[Periocular metastasis as differential diagnosis of pyogenic granuloma and therapeutic marker of a systemic disease].

Authors:
Jens Heichel
Jens Heichel
Martin Luther University Halle-Wittenberg
Germany
Udo Siebolts
Udo Siebolts
Institute of Pathology
Germany
Claudia Wickenhauser
Claudia Wickenhauser
University of Cologne
Germany
Arne Viestenz
Arne Viestenz
Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg
Nuremberg | Germany

Ophthalmologe 2019 Mar 14. Epub 2019 Mar 14.

Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle, Deutschland.

Background: A pyogenic granuloma is a frequent palpebral pseudotumor. Showing a typical clinical picture after an inflammation (hordeolum, chalazion) it can be easily diagnosed and sometimes a histopathological analysis is thought to be unnecessary.

Methods: A case report of a patient suffering from a palpebral metastasis of a clear cell renal cell carcinoma (cRCC) as an atypical differential diagnosis of an inflammatory pseudotumor of the eyelid is presented.

Results: A 72-year-old man presented for surgical treatment of a pyogenic granuloma. The medial portion of the inferior eyelid showed a nodular and pediculate lesion of the tarsal conjunctiva. At the time of presentation the patient was receiving adjuvant systemic treatment with cabozantinib because of lymphonodal and pulmonal metastases of the cRCC. The tumor was resected and the histopathological examination revealed a sarcomatoid dedifferentiated metastasis of the cRCC. After 4 weeks the tumor showed a local recurrence and histologically a local relapse was found. Therefore, a change in the systemic therapy was initiated (nivolumab). In the follow-up of 18 months no recurrence of the palpebral tumor occurred. A stable disease condition of the cRCC was achieved.

Conclusion: Even if the clinical aspect of an inflammatory tumor of the lids seems to be clear, a histopathological examination is still necessary. An interdisciplinary approach with reevaluation of the systemic therapy led to an improvement of the patient treatment.

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00347-019-0877-3DOI Listing
March 2019
4 Reads

Publication Analysis

Top Keywords

a pyogenic granuloma
8
systemic therapy
8
differential diagnosis
8
tumor occurred
4
medial portion
4
portion inferior
4
granuloma medial
4
surgical treatment
4
treatment a pyogenic
4
inferior eyelid
4
palpebral tumor
4
pediculate lesion
4
follow-up 18 months
4
lesion tarsal
4
18 months recurrence
4
a nodular pediculate
4
eyelid a nodular
4
recurrence palpebral
4
presented surgical
4
occurred a stable
4

References

(Supplied by CrossRef)
Article in Clin Genitourin Cancer
B Beuselinck et al.
Clin Genitourin Cancer 2014

W Böcker et al.
2004
Article in Ophthalmologe
I Caspar et al.
Ophthalmologe 2007
Article in medgen
J Decker et al.
medgen 2006

JN Eble et al.
2004
Article in Ophtalmol
R Haimovici et al.
Ophtalmol 1997

WR Kindermann et al.
1981
Article in Graefes Arch Clin Exp Ophthalmol
T Lapp et al.
Graefes Arch Clin Exp Ophthalmol 2012
Article in N Engl J Med
B Motzer et al.
N Engl J Med 2015
Article in Arzneimitteltherapie
C Unger et al.
Arzneimitteltherapie 2016
Article in Am J Optalmol
P Wizinski et al.
Am J Optalmol 1981

Similar Publications