Jurnal Mata chalazion

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3 GUJARAT MEDICAL JOURNAL / MARCH-2015 Vol. 70 No. 1

ORIGINAL ARTICLE

Discordance between clinical and histopathological fndings in cases ochalazion

Dr. Radha I. Da!" Dr. #ha$%$ #. #h&%'h!!" Dr. D&(da))a J. Goh&l!!!

*Associate Professor, **Associate Professor, ***Professor & Head,

Dept. of Ophthalmology , Shri M.P. Shah Goer!me!t Medical "ollege, #am!agar

*E+ ,ORD# chala$io!, se%aceos gla!d carci!oma, hp fi!di!gs i! chala$io!.

INTRODUCTION

'yelid is a comple( strctre, ths tmors of lids

arises from the Mei%omia! gla!ds of tarsal plate. )he

pper eyelids, acco!ts for appro(imately 2*3 of

form a heteroge!eos collectio! +-ra!gi!g from cases. ess commo!ly, it is fo!d i! the Gla!ds of

%e!ig!, premalig!a!t to malig!a!t o!es. "hala$io! / a

chro!ic i!flammatory lesio! of tarsal gla!d ca!simlate a !m%er of these %e!ig!, premalig!a!t or

malig!a!t lesio!s+2,3-

.

A chala$io! +a small hail sto!e- is a chro!ic

i!flammatory gra!loma cased primarily %y the

rete!tio! of the secretio! of a tarsal gla!d+-

. Preios

stdies hae reealed that chala$io! is o!e of the

most commo! i!flammatory lesio! of the eyelid.+ 2-

0t

1as formerly regarded as a mei%omia! cyst

a!alogos to the atheromata of the se%aceos gla!ds

of the si! %t as rete!tio! cysts of mei%omia!

gla!ds is ery rare a trer a!alogy is 1ith ac!e

rosacea of the si! 1herei! the se%aceos gla!ds

play a part compara%le to that of the mei%omia!

gla!ds i! the deelopme!t of a chala$io!.+-

0t starts

slo1ly a!d i! symptomless ma!!er appeari!g as a

!odle a!d althogh it seems easy to diag!ose

cli!ically, yet certai! malig!a!t lesio!s ca! %e

misdiag!osed as chala$io!.

Se%aceos cell carci!oma ca! arise from a!y of the

types of se%aceos gla!ds. Ho1eer, it classically

Corr&od&& Addr& Dr. Radha I. Da

4eiss a!d the lo1er eyelids. )he cli!ical prese!tatio!

may ary across a 1ide spectrm. )he mostcommo! prese!tatio! is a small, r%%ery, firm !odle

that loos lie a chala$io! or a recrre!t chala$io!+5-

.

)his is complicated %y the fact that sometimes there

is tre chala$io! formatio! seco!dary to o%strctio!

of the Mei%omia! dcts %y a mass+6-

.

A limited !m%er of si!gle case reports or small

series, discssi!g misdiag!osis of lesio!s

mas7eradi!g as chala$io!, hae appeared i! the

literatre+2-

. Ma!y times a recrre!t chala$io! has

more cha!ces of getti!g malig!a!t. )hs a! accrate

a!d prompt diag!osis is crcial si!ce it is o!e of the

most malig!a!t lesio!s of the eyelid a!d leads to

metastasis i! lymph !odes a!d lier.

AIM

ﾧ

)his prese!t stdy 1as performed to determi!e the

discorda!ce of the cli!ical diag!osis of chala$io! i!

relatio! to its histopathological +hp- fi!di!gs a!d

esta%lish the importa!ce of hp co!firmatio! of the

cli!ical diag!osis i! 68 cases.

"*O Dr. Prasha!t Di(it 9 :lat ;o. / 2<, Shag! 3 apartme!t, ;ear S!shi!e School,

A#TRACT

)he prese!t stdy 1as performed to determi!e the discorda!ce of the cli!ical diag!osis of chala$io! i!

relatio! to its histopathological +hp- fi!di!gs a!d esta%lish the importa!ce of hp co!firmatio! of the cli!ical

diag!osis i! 68 cases.

