1Klüppel M., 1Marx W., 2Müller W., 1Sundmacher R.

1Eye Hospital und 2Pathology, University, Moorenstr. 5, 40225 Düsseldorf

Objective: Nodular ulcerating tumors of the eyelids with a slow growth over months and years are suspicious of basal cell carcinoma. If a tumor has developed within a few weeks, however, other types of tumors are more likely. Benign (eg. keratoacanthoma) and malignant tumors (eg. squamous cell carcinoma) are important differential diagnoses. Primary lymphatic tumors of the eyelids are rare, and rarely thought of.
Methods: Two male patients at the age of 53 and 64 years respectively were seen with ulcerating tumors of the medial canthus and the upper eyelid which had been developed within several weeks. According to the quick growth and the size of the tumors the first diagnosis was "keratoacanthoma", although the clinical appearance was kind of different from typical keratoacanthoma. The tumors were excised and histopathologically processed.
Results: Both cases resembled a malignant ki-1 anaplastic large cell lymphoma. Subsequent radiation therapy of the eyelids with 30 Gy followed. The first staging showed no dissemination. One patient, however, developed cutaneous scalp infiltrations nine months later. A CHOP chemotherapy and a further local radiation were successfully performed.
Conclusion: We present two cases of a primary cutaneous ki-1 anaplastic large cell lymphoma of the eyelids which developed within several weeks with rapid growth rather suspicious of keratoacanthoma. In such cases a malignant t-cell lymphoma should be included in the differential diagnoses. An immediate diagnosis and therapy can be of crucial vital importance for the patient.

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