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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.

    Medications:
    Fosinopril, omeprazole, baby aspirin, and sertraline

    Allergies:
    Beta blockers and atorvastatin

    Family History:
    He has a cousin with cutaneous melanoma

    Social History:
    Non-smoker

    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
    Course:
    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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    Full Details with Figures:

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

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