Sebaceous gland carcinoma

Sebaceous glands are appendages in epidermis. Tumors of the sebaceous glands may be benign, such as sebaceous hyperplasia or sebaceous gland adenomas. The malignant sebaceous gland carcinoma generally arises from the glands within the eyelids, caruncle or eyebrow. They are more commonly occurred on the upper eyelid and in middle-aged patients. Meibomian gland carcinoma is the most common type. Sebaceous cell carcinoma is a lethal eyelid malignancy with metastasis (spreading of the disease to other parts of the body) but misinterpreted as benign conditions therefore error or delay in diagnosis is common thus tumor carries a significant mortality rate, 22%. The sebaceous cell carcinoma occurs 3.2% among malignant tumors and 0.8% of all eyelid tumors.

Sebaceous cell carcinomas are typically found in women, more often in old people, and they usually occur on the upper eyelid margin. It tends to invade locally, as well as spreading to regional lymph nodes.

Symptoms – There is an insidious onset of a painless firm eyelid mass. Tumors at the upper eyelid have a yellowish appearance. Classically, lesion is a firm, painless, indurate mass or ulceration associated with the loss of cilia, in an area that has been treated for recurrent stye. Sebaceous carcinomas are rare eye cancers and appear like a stye. But any eye tumor with persistent conjunctivitis, blepharo-conjunctivitis or chronic/recurrent stye and is not getting better after 3 months of observation must be suspected as sebaceous carcinoma and biopsied

Sebaceous cell carcinoma tends to invade locally, as well as spreading to regional lymph nodes.

Treatments – When the diagnosis is confirmed through biopsy, a survey for metastasis is done. Sebaceous carcinoma can spread to regional lymph nodes (pre-auricular and cervical) as well as to lungs, brain, liver and bone. The occurrence of metastatic disease is dependent on the size and location of the primary tumor and occurred in up to 27% of patients. Local tumor invasion of the lymph nodes, orbit or metastatic sites were associated with a poor prognosis for survival.

Surgical – COMPLETE resection is suggested. Procedure of permanent section control or Frozen section control is applied to provide negative margins. Larger surgeries, cryo-destruction and radiation may be required if resection is not possible. Exenteration (complete removal of the orbital contents) is sometimes required for extensive or recurrent disease.

Medical Treatment – Carcinoma tumors are generally removed with the help of surgery. More serious carcinoma tumors require advanced medical treatment like Chemotherapy and Radiation. Sebaceous Gland Carcinoma tumors cause death of many patients due to spreading of the disease to other parts of the body (metastasis). Hence it is important to treat Sebaceous Gland cancer at the earliest.

Homoeopathic treatment – Though there are many homoeopathic medicines for tumors and glands, there is no specific medicine for sebaceous carcinoma of eyelid, mentioned in homoeopathic literature.  Homoeopaths treat all types of disease with medicines selected on homoeopathic principles from that angle any of the homoeopathic medicine may be indicated covering the totality of symptoms.

The commonly used antitumor medicines are – Abrotanum, arsenicum alb., baryta carb., bromium, calcarea carb., calcarea flour., carbo animalis, conium, formic acid, hecla lava, lapis albus, lycopodium, nitric acid, phosphorus, phytolacca, scirrhinum, silicea, thuja etc.

Case – Smt. R. D.      55 yrs.           Female           Married                Hindu             Vegetarian              

C T Scan (14/08/2010) – Small 17x11x11 cm size tissue density lesion seen along supra- lateral quadrant of right orbit – involving right eyelid. No underlying bone erosion. Lesion abutting (touching) the eye ball.

Biopsy (15/11/2010) – Sebaceous carcinoma of right upper eyelid.

Patient reported on 09/05/11 with a bluish red hard swelling with multiple nodules on upper eye lid. Some sites were softened to bleed freely after punch biopsy. Bleeding from two ulcerated sites of biopsy aggravated after walking or exertion. Stitching and pulsating pain and lachrymation aggravated from sun and after exertion. Pain on right side of the head during talking.  The swelling was noticed in July – August 2010. It increased gradually but aggravated after November 2010. The patient observed that the swelling has increased after biopsy.

