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Research Letter |

Squamous Cell Carcinoma With Clear-Cell Features of the Palpebral Conjunctiva

Alia Rashid, MBChB1; Frederick A. Jakobiec, MD, DSc1; John T. Mandeville, MD2
[+] Author Affiliations
1David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
2Eye Health Services, Quincy, Massachusetts
JAMA Ophthalmol. 2014;132(8):1019-1021. doi:10.1001/jamaophthalmol.2014.971.
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The clear-cell variant makes up a distinct minority of squamous cell carcinomas.1 The microscopic appearance of the clear cells can be difficult to distinguish from those of sebaceous carcinoma cells. Determining the correct diagnosis is of great therapeutic and prognostic significance, as sebaceous cell carcinoma is associated with a poorer prognosis.

Article InformationCorresponding Author: Frederick A. Jakobiec, MD, DSc, David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (fred_jakobiec@meei.harvard.edu).

Published Online: May 22, 2014. doi:10.1001/jamaophthalmol.2014.971.

Author Contributions: Dr Jakobiec had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Jakobiec, Mandeville.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Rashid, Jakobiec.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: All authors.

Study supervision: Jakobiec.

Conflict of Interest Disclosures: None reported.

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Figure 1.
Clear-Cell Squamous Cell Carcinoma

A, A woman in her mid-50s developed left upper eyelid ptosis and fullness over 3 months. B, Eversion of the eyelid reveals diffuse palpebral conjunctival thickening caused by a faintly corrugated or papillary mass exhibiting a nonkeratinizing surface. This appearance is most characteristic of a squamous lesion, but occasionally sebaceous tumors may present as a papillary mass. C, In the top panel, infiltrating tumor displays the eosinophilic cytoplasm of an epidermoid (squamous) proliferation (hematoxylin-eosin, original magnification ×12.5); in the bottom panel, areas of necrosis (comedonecrosis [arrowheads]) superficially suggest a sebaceous carcinoma (hematoxylin-eosin, original magnification ×100). D, Higher-power photomicrograph shows comedonecrotic focus with surrounding viable eosinophilic cells occasionally displaying vacuoles (hematoxylin-eosin, original magnification ×400). E, Pronounced vacuolization of the constituent tumor cells is featured in this field (hematoxylin-eosin, original magnification ×600). F, Palpebral carcinoma in situ adjacent to the invasive mass displays focal vacuolization (arrowheads) (hematoxylin-eosin, original magnification ×200).

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Figure 2.
Mucicarmine and Immunohistochemical Staining Results

A, The mucicarmine stain fails to demonstrate positive magenta staining of either the necrotic cell clusters or surrounding viable cells (mucicarmine stain, original magnification ×100). B, Epithelial membrane antigen positivity is demonstrated in the cell membranes of the infiltrating tumor cells. The surrounding lymphocytic host response is nonstaining (immunoperoxidase reaction, diaminobenzidine chromogen, hematoxylin counterstain, original magnification ×400). C, Androgen receptor nuclear negativity characterizes the entire tumor (immunoperoxidase reaction, diaminobenzidine chromogen, hematoxylin counterstain, original magnification ×400). Inset, Androgen receptor nuclear positivity is seen in a small lobule of a meibomian sebaceous gland (immunoperoxidase reaction, diaminobenzidine chromogen, hematoxylin counterstain, original magnification ×400). D, Adipophilin positivity (arrowheads) for lipid identification was identified only rarely in tumor zones adjacent to necrosis (immunoperoxidase reaction, diaminobenzidine chromogen, hematoxylin counterstain, original magnification ×400). E, Cytokeratin 7 (intermediate weight) is strongly and uniformly present in the tumor cells (immunoperoxidase reaction, diaminobenzidine chromogen, hematoxylin counterstain, original magnification ×100). Inset, Same observation around a necrotic focus (immunoperoxidase reaction, diaminobenzidine chromogen, hematoxylin counterstain, original magnification ×150). F, Ki-67 nuclear positivity for detecting premitotic DNA synthesis was observed in around 25% of the tumor cells (immunoperoxidase reaction, diaminobenzidine chromogen, hematoxylin counterstain, original magnification ×200).

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