WADSWORTH: An Adenoma of the Meibomian Glands. 383
AN ADENOMA OF THE MEIBOMIAN GLANDS. BY 0. F. WADSWORTH, M.D., BOSTON.
Few cases of adenomata of the lids have been described. Salzmann (Archives of Ophthalmology, XX, 3) reports three cases and refers to four others.
I
Fig. i.
Fig. 2.
F. M., aged i8, presented himself at the Massachusetts Charitable Eye and Ear Infirmary in October, I894, with a growth of the left upper eyelid. The history to be obtained was meagre: he stated that there had,been an operation for removal four years before, and since that time growth had been gradual. The tumor was situated at the middle of the lid, involved considerably more than half its width, the whole height of. the tarsus, and overhung the lower lid. About half of the tumor
384 WADSWORTH: An Adenoma of the Meibomian Glands. lay below the level of the cilia. It measured about 25""'n vertically, 20onm horizontally, and I5"'m in thickness. The conjunctiva on its posterior surface was somewhat thickened and congested. The anterior surface above the lashes was nodular, the skin of fairly normal appearance, but not movable. The part which corresponded to the lid edge was greatly increased in size, irregularly nodulated, the nodules of slightly yellowish color and faintly umbilicated. The cilia were not much changed except in position. To ihe touch the growth was firm and without sense of fluctuation. The globe was normal. No definite diagnosis was made. The tumor was removed by division of the whole thickniess of the lid with scissors on either side, and completing the sec-
~~~y Fig-.
9 3.
tion above with the knife. The gap left was a large one. Forwas naturally loose, so that, by incising the skin directly outward from the outer canthus about one and a half c.m., and freely dividing the fascia extending from the tarsus to the outer edge of the orbit, it was possible to bring the edges of the wound together and cover the space denuded without much strain. Sutures on the conjunctival as well as on the outer surface completed the operation. Under powdered iodoform and bandage the wound healed by first intention. I am indebted to Dr. W. D. Hall for sections and, photo-
tunately, the lid
WADSWORTH: An Adenoma of the AMcibomian Glands. 385graphs, and to Dr. F. B. Mallory for the following description of the tumor: On one side is seen normal epidermis containing sebaceous glands and a few small hairs; on the other is an epidermis with marked papille (conjunctiva), beneath it is considerable round cell infiltration. The tumor (in the section) measures about I.5 c.m. long, and i c.m. wide. It contains a number of cysts, of which the largest measure from 2 to 3 m.m. in diameter. Microscopically, the growth consists essentially of a great number of glands which resemble more or less perfectly in their structure normal sebaceous glands. The cells, especially towards the centers of the glands, are large, with coarsely reticulated protoplasm, and a small, lightly staining nucleus. In many of the glands the cells in -the center have been transformed, so that their outlines are shadowy and the nuclei do not stain. Many of the glands are dilated into larger or smaller cysts containing the remains of desquamated cells. At the base of the growth, the glands have invaded to a slight extent the striated muscle fibres, and at one point have almost surrounded a nerve bundle. Towards the margin of the lid there is a marked papillary growth of fibromyxomatous tissue, covered with epidermis and containing numerous branching glands and even small cysts, into a large irregular cavity which would seem to be the dilated duct of the sebaceous gland from which the growth started. Diagriosis: An adeno-cystoma originating in a Meibomian gland, showing in its outer portion a marked intracanalicular papillary structure, and at its base a slight tendency to invade the deeper tissues.
AN ADENOMA OF THE MEIBOMIAN GLANDS. BY 0. F. WADSWORTH, M.D., BOSTON.
Few cases of adenomata of the lids have been described. Salzmann (Archives of Ophthalmology, XX, 3) reports three cases and refers to four others.
I
Fig. i.
Fig. 2.
F. M., aged i8, presented himself at the Massachusetts Charitable Eye and Ear Infirmary in October, I894, with a growth of the left upper eyelid. The history to be obtained was meagre: he stated that there had,been an operation for removal four years before, and since that time growth had been gradual. The tumor was situated at the middle of the lid, involved considerably more than half its width, the whole height of. the tarsus, and overhung the lower lid. About half of the tumor
384 WADSWORTH: An Adenoma of the Meibomian Glands. lay below the level of the cilia. It measured about 25""'n vertically, 20onm horizontally, and I5"'m in thickness. The conjunctiva on its posterior surface was somewhat thickened and congested. The anterior surface above the lashes was nodular, the skin of fairly normal appearance, but not movable. The part which corresponded to the lid edge was greatly increased in size, irregularly nodulated, the nodules of slightly yellowish color and faintly umbilicated. The cilia were not much changed except in position. To ihe touch the growth was firm and without sense of fluctuation. The globe was normal. No definite diagnosis was made. The tumor was removed by division of the whole thickniess of the lid with scissors on either side, and completing the sec-
~~~y Fig-.
9 3.
tion above with the knife. The gap left was a large one. Forwas naturally loose, so that, by incising the skin directly outward from the outer canthus about one and a half c.m., and freely dividing the fascia extending from the tarsus to the outer edge of the orbit, it was possible to bring the edges of the wound together and cover the space denuded without much strain. Sutures on the conjunctival as well as on the outer surface completed the operation. Under powdered iodoform and bandage the wound healed by first intention. I am indebted to Dr. W. D. Hall for sections and, photo-
tunately, the lid
WADSWORTH: An Adenoma of the AMcibomian Glands. 385graphs, and to Dr. F. B. Mallory for the following description of the tumor: On one side is seen normal epidermis containing sebaceous glands and a few small hairs; on the other is an epidermis with marked papille (conjunctiva), beneath it is considerable round cell infiltration. The tumor (in the section) measures about I.5 c.m. long, and i c.m. wide. It contains a number of cysts, of which the largest measure from 2 to 3 m.m. in diameter. Microscopically, the growth consists essentially of a great number of glands which resemble more or less perfectly in their structure normal sebaceous glands. The cells, especially towards the centers of the glands, are large, with coarsely reticulated protoplasm, and a small, lightly staining nucleus. In many of the glands the cells in -the center have been transformed, so that their outlines are shadowy and the nuclei do not stain. Many of the glands are dilated into larger or smaller cysts containing the remains of desquamated cells. At the base of the growth, the glands have invaded to a slight extent the striated muscle fibres, and at one point have almost surrounded a nerve bundle. Towards the margin of the lid there is a marked papillary growth of fibromyxomatous tissue, covered with epidermis and containing numerous branching glands and even small cysts, into a large irregular cavity which would seem to be the dilated duct of the sebaceous gland from which the growth started. Diagriosis: An adeno-cystoma originating in a Meibomian gland, showing in its outer portion a marked intracanalicular papillary structure, and at its base a slight tendency to invade the deeper tissues.
