[Sebaceous carcinoma of the eyelids--case reports and review of the literature]. / Das Talgdrüsenkarzinom der Augenlider--Fallbeschreibung und Literaturübersicht.

BACKGROUND: Sebaceous carcinomas are among the most rarely found skin tumours (0.2 - 4.6 %). As with most skin tumours the predominant region of occurrence is the head and neck, in particular the eyelids. The cytological origins are foremost the Meibomian and the glands of Zeis. CASE REPORTS: We report on two female patients suffering from sebaceous carcinoma of the upper and lower lid. The time span from initial treatment up to definite diagnosis and treatment was one year. In both cases the tumour was radically removed surgically and the eyelid reconstructed. In the first case there was no tumour recurrence within six years after surgery. In the second case a lymph node metastasis of the parotid gland was found seven years after initial therapy and surgically removed followed by a complete parotidectomy and neck dissection. DISCUSSION: As the sebaceous carcinomas are difficult to differentiate from other kinds of benign and malignant eyelid diseases, a considerable delay between the initial examination and final diagnosis is not uncommon. This type of tumour is characterised by a high degree of biological aggression concerning local recurrence and lymphogenous and hematogenic tumour spread. The mortality rate is reported to be between 9 and 40 %. Therapy of choice is the radical surgical removal of the tumour. Depending on preoperative findings, neck dissection may be indicated. The biological behaviour of this kind of tumour requires long-term oncological aftercare.

[Incorporation of multiple foreign bodies due to borderline personality disorder]. / Inkorporation multipler Fremdkörper bei Borderlinepersönlichkeitsstörung. Literaturübersicht und Fallbeschreibung.

BACKGROUND: Autoaggressive behaviour is one of the pathognomonic characteristics in patients with borderline personality disorder. Clinical symptoms of such behaviour can be the self-induced incorporation of foreign bodies. In the head and neck area, this form of autoaggressivity causes primary or secondary infectious complications with different clinical manifestations. Below follows a description of diagnosis, therapy and follow-up of such a case, comparing our own findings with the corresponding literature. CASE REPORT: A 24-year-old woman with manifest borderline personality disorder was referred to the Department of Maxillofacial Surgery after developing a swelling in the infra-auricular region. After antibiotic therapy failed to reduce inflammatory symptoms, local revision was performed including excision of two metallic foreign bodies. Comprehensive radiological evaluation identified multiple foreign bodies in the head and neck region and lower arms. A total of 76 metallic foreign bodies was removed surgically. During early surgical follow-up and subsequent psychiatric treatment, the patient incorporated new foreign bodies. DISCUSSION: The case reported represents a pattern of foreign body incorporation which is unusual based on review of the literature but characteristic for patients with borderline personality disorder. Diagnostics and therapy require an individual concept which only can be implemented in close co-operation with psychiatrists. Secondary clinical benefit derived from surgical diagnostics and therapy as well as the possibility of autoaggressive relapse have to be taken into consideration.