A 79-year-old male visited our clinic for the evaluation of left ocular pain that had recently worsened. His left eye was phthitic due to glaucoma. The patient had also previously undergone an endoscopic rectal polypectomy. Evisceration and silicone ball (18 mm) implantation were performed. He returned six weeks later with symptoms of mild fever, cough, and chills, as well as left facial erythema, swelling, and tenderness (). We diagnosed the symptoms as orbital cellulitis induced by recent evisceration surgery and the common cold. However, despite two weeks of empirical antibiotic therapy, the patient's symptoms worsened. An orbital computed tomography (CT) scan revealed enhanced soft tissue infiltrations in his left extraconal and intraconal spaces and a thickening of the left eyelid (). An incisional biopsy of the orbital tissue was performed through the superomedial portion of the conjunctiva. The tumor was gray-white colored and was not separated from the surrounding tissue on gross examination. Histopathology demonstrated cells with round to oblong nuclei, small distinct nucleoli, and relatively abundant granular amphophilic cytoplasm. Some cells had signet ring cytology, with a dominant cytoplasmic vacuole and an eccentrically placed, crescent-shaped nucleus (). Immunohistochemistry revealed that the tumor tissue was positive for cytokeratin and cytokeratin 7 but negative for cytokeratin 20.\nResults of an abdominal ultrasound, abdominal-pelvic CT, and a whole body bone scan suggested no systemic involvement. Additionally, tumor marker tests were all within the normal ranges. However, brain magnetic resonance imaging and positron emission tomography revealed metastatic lesions on the left frontal and temporal lobes of the skull; nasal bone; left basal skull; right mandibular ramus and sternum; vertebra in the cervical, thoracic, lumbar and sacral regions; and the left ischium (). To rule out a secondary tumor from the previous rectal lesion, rectal biopsy was performed and revealed a benign adenoma confined to the mucosal layer. Consequently, the lesion in question was diagnosed as a primary malignant eccrine sweat gland carcinoma of the eye (a histiocytoid variant of eccrine sweat gland carcinoma) with multiple bone metastases. Although the patient was fully functional on the first visit, his general condition declined during the subsequent three months. The patient became bedridden, refused all recommended treatments, and received only conservative treatment.
A 70-year-old male noticed a swelling near the the left canthus since one-and-a-half years. The swelling was gradually increasing in size. On examination, a raised, freely mobile, firm skin mass of approximately 3.0 × 2.5 cm was present on the lateral canthal region on the left eye . The patient's extraocular eye movements were unaffected. Examination revealed no other suspicious skin lesions or palpable lymph nodes. The case was clinically diagnosed as fibroma. Excision biopsy was done and the specimen was sent for histopathological examination. Gross examination revealed a well-circumscribed, spherical soft tissue mass, partially skin covered, measuring 2 cm in diameter. The cut surface of the tumor had a gray-brown gelatinous appearance []. Microscopically, the sections revealed a tumor in the dermis composed of tumor cells arranged in nests, glands, and cribriform patterns []. The individual tumor cells were columnar and had a hyperchromatic nucleus. The cells were seen floating in large pools of mucin separated by thin fibrovascular septa []. The mucin was periodic acid schiff (PAS) positive and diastase-resistant. [] Further investigations, including a colonoscopy, ultrasonographic examination of the abdomen, and computerized tomography (CT) scans of the chest, abdomen, and pelvis were found to be normal. Thus, the lesion in the skin was reported to be PMC of the skin.