Mucinous carcinoma of the eyelid with colonic mass: a rare partnership

Mucinous carcinoma of the eyelid is a rare cancer. In medicine, rarely will the diagnosis of one cancer lead to the diagnosis of a second unrelated cancer. However, mucinous carcinoma of the eyelid has been rarely associated with colon cancer [1]. This case demonstrates a very rare occurrence of mucinous carcinoma of the eyelid leading to the diagnosis of sporadic colon cancer.

An 82-year-old man presented to his primary-care physician and was found to have a slow-growing lesion on his right upper eyelid. Subsequently, he was evaluated by a dermatologist and underwent Mohs surgery. The pathology of the lesion returned a diagnosis of mucinous carcinoma. At that time, given that mucinous carcinoma is most often a secondary carcinoma, a primary cancer was suspected. The patient underwent esophagogastroduodenoscopy (EGD) and colonoscopy. His EGD showed only mild gastric atrophy. His colonoscopy revealed a 4 cm ulcerated cecal mass occupying most of the cecum ([Fig. 1]). Pathological analysis of the mass demonstrated a moderately differentiated adenocarcinoma ([Fig. 2]). Subsequently, the patient underwent a right hemicolectomy. Surgical specimens confirmed a moderately differentiated adenocarcinoma with perineural invasion but negative lymph nodes (0/18). After 6 months, the patient is doing well with no recurrence or evidence of distal metastases from either tumor.

Fig. 1 An ulcerated cecal mass found on colonoscopy, estimated to be 4 cm in size and occupying most of the cecum.

Fig. 2 Colonic mucosa with an invasive adenocarcinoma comprised of malignant cells occurring in singleton and in incomplete glands with surrounding desmoplastic response. H&E stain, magnification 4 × (a), 20 × (b).

Cutaneous mucinous carcinoma is most commonly a secondary lesion rather than a primary carcinoma [2] [3]. In the case of our patient, the finding of the mucinous carcinoma of the eyelid led to the discovery of a separate and distinct sporadic colonic adenocarcinoma. The occurrence of two separate primary carcinomas, one of them histologically a cutaneous mucinous carcinoma, is incredibly rare. Because this association was known, our patient was treated promptly and now shows no evidence of metastasis of either primary tumor.

Endoscopy_UCTN_Code_CCL_1AD_2AB

Competing interests: None

• References

• 1 Agiannidis C, Pana ZD, Molyva D et al. Metachronous occurrence of colorectal cancer in a Muir-Torre syndrome patient presenting with recurrent sebaceous adenoma of the eyelid: case report and updated review of the literature. J Cutan Med Surg 2012; 16: 394-399
• 2 Mardi K, Diwana VK. Primary cutaneous mucinous carcinoma: a rare entity. Indian Dermatol Online J 2011; 2: 82-84
• 3 Bansal R, Patel T, Sarin J et al. Cutaneous and subcutaneous metastases from internal malignancies: an analysis of cases diagnosed by fine needle aspiration. Diagn Cytopathol 2011; 39: 882-887