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Misdiagnosis Chalazion

1Haentzsch A., 2Pittasch K., 3Schütz A., 2Wiedemann P.,
1Universitätsaugenklinik Leipzig (Leipzig)
2Universität Leipzig, Klinik und Poliklinik für Augenheilkunde (Leipzig)
3Universität Leipzig, Institut für Pathologie (Leipzig)

Purpose: Although the clinical picture of the chalazion is mainly a benign disease, in some cases it can also hide malign lesions of the eyelid.
Methods: In this report we present two patients who where treated for chalazion but later revealed a malign tumour of the eyelid.
Results: The first patient was a 59-year-old woman who showed a bulging lesion, reddish in colour and erythematous with teleangiectatic vessels on the lid margin. Half of the left lower lid was destroyed. The tumour and the matching lymphatic node were removed. The histology revealed a neuroendocrine Merkel cell carcinoma. The lymphatic node was not invaded. For reconstruction of the eyelid we used Hughes-tarsoconjunctival-flap and free skin tissue from the upper eyelid of the right eye. The second patient, a 63-year-old women, showed a very dramatic progress. A lesion which was removed 4 years ago developed a local recurrence within 6 months. Because of the clinical diagnosis chalazion the tumour was excised without a histopathological examination. With further increase in size the patient was referred to our clinic. One could see a painless hard yellow lesion that infiltrated the right upper eyelid. The histology revealed a sebaceous gland carcinoma. The tumour was resected and a wide excision of the surrounding was carried out. An extensive reconstruction of the eyelid with a median forehead flap and mucous membrane of the mouth was performed. Unfortunately 2½ years later we diagnosed a local conjunctival recurrence. The last opportunity to remove all malign cells was an “Exenteratio orbitae”. At present both women do not show any signs of regional or distant metastases.
Conclusions: The diagnosis chalazion is always connected with the possibility to develop a malign lesion, especially in older patient and in chalazion that show a local recurrence or do not improve under treatment. Therefore it is important to do histological examination on all excised tumours and to do frequent follow-up visits.