HPI: A 60 year old female presented with a recurrent left lower eyelid cyst. (Figure 1) It had been excised previously by an outside physician. She said that the cyst did not hurt, bleed, or itch. She became worried because of the increasing size. Given the recurrent nature of the cyst, a biopsy was performed for histopathologic confirmation.
Past Medical History: Schizophrenia
Medicines: No reported medications
Family History: Non-contributory
Physical Exam: a 2.5 x 1.5 cm multiloculated cystic plaque at the left lower eyelid extending to the left cheek.
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Diagnosis: Mucinous Carcinoma
Histology of the left eyelid demonstrated clusters of basophilic columnar cells with hyperchromatic nuclei arranged as small nests and glands set within pools of mucin within the dermis, suggesting an invasive mucinous carcinoma. (Figures 2 and 3)
Margins were positive on the initial excision, but unfortunately the patient was lost to follow up. She presented again years later with complaints of a new 2 x 3 cm cyst on the left lower and upper eyelids extending to the left cheek. There was no appreciable associated lymphadenopathy. This lesion was biopsied and proven as recurrent mucinous carcinoma. Full staging was recommended to rule out metastatic disease with a PET/CT scan. She will have Mohs Micrographic Surgery and a planned repair with Oculoplastics.
Mucinous carcinoma is a rare eccrine malignant neoplasm that is slow growing and commonly located on the head and neck. Typically, it is painless and often misdiagnosed as other benign neoplasms such as epidermoid cysts or hidrocystoma. The immunohistochemical features of the primary mucinous carcinoma overlap considerably with breast and colon adenocarcinomas, and these must be ruled out as primary sites of disease. Historically primary cutaneous mucinous carcinomas are excised, but Mohs Micrographic Surgery may have superior recurrence outcomes.
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