眼睑皮脂腺癌的穿刺细胞学诊断及鉴别诊断

Fine needle aspiration cytology of eyelid sebaceous gland carcinoma and its differential diagnosis

目的 探讨眼睑皮脂腺癌的穿刺方法、细胞学特点和鉴别诊断。方法 4例眼睑肿物行细针穿刺细胞学 (FNAC)检查 ,穿刺涂片行常规HE染色以及脂肪染色 (苏丹Ⅲ染色 ) ,光镜观察其细胞学特点 ;与活检结果对照 ,并与霰粒肿、眼睑毛母质瘤和基底细胞癌的细胞学特点进行比较。结果 4例肿物穿刺结果考虑为皮脂腺癌。涂片内细胞丰富 ,特征明显 ,可见 2种肿瘤细胞 ,一种为胞质丰富呈泡沫样的皮脂腺分化细胞 ,一种为核大深染、异型明显的低分化癌细胞 ,脂肪染色显示肿瘤细胞胞质内及背景中可见橘红色脂滴。穿刺诊断与活检结果基本一致。而霰粒肿细胞学表现为肉芽肿性炎症 ,毛母质瘤内见无异型的基底样细胞、嗜碱性细胞、影细胞及钙化 ,基底细胞癌表现为核致密深染、排列紧密的细胞团 ,与皮脂腺癌易于区别。结论 眼睑肿物穿刺细胞学检查是一种安全有效的检查方法 。

ObjectiveTo investigate the fine needle aspiration cytology(FNAC) features and differential diagnosis of eyelid sebaceous gland carcinoma. MethodsFour cases of eyelid sebaceous gland carcinoma diagnosed by FNAC were reported and confirmed by biopsy. Three of the cases were in early stages with tumor sizes smaller than 10 mm in diameter and without metastasis. The smears were stained by routine H&E and SudanⅢ methods. The cytologic findings were described and compared to corresponding histological features, and moreover, compared to chalazion, pilomatrixoma and eyelid basal cell carcinoma. Results Neither hemorrhage nor infection were found after the examination. Abundant cells were observed in the sebaceous carcinoma FNAC smears. Two types of tumor cells were found: one showed tumor cells differentiating toward sebaceous gland, with large pale cellsand vacuolated cytoplasm, the other demonstrated poorly-differentiated cell with dark and irregular nuclei. Numerous vacuoles with inequality of size were found in cytoplasm or in background in all four cases, and the SudanⅢ stain showed that these vacuoles contained lipid. Some smears demonstrated cells with basaloid, fusiform or squamous features, corresponding to various histopathological types. In contrast, smears of chalazion displayed inflammatory granuloma, containing several types of inflammatory cells without malignant cells. Smears of pilomatrixoma were cellular with three cell populations, which included bland sheets of basaloid cells, nucleated basophilic cells and anucleated keratinized “ghost cells”, along with calcific debris. The smears of basal cell carcinoma were typically less cellular, more tightly cohesive and had smaller clusters of uniform hyperchromatic basaloid cells without vacuolization in cytoplasm or background. Overall, the cytological features of eyelid sebaceous carcinoma weredistinct from those of chalazion, pilomatricoma and basal cell carcinoma ConclusionsFNAC is a safe and effective approach for the diagnosisof eyelid sebaceous carcinoma and lipid stain is useful in differential diagnosis. The application of FNAC may be important in reaching an early diagnosis and initial treatment of eyelid nodule.