A limited !m%er of si!gle case reports or small series, discssi!g misdiag!osis of malig!a!t lesio!s

mas7eradi!g as chala$io!, hae appeared i! the literatre+2-

. Ma!y times a recrre!t chala$io! has more

cha!ces of getti!g malig!a!t. )hs a!, accrate a!d prompt diag!osis is crcial si!ce it is o!e of the

most malig!a!t lesio!s of the eyelid.

Discorda!ce %et1ee! cli!ical a!d histopathological diag!osis 1ere fo!d i! 2=.=> of 68 cases i! or

stdy. Ot of these cli!ically misdiag!osed cases, accordi!g to hp stdy 2?> 1ere %e!ig! a!d .=> 1ere

diag!osed as malig!a!t a!d premalig!a!t lesio!s. Se%aceos gla!d carci!oma 1as the case that 1as

co!firmed %y histopathology a!d 1as misdiag!osed cli!ically as recrre!t chala$io!.



3 GUJARAT MEDICAL JOURNAL / MARCH-2015 Vol. 70 No. 1

@alesh1ari ;agari, #am!agar 3B<<?.



MATERIAL AND METHOD

A retrospectie stdy of 3 years +2<<= / 2<- 1as

do!e i! M. P. Shah Medical "ollege, #am!agar

1herei! the O) records of eye departme!t a!d the

correspo!di!g records of histopathology sectio! of pathology departme!t 1ere traced a!d scrti!i$ed.

:irstly the records of ophthalmology O) 1ere sreyed

for fi!di!g ot the cases of chala$io!s operated a!d

the! their correspo!di!g data 1as traced i!

histopathology for fi!di!g ot the hp report of the

same to esta%lish the correlatio! of the cli!ical

diag!osis 1ith the hp fi!di!gs.

0! the gie! setp chala$io! cases are operated o!

OPD %asis after cli!ically esta%lishi!g the diag!osis,

%y the

RE#ULT#TALE-I AGE GROU

Method of i!cisio! a!d crettage a!d e(cisio! of the

cyst if crettage is !ot possi%le. )he material e(cised

throgh e(cisio! or the small lmp o%tai!ed dri!g

crettage is se!t to Histopathology for reporti!g. )he

specime!s i! histopathology 1ere processed asroti!e paraffi! em%eddi!g method a!d stai!ed 1ith

Hemato(yli! a!d 'osi! stai!s.

)he data 1as compiled !der arios headi!gs

1hich follo1 %elo1 a!d the correlatio! 1as made

%et1ee! the cli!ical fi!di!gs a!d the hp fi!di!gs.

)he discrepa!cy %et1ee! the cli!ical fi!di!gs a!d

the hp fi!di!gs 1as !oted a!d 1as also classified

o! the %asis of the fi!di!g esta%lished i! the hp

reporti!g.

TALE- III #ITE O3 CHALA4ION

TALE-IV CLINICAL DIAGNO#I#

Cl%%al d%ao% No. o6 Ca&

Primary chala$io! 5

Cecrre!t chala$io! B

total 68

TA1LE-II GENDER INCIDENCE TA1LE- V CLINICAL AND HI#TO2ATHOLOGICAL DI#CORDANCE

TALE- VI HI#TOATHOLOGICAL DIAGNO#I# O3 CLINICALL+ MI#DIAGNO#ED CA#E#

H%)oa)holo%al d%ao% Na)r& o6 l&%o l%%al d%ao% No. o6 a&

"hro!ic i!flammatio! e!ig! Primary chala$io! 25

'pithelial i!clsio! cyst e!ig! Primary chala$io! <?

Se%aceos gla!d hyperplasia e!ig! Primary chala$io! <8

Gra!lomatos foreig! %ody reactio! e!ig! Cecrre!t chala$io! <5

"hro!ic i!flammatio! 1ith

mitotic actiity & dysplasia Premalig!a!t Cecrre!t chala$io! <2+5.5>-

Se%aceos gla!d carci!oma Malig!a!t Cecrre!t chala$io! <+2.>-

G&d&r No. o6 Ca&

Male =3

:emale B5

)otal 68

Co6%r$a)%o 89 h%)oa)holo9 No. o6 Ca&

Diag!osis co!firmed <+8<.>-

Discorda!ce 1ith hp 58+2=.=>-

total 68

#%)& No. o6 a&

Epper lid =?

o1er lid 6=

total 68

A& ro:9&ar; No. o6 Ca&

<< <6

2< 68

23< B5

35< 6

56< <?