She had excessive thirst. Craving for cold, aversion to milk. Burning esophagus from spices.  Perspire on face while walking.

Obese. Hight 5’3”. Weight 78 kg. Blood  pressure 180/120 mm of hg.

Right upper Eyelid – A bluish red hard mass with multiple nodules covering whole eyelid. Some sites are softened and bleeding freely.   No peri-auricular and cervical lymph node palpable.

09/05/11 Rx 1. Pulsatilla         30    two pills thrice daily.

                       2. Phosphorus   200  two doses at 10 minutes interval weekly

                       3. Rauwolfia        Q   15 drops in ½ cup of water twice a day.

25/05/11 No change in bleeding and pain. there was burning along right eye brow extending to whole growth. Perspiration face increased. Blood pressure 150/110.

                  Rx 1. Pulsatilla         30    two pills thrice daily for one month.

                       2. Sulphur            30    two doses at 10 minutes interval weekly

                       3. Silicea               6x    four tablets thrice a day for one month.

                       4. Hekla lava        4x     thrice a day for one month.

                       5. Ointment Calendula to apply on the wound.

25/06/11 Discharge decreased but burning in inner canthus.

                   Rx 1. Zincum met    30    two pills thrice daily for one month.

                        2. Sulphur          200    two doses at 10 minutes interval weekly

                        3. Silicea               30    two pills thrice a day for one month.

                        4. Hekla lava        4x     thrice a day for one month.

                        5. Ointment Calendula to apply on the wound.

13/07/11 As there was no change the patient reported before time.

                 Rx 1. Silicea              1M    two doses at 10 minutes interval

                      2. Thuja                200   two doses at 10 minutes interval on 8^th day after silicea.

                      3. Calcarea carb. 200 two pills once a day for 15 days.

                      4. Calendula          30 two pills thrice a day for 15 days.

                      5. Ointment Calendula.

29/07/11 All the previous prescriptions failed to bring any satisfactory result.

                Rx 1. Conium          30    two pills thrice a day for 30 days.

                      2. Silicea            6x     four tablets thrice a day for 30 days.

                      3. Ointment Calendula

05/09/11 Had viral fever about ten days back, took allopathic medicines. Now, weakness and sometimes vertigo are felt.

Tumor size decreased. Discharge and pain decreased. (May be due to antibiotics?). Picture taken.

Weight – 75 kg.

                 Rx 1. Conium          30    two pills thrice a day for 30 days.

                      2. Silicea            6x     four tablets thrice a day for 30 days.

                      3. Ointment Calendula

Photo on 05/09/11

15/10/11 The right upper eye lid tumor size decreased more than 80% (See photo taken on 15/10/11).  Now patient could open eye and had clear vision.

Since after viral fever she has right sided head pain off and on, vertigo while walking with sensation of falling forward. Not recovered from weakness.

Appetite, thirst, bowel and sleep normal. B. P. 140/100 mmHg.

                 Rx 1. Conium          30    two doses at 10 minutes interval every week.

                       2. Silicea             6x     four tablets thrice a day for 30 days.

                       3. S. L.                 30    two pills thrice a day.

                       4. Rauwolfia      Q      10 drops once a day.

Photo on date 15/10/11

28/11/11 Vision was though clear and could open the eye but following symptoms persisted. The eyelid itch and burn after rubbing and from heat of stove. Redness of the eye and lachrymation from air draft, light and rubbing. Agglutination in morning with yellow discharge.

Vertigo on walking. Blood Pressure 130/100 mm Hg.

                  Rx 1. Conium          1M    two doses at 10 minutes interval.

