Conjunctival oncocytic adenocarcinoma of lacrimal gland origin
Authors: Ahmed Syed , Shahid Syed , Saldana Manuel 
Published: December 2019

AbstractPurposeTo present a rare case of a conjunctival tumour, in a patient who presented to the Ophthalmology department at Eastbourne District General Hospital with ocular surface symptoms.MethodsReview of patient case notes and electronic patient record.ResultsAn 83‐year old man presented with a 6‐month history of dry, gritty sensation in the right eye with a recent reduction in vision. He had a history of previously treated squamous cell carcinoma of the scalp. Examination revealed a large lesion extending from the conjunctival surface onto the temporal aspect of the cornea. The visual acuity was 6/12 with pinhole and there was no affect on ocular motility. Systemic evaluation did not suggest any features of metastatic disease and an MRI scan was unremarkable. The patient underwent an incisional biopsy of the lesion and histopathology showed a moderately differentiated adenocarcinoma with oncocytic features. Immunohistochemistry was positive for CK5/6, CK7, EMA and p63. He underwent successful excision of the lesion with adjuvant chemotherapy.ConclusionOncocytic adenocarcinoma (OCA) is a rare epithelial tumour that usually arises from the ductal cell lining of apocrine glandular structures. The oncocytes have a distinctive large size with granular acidophilic cytoplasm secondary to the presence of extensive mitochondria with fragmented cristae. The tumour is more commonly associated with the kidneys, thyroid and salivary glands. Cases within the eye although rare are associated with caruncle, lacrimal sac, accessory lacrimal glands of the conjunctiva and in the lacrimal gland. Cytokeratin (CK) are intermediate filaments found in the cytoskeleton of epithelial tissue and are used in the differential diagnosis of neoplasms as their expression varies with cell origin. CK5/6 found to be expressed in our patient is a marker of stratified squamous epithelium. The patient was also negative for CK 20 expression which would be seen in simple epithelium.References1. Hartman LSC, Mourits MP, Canninga‐van Dijk MR. An unusual tumour of the lacrimal gland. Br J Ophthalmol. 2008;87:363.2. Hamperl H. Onkocyten und Geschwu lste der Speicheldru sen. Virchows Arch A Pathol Anat Histol. 1931;282:724–736.3. Hamperl H. Benign and malignant oncocytoma. Cancer. 1962;15:1019– 1027.4. Tallini G. Oncocytic tumours. Virchows Archiv. 1998 Jul 1;433(1):5‐12.5. Østergaard J, Prause JU, Heegaard S. Oncocytic lesions of the ophthalmic region: a clinicopathological study with emphasis on cytokeratin expression. Acta Ophthalmol 2011;89:263–7.6. Biggs SL, Font RL. Oncocytic lesions of the caruncle and other ocular adnexa. Arch Ophthalmol 1977;95:474 – 8.7. Chen LJ, Liao SL, Kao SC, et al. Oncocytic adenomatous hyper‐plasia of the lacrimal sac: a case report and review of the literature. Ophthal Plast Reconstr Surg 1998;14:436 ‐40.8. Simonnet H, Alazard N, Pfeiffer K, et al. Low mitochondrial respiratory chain content correlates with tumor aggressiveness in renal cell carcinoma. Carcinogenesis. 2002;23:759–768.9. Chu PG & Weiss LM (2002): Keratin expres‐ sion in human tissues and neoplasms. Histopathology 40: 403–439.10. Shields JA, Shields CL. Epithelial tumors of the Lacrimal gland. Atlas of Orbital Tumors. Philadelphia: Lippincott Wiliams and Wilkins, 1999.chap 12.