Cytological evaluation of palpebral lesions: An insight into its limitations aided with histopathological corroboration (original) (raw)

2021, Journal of Microscopy and Ultrastructure

IntroductIon Structurally, the eyelids engross a complex histomorphology. At its core lies the dense fibroelastic tarsal plate, which is covered externally by redundant skin and internally by smooth conjunctival mucosa. The tarsal plate is impregnated with multiple meibomian-type modified sebaceous glands. Modified sweat glands of Moll and sebaceous glands of Zeis are associated with the eyelashes. Superficially, the tarsal plate is separated from the skin by the orbicularis oculi muscle and the levator palpebrae muscle only in the upper eyelid. The lacrimal glands in its superior palpebral location resemble serous-type salivary glands. [1] Therefore, quite understandably, a whole diverse lot of pathological conditions infest the eyelids. It may be either infective or inflammatory lesions, cysts, congenital anomalies, local manifestations of some systemic metabolic derangements or any neoplastic condition of surface epithelia, appendageal structures, lacrimal gland, or even the soft-tissue mesenchyme. [2] The therapeutic alternatives range from conservative management, incision with curettage, simple enucleation, up to radical excision with or without radiotherapy, or cryotherapy. [3] In general, surgical maneuver within the eyelids requires extra attention toward future cosmesis, afterward preservation of visual and ocular health, intraoperative accessibility, safety of vital structures, and specialized facilities for anesthesia or operating theatre. [3-5] Hence, a pretherapeutic knowledge about the nature of palpebral pathology is essential to sequester the patients who really need surgery. Cytological material obtained in this purpose by fine-needle aspiration or nonaspiration technique, by exfoliation or imprint method yields the best Context: Eyelids by virtue of its unique histomorphology give rise to multitudes of different pathological conditions. Appropriate preoperative cytological diagnoses of these cases are necessary to determine their optimal therapy. Aims: The aims of this study were to evaluate the utility of various cytological techniques in diagnosing the definite pathology for palpebral lesions and thereby to highlight the drawbacks associated with cytology in this context. Materials and Methods: Fine-needle cytology with or without applying the aspiration was the preferable method. Ulcerated lesions were sampled through scrapings. Results: Totally 62 cases were examined. Cytologically, 22 lesions were diagnosed as nonneoplastic, 38 lesions were neoplastic, and nondiagnostic material was obtained twice. Malignant tumors predominated among the neoplastic cases. Basal cell carcinoma (BCC) was the most common malignancy observed. On histopathological corroboration, benign skin adnexal tumor was found to be the most frequently misinterpreted entity. Two (out of four cases) of those tumors were confirmed as melanocytic nevus and BCC. A single case of squamous cell carcinoma was also cytodiagnostically erred into sebaceous carcinoma. Conclusions: Cytologically palpebral pathologies, including the neoplastic ones, are at times vulnerable to misinterpretation. To avert such dilemma, it is better to readily excise any recurrent lesion, basaloid neoplasm, or any necrohemorrhagic lesion presumptive of overshadowing the neoplastic pathology underneath.