                       2. Silicea              6x     four tablets thrice a day for 30 days.

                       3. S. L.                  30     two pills thrice a day.

                       4. Rauwolfia        Q      15 drops twice a day.

 Though the patient said that she was ok and has clear vision but the case cannot be declared as cured as the symptoms redness of the eye, lachrymation and photophobia are still persisting. Personally, I call a case cured only when the patient remain free from all the concerned symptoms and pathology at least for two years. So the patient is advised to continue the treatment.

Dr. M. K. Tyagi
D.H.M.S., Dip. N.I.H., Research Officer

Mobile" 09829157926

Email: manju_mkt2003@yahoo.co.in
Sewa Mandir
Email: sewamandir@usa.net

HYPOTHYROIDISM AND PREGNANCY

Hypothyroidism is a disorder of thyroid gland where the thyroid secrets less than the required thyroid hormones.

A woman with too low thyroid hormones levels may not ovulate normally, which makes conception difficult. Right dose of thyroxine (T₄) can get ovulation back on track and restore fertility of the female.  In some ladies menstrual cycle does not cause any concern still it is necessary to get thyroid levels checked, if thyroid levels are too low then it is recommended to correct the level of thyroxine before one try to conceive. 

There is an increase in serum free T4 (thyroxine) and a decrease in serum TSH (Thyroid Stimulating Hormone) levels in early pregnancy. An increased level of free T4 and a reduced level of TSH in early normal pregnancy are not indications of hyperthyroid but in a hypothyroid pregnant woman a fresh estimation of thyroid hormones is a must as a well managed hypothyroid does not have a significant effect on pregnancy. Thyroxine is needed for the development of baby's brain in womb. It easily crosses the placenta, the organ which provides nutrients for the fetus and takes away waste during pregnancy.

During pregnancy need for thyroxine is increased by 50 to 100% which is manageable. Beside the baby needs it for brain development it helps mother’s body to adapt to the changes of pregnancy, especially in the first twelve weeks. Maternal hypothyroidism or underactive thyroid increases the risk of pregnancy complications, such as miscarriage, premature birth, gestational hypertension and pre-eclampsia, as well as deficits of intellectual development in the children as lower IQs and learning problems, such as attention-deficit hyperactivity disorder (ADHD). Therefore thyroid levels in blood should be monitored throughout the pregnancy to maintain the correct level of thyroxine.

The increased free T4 and hCG (human chorionic gonadotropin) and decreased TSH are correlated with the severity of morning sickness. If morning sickness is severe changing the time of taking thyroxine tablets is recommended, for this consult the treating physician.

The thyroid functions of all babies should be checked when they are about nine days old. Depending on the cause of underactive thyroid the baby may need to have some additional tests of thyroid function after birth. 

The most frequent cause of the inability of the maternal thyroid to produce enough thyroxine is an inadequate supply of iodine. This micronutrient is a necessary component of thyroid hormone. Its need with the onset of pregnancy is almost doubled than needed by children and non-pregnant adults. "Intellectual impairments of many children could be easily prevented by promoting the use of iodine supplements taken before, throughout pregnancy and lactation," 

Homoeopathy though has no specific medicine to maintain the levels of thyroid hormones but homoeopathic treatment could be continued during pregnancy with time to time evaluation of thyroid function and regulation of the hormone supplements added with the iodine.

However, well regulated homoeopathic treatment can resolve hypothyroidism permanently. Some of indicated medicines are as follow –

Alumina, argentum-nit., bacillus-7, calcarea carb., calcarea-iod., conium, cortisonum, gelsemium, graphite, histaminum, hypothalamus, Iodium,. kali-carb, kali-iod., lycopodium, merc. sol., natrum-m., nux-vom., penicillinum, ribonucleic-ac., sepia, thalamus, thyroidinum.

Dr. M. K. Tyagi
D.H.M.S., Dip. N.I.H.Research Officer 
Sewa Mandir
Mobile" 09829157926
Email: 1.sewamandir@usa.net, 2.manju_mkt2003@yahoo.co.in