Metastatic mammary carcinoma in the eyelid with histiocytoid appearance.

Abstract

A clinicopathologic study of 13 cases of carcinoma of the breast with metastasis to the eyelids has been made. Seven of these presented diagnostic problems for several reasons: 1. because the lesion in the lid became symptomatic before the primary tumor of the breast was detected; 2. because it was the first sign of metastasis at least 2 years after an apparently curative mastectomy, and/or 3. because of a peculiar histiocytoid pattern of the metastatic tumor that mimicked a benign histiocytic lesion. The histiocytoid pattern, however, once recogognized, is highly suggestive of a metastasis from a primary mammary carcinoma. Of the 13 metastatic tumors in the lid, only 3 had the histopathologic pattern of a typical infiltrating ductal carcinoma. Two had sufficiently pleomorphic patterns that the diagnosis of malignancy was inescapable. Eight tumors had the histiocytoid pattern, and seven of these had presented diagnostic problems histopathologically, the misinterpretations resulting in diagnoses of xanthelasma, xanthoma, histiocytoma, histiocytosis, granular cell myoblastoma, and possible blastomycosis, all of which reflect the histiocytic appearance of these mucus-secreting metastatic adenocarcinomas.