Lymphoepithelioma-like carcinoma originating on the eyelid

An 89-year-old woman presented a rapidly growing red nodule of 5 years' duration on her left eyelid. Histologically, the entire dermis was occupied by multiple lobules of atypical tumor cell nests surrounded by inflammatory cells and fibrous stroma. The tumor cell nests were connected with the overlying epidermis and extended into the subcutaneous fat and muscles. There were no tendencies towards squamous or glandular differentiation of the tumor cells. Immunohistochemistry showed the tumor cells to be positive for keratin/cytokeratin and epithelial membrane antigen, but negative for neuron specific enolase and vasoactive intestinal polypeptide. S-100 protein-positive Langerhans cells were also found within the tumor nests. There was no apparent evidence of a primary lesion elsewhere.