The Clinical Diagnosis And Treatment Of Meibomian Adenocarcinoma

Objective:meibomian adenocarcinoma is a kind of highly malignant and deadly tumor which is originated in eyelid and occurred in the eyelid Meibomian gland (meibomian glands), a few people also occur in the eyelid of the Zeis glands. It is difficult to identify it in the early stage, it is difficult to define its scope after once found. Because of the jumping growth characteristics ,it is difficult to control and early diagnosis and wide excision is the key to have a successful treatment. It is more common in women than in men, and often occure in the age of 50 to 90 years old. The clinical diagnosis is difficult because it is easy to confuse with chalazion, eyelid conjunctivitis, conjunctivitis and basal cell carcinoma [1]; and it is easy to offend the surrounding tissue via lymphatic and blood metastasis [2]. Meibomian adenocarcinoma rarely have typical characteristics of gland, and the surgery and pathological examination material is very important to no obvious damage expressions of the eyelid goiter[3].Due to the high incidence in old people ,meibomian adenocarcinoma often result in misdiagnosis. Incomplete surgery lead to destructio in eye sockets and transfer until death. Surgical treatment is the main therapy, and radiation therapy is only a supplementary therapy because the tumor is not sensitive to radiation. This research investigate the clinical feature, diagnosis, treatment, and reconstructive methods after operation in meibomian adenocarcinoma, in order to assist the diagnosis and treatment in clinical treatment.Method:14 patients from May 2008 to January 2011, at the second hospital of Hebei Medical University, all were sent to tumor frozen section to determine the nature of the tumor, by living tissue pathology after treatment is identified as the meibomian adenocarcinoma. Including 12 females, 2 males; left eye in 10 cases, right eye in 4 cases; age between 37 to 72 years. 11 cases with invasion of upper eyelid, 2 cases with invasion of lower eyelid ,and 1 case with invasion at the back of the ball and the orbital bone tissue. Intraoperative frozen section were done in order to confirm the nature, and margins were examed until negative before making a repair operation. The repair program was made according to the design defects of different size and shape after the operation.To achieve the best therapeutic effect, Mohs[4] microsurgery applications were used in reconstructive surgery. Mohs microsurgery is a surgical technique combined the skin of frozen tissue sections with surgical techniques for treatment. It is not a generally called surgery done under the microscope, but a combination of surgical excision, fixed tissue sections or special chemical frozen section detection method (horizontal frozen sections and staining), and forming of remediation technologies. Mohs microsurgery has two advantages, the first is high cure rate, low recurrence and metastasis rate. This method is the level of sampling, not only can detect lesions in the side and bottom of the tumor whether the residual tumor can be detected; the second is to save the maximum normal tissue, to avoid unnecessary surgical wound, which is very important to the sensitive parts of the eyelids ministry for beauty.Results: All 14 patients with tumor resection for meibomian adenocarcinoma use different rehabilitation programs of eyelid defects based on the location and size, follow-up 6-18 months, and all have achieved good clinical results.Conclusions:To no significant damage of the eyelid tumor, resection and pathological examination after excision are significant to reduce the misdiagnosis rate, improve the detection rate, have long-term impact on the prognosis of the patients. In recent years, as the understanding on the Mohs microsurgery (Mohs' micrographic surgery) deepen day by day, surgery healing meibomian adenocarcinoma is becoming possible. The choice of surgical procedure and materials of reconstruction mainly depend on diseased region, tumor size, depth of invasion, and patients with systemic conditions. The principle is to remove the tumor tissue as thoroughly as possible, meanwhile, fully take into account the patient's cosmetic problem and eyelid function.