performed excision biopsy and histopathological examination indicated that he had a primary NEC of the left lacrimal gland. He underwent chemotherapy followed by excision including the clinically visible margins and 50 Gy radiotherapy of the surgical margins. He had neither recurrence nor metastasis for 6 months since the last radiotherapy. An 80-year-old man noticed a nodule in the right upper eyelid and was referred to our hospital because the size was increasing rapidly. A complete surgical excision of the margins of the tumor was performed with histopathological confirmation of negative margins. The final diagnosis was a primary MCC of the right upper eyelid. After surgery, he underwent 50 Gy radiotherapy on the neck to prevent metastasis. No recurrence or metastasis was found for two years. Although primary NEC of the ocular adnexa is extremely rare, the tumor has high malignancy and readily metastasizes. Thus, combined therapy including surgery, radiotherapy, and/or chemotherapy is needed for complete management of NEC.

Early-stage mucinous sweat gland adenocarcinoma of eyelid.

We present the findings of an early-stage primary mucinous sweat gland adenocarcinoma in the lower eyelid of a Japanese patient. The patient was a 73-year-old man who had had a nodule on the left lower eyelid for two years. He was referred to our hospital with a diagnosis of a swollen chalazion. The clinical and histopathological records were reviewed and the mass was excised. Histopathological examination revealed a mucinous sweat gland adenocarcinoma. Postoperative magnetic resonance imaging and positron emission tomography excluded systemic metastases. After the histopathological findings, a complete surgical excision of the margins of the adenocarcinoma was performed, with histopathological confirmation of negative margins. After the final histopathological examination, the patient was diagnosed with a primary mucinous sweat gland adenocarcinoma of the left eyelid. Six months after the surgery, no recurrence has been observed. Because the appearance of mucinous sweat gland adenocarcinoma of the eyelid is quite variable, the final diagnosis can only be made by histopathological examination. A complete surgical excision is recommended.

A case of squamous cell carcinoma of conjunctiva as initial sign of systemic cancers.

The purpose of this report is to present the findings in a case of squamous cell carcinoma (SCC) of the conjunctiva which was the initial sign of systemic cancers. A 94-year-old woman without known systemic diseases developed a mass in her right conjunctiva. She was referred to our hospital 5 months after the onset. She was diagnosed with conjunctival SCC by biopsy. Systemic CT before the surgery revealed multiple liver lesions, lung legions, and a large mass surrounding the appendix. The patient requested the surgery, and the main aim of the surgery was cosmesis. Histopathological examinations of the specimen led us to the final diagnosis as SCC. She did not receive any other therapy because of her age. As no other surgical procedures were undertaken, it is uncertain as to whether the conjunctival lesion was primary or secondary. Although, it is extremely rare that SCC of the conjunctiva is the initial sign of systemic cancers, careful systemic examinations to find other cancers should be made.

Case of primary diffuse large B-cell lymphoma of lacrimal sac in a Japanese patient.

The purpose of this study was to determine the characteristics of primary diffuse large B-cell lymphoma (DLBCL) of the lacrimal sac. A 77-year-old man had epiphora of the right eye for three years. After visiting five clinics and hospitals, he was referred to our hospital, and the preoperative magnetic resonance imaging findings suggested a lacrimal sac mass. Dacryocysteography showed an obstruction of the right nasolacrimal duct, so we performed dacryocystectomy. After a histopathologic examination of the specimen, the patient was diagnosed with a DLBCL. Positron emission tomography scanning excluded metastases, and the final diagnosis was made of a primary DLBCL of the right lacrimal sac. He underwent radiotherapy with 30.6 Gray in total to the right lacrimal sac. After radiotherapy, no recurrence has been observed anywhere in his body for one year. Although a malignant lymphoma of the lacrimal sac is rare, clinicians should consider a primary malignant lymphoma in the differential diagnosis in patients with chronic dacryocystitis.