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Thread: Sebaceous Cell Carcinoma: A Masquerade Syndrome

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    Arrow Sebaceous Cell Carcinoma: A Masquerade Syndrome

    Sebaceous Cell Carcinoma: A Masquerade Syndrome

    Case Study:

    Chief Complaint:
    Decreased visual acuity and foreign body sensation in the right eye for the past months.

    History of Present Illness:
    The patient is a 67-year-old male who presents with a pigmented conjunctival lesion in his right upper eyelid. He initially noticed it 1 year ago, but was asymptomatic until 6 months ago when he started experiencing decreased visual acuity and a foreign body sensation in that eye. He initially thought that his symptoms were due to dry eye.

    Past Ocular History:
    He wears glasses, but has no other ocular history.

    Past Medical History:
    He has multiple chronic medical conditions including hypertension, coronary artery disease, hypercholesterolemia, gastroesophageal reflux disease, migraines, degenerative joint disease and bilateral hearing aids.

    Fosinopril, omeprazole, baby aspirin, and sertraline

    Beta blockers and atorvastatin

    Family History:
    He has a cousin with cutaneous melanoma

    Social History:

    Physical Exam:
    •General: No acute distress
    •Visual Acuity, with correction: Right eye (OD)--20/40-1; Left eye (OS)--20/20
    •Extraocular Motility: Full, both eyes (OU)
    •Pupils: equally reactive with no relative afferent pupillary defect (RAPD)
    •External and anterior segment examination:
    ◦Palpepral fissures: 11/11mm
    ◦Marginal reflex distance 1 (MRD1): 4/4 mm
    ◦Erythematous, elevated lesion within the tarsus of the right eyelid and protruding through the upper palpebral conjunctiva of the right eyelid (see Figure 1)
    •Dilated fundus exam (DFE): No pallor or edema of either disc. Normal macula, vessels, and periphery, OU
    The patient underwent an excisional biopsy that revealed a diagnosis of poorly differentiated Sebaceous Cell Carcinoma on histopathology. He subsequently underwent maps biopsies and a right upper eyelid wedge biopsy which showed atypical Meibomian glands consistent with Sebaceous Cell Carcinoma. He had a final wedge resection which showed no residual Sebaceous Cell Carcinoma. The histopathologic findings are demonstrated in the following photomicrographs.


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    Last edited by trimurtulu; 01-12-2009 at 07:23 AM.

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