6B< <5

FB< <5

)otal 68



total 58



As see! i! the ta%le 0@ , ot of 68 cases there co!ditio!s lie Se%aceos gla!d carci!oma of eyelid

1ere B cases of recrre!t chala$io! a!d 8 of the +?,=-microcystic ad!e(al carci!oma

,+<-,Merel cell

recrre!t chala$io! 1ere misdiag!osed as see! i!tmor

+-, a!d !erilemoma+2-

hae %ee! reported

ta%le @0. )he cli!ical diag!osis of the rest = recrre!t

chala$io! 1as i! accorda!ce 1ith the hp fi!di!g.Ot of the 8 cli!ically misdiag!osed chala$io! 5

1ere %e!ig! lesio!s, premalig!a!t lesio! a!d

1as malig!a!t lesio! as per the hp fi!di!g.

DI#CU##ION

"li!ical misdiag!osis is fre7e!t 1ith eyelid lesio!s

%ecase of diersity of tisses that are prese!t i! the

eyelid. Ma!y types of %e!ig! a!d malig!a!t tmors

ca! occr i! the eyelids+B-

.

A chala$io! is a commo! %e!ig! i!flammatory eyelid

lesio! hai!g slo1 a!d pai!less gro1th +8-. Ma!y

mas7eradi!g cli!ically as chala$io!.

Discorda!ce %et1ee! cli!ical a!d histopathological

diag!osis 1ere fo!d i! 2=.=> of 68 cases i! or

stdy. Ot of these cli!ically misdiag!osed cases,

accordi!g to hp stdy 2?> 1ere %e!ig! a!d .=>

1ere diag!osed as malig!a!t a!d premalig!a!t

lesio!s. Se%aceos gla!d carci!oma 1as the case

that 1as co!firmed %y histology a!d 1as

misdiag!osed cli!ically as recrre!t chala$io!.

:i!di!gs of or stdy 1ere compared 1ith other

stdy as follo1s9

Ta8l& VII < Co$ar%o 6or )h& ra)& o6 l%%al $%d%ao%

A)hor Ra)& o6 l%%al $%d%ao% =%)h h%)oa)holo%al d%ao%

&%>Mal%a)/

r&$al%a) >To)al >

Domars et al+3- B.B 8.2 23.=

Holli1ich et al+5- 5.B =. 23.B

erste! et al+6- 2.<

Margo " '+B- 5.B .B B.2

Or stdy 2?.< .= 2=.=

)his photograph is sho1i!g the histopathological

sectio! of the a%oe case 1herei! 1e ca! see the

malig!a!t cha!ges of the se%aceos gla!d.

Epper photograph sho1s the preoperatie eye of the

patie!t hai!g lo1er lid s1elli!g mimici!g mltiple

chala$io!.

o1er photograph sho1s the postoperatie loo.



e fo!d that thogh the i!cide!ce of malig!a!t a!d

premalig!a!t lesio!s is ery lo1 %t 1ithot

histopathological stdy sch lesio!s ca! %e

misdiag!osed cli!ically a!d ths there may %e delay

i! the right a!d timely treatme!t there%y leadi!g to

metastasis a!d other complicatio!s e!ha!ci!g thesfferi!g of the patie!ts.



CONCLU#ION

All cli!ically looi!g chala$io! are !ot al1ays

chala$io!.

Se%aceos gla!d carci!oma is hai!g lo1 i!cide!ce

%t hai!g high cha!ces of cli!ical misdiag!osis as

recrre!t chala$io!.

)he possi%ility of malig!a!t lesio!s i!creases i!

recrre!t chala$io! therefore it shold %e ma!datory

to co!firm the cli!ical diag!osis of recrre!t

chala$io! %y histopathological e(ami!atio! of the

tisse o%tai!ed.

