Case of the Month

January 2018

Case details

Figure 1

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.

Scroll down to reveal diagnosis

Diagnosis: Mucinous Carcinoma

Histopathology

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)

Clinical Course

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.

Discussion

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.

References

  • J.A. Adefusika. J.D. Pimentel. R.N. Chavan. J.D. Brewer. Primary Mucinous Carcinoma of the Skin: The Mayo Clinic Experience Over the Past Two Decades. Dermatol Surg. 2015 Feb;41(2):201-8.
  • A. Chavez, K. Linos, F.H. Samie, Primary Cutaneous Mucinous Carcinoma of the Eyelid Treated with Mohs Surgery. JAAD Case Reports. 2015 Mar; 1 (2): 85-87
  • L. Kamalpour, R.T. Brindise, M. Nodzenski, D.Q. Bach, E. Veledar, E. AlamPrimary Cutaneous Mucinous Carcinoma: A Systematic Review and Meta-analysis of Outcomes After Surgery

JAMA Dermatol, 150 (4) (2014), pp. 380-384

  • D.V. Kazakov, S. Suster, P.E. LeBoit, et al.Mucinous carcinoma of the skin, primary and secondary: A clinicopathologic study of 63 cases with emphasis on the morphologic spectrum of primary cutaneous forms: homologies with mucinous lesions in the breast. Am J Surg Pathol, 29 (2005), pp. 764-782
  • B.C. Kelly. J. Koay. M.S. Driscoll. S.S. Raimer et al.. Report of a case: primary mucinous carcinoma of the skin. Dermatol Online J 2008;14:4
  • J.D. Wright, R.L. Font. Mucinous sweat gland adenocarcinoma of eyelid: A clinicopathologic study of 21 cases with histochemical and electron microscopic observations. Cancer, 44 (1979), pp. 757-768

This case is presented by Meghan Heberton, MD, Laurin Council, MD, Ilana Rosman, MD, and Margareth Pierre-Louis, MD.

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