Histopathological ealatio! of all chala$io! samples

is the safest approach to aoid the missi!g of

malig!a!t lesio!s lie Se%aceos gla!d carci!oma.

:or cases of chala$io! i! 1hich collectio! of tisseis !ot possi%le as o!ly flid material oo$es dri!g

i!cisio! a!d crettage, some proisio! shold %e

made to collect the flid specime! a!d se!d for

cytological e(ami!atio! so as to co!firm the cli!ical

diag!osis.

hyte 0:, Orrell #M, Co(%rgh S). Merell cell tmor of the

eyelid mas7eradi!g as a chala$io!. # C "oll Srg 'di!%rgh

== 3B9 2=/3<.

2 Shields #A, Gi%or P. ;erilemoma of the eyelid resem%li!g a

recrre!t chala$io!. Arch Ophthalmol =?5 <29 B6<. IP%Med I

3 Domars D@, Hi!$peter ';, ;ama!! GOH. )he cli!ical

misdiag!osis of chala$io!. li! Mo!ats%l Age!heild =8B

B?9 86/?. I P%Med I

5 Holl1ich :, Schiffer HP, sse H. Misdiag!osis of Jchala$io!J.

li! Mo!ats%l Age!heild =8B B?9 6=/6=5. I P%Med I

6 erste! C", '1i!g"ho1 D, l1i! DC, Gallo! M. Accracy

of cli!ical diag!osis of cta!eos eyelid lesio!s.

Ophthalmology ==8 <59 58=/5B5. I P%Med I 0S0 I

"hemPort I

B Margo "'. 'yelid tmors9 accracy of cli!ical diag!osis. Am

# Ophthalmol === 2?9 B36/B3B. I Article I P%Med I

"hemPort I

RE3ERENCE#

"hala$io!, System of ophthalmology, Sir Ste1art De /

'lder. @ol. / (iii, Part ii, page 252.

2 K L$dal,

, : "odre, S "alleNo, A "aissie a!d M ; r!ier3 Accracy of the cli!ical diag!osis of chala$io!, 'ye +2<<5-

?, 36/3? ;atre P%lishi!g

3 )mors of the lids, System of ophthalmology, Sir Ste1art De

/ 'lder. @ol. / (iii, Part ii, page 3=?

5 Diseases of the lids, Parso!sJ diseases of the eye, 2< th

editio!,page 55<

6 is . , MD, :A"S ,Director, 'l "o!ty 'ye "li!ic

,Se!ior Staff M em%er, P e!!syla!ia 'ye

"o!s l ta!ts , 111.elco!tyeyecli!ic.com . Ceista

cy%er!etica de opthalmologia

B Mc ea! 0, r!ier M;, 4immerma! ', #aco%iec :A.

)mors of the eyelid. 0!9 Cosai #, So%i! H +eds-. Atlas of

)mor Pathology. )mors of the 'ye a!d Oclar Ad!e(a.

Armed :orces 0!stitte of Pathology9 ashi!gto!, D", ==5,

pp 2?/36.

8 :o!t C. 'yelids a!d lacrimal drai!age system. 0!9 Spe!cer

H +ed-. Ophthalmic Pathology @ol 5. Sa!ders9

Philadelphia, PA, ==B p 2366.

? 4rcher M, Hi!tschich "C, Gar!er A, !ce ", "olli! #CO.

Se%aceos carci!oma of the eyelid9 a cli!icopathological

stdy. r # Ophthalmol ==? ?29 <5=/<66. I P%Med I

= Ger%er DM, Meyer P, Messerli #O, Piffaretti #M, Haefliger 0O.

Mas7erade of se%aceos gla!d carci!oma as a rapidly

recrri!g Jchala$io!J, a case report. li! Mo!ats%l

Age!heild 2<< 2?9 3=/3=3. I Article I P%Med I

< rooes #, e!tley ", @erma S, Oler #M, Mcee PH.

Mycrocystic ad!e(al carci!oma mas7eradi!g as achala$io!. r # Ophthalmol ==? ?29 =B/2<<. I P%Med I

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