A 60-year-old, otherwise healthy male patient presented with a painless swelling near the lower lid of his left eye at the ophthalmology clinic of Ohud hospital in Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia. At that time, he had had the swelling for almost 3 years. He had no similar swelling elsewhere in the body and no history of any malignancy in the past ().\nOn examination, the swelling was a superficial, non-tender, pink-colored nodule located horizontally on the tarsal plate of the left lower eyelid. It measured 2 cm x 1.5 cm x 1 cm and was mobile and firm in consistency. The swelling clinically resembled a benign lesion. The rest of the ocular examination was unremarkable in both eyes.\nThe excision biopsy of the lesion revealed a 2.5 cm x 1.5 cm x 1.3 cm mass. On the cut surface, a well-circumscribed, 2 cm x 1 cm x 0.8 cm grayish-white, firm tumor was seen in the center with 5millimeter (mm) surgical margins on all sides. A histological examination of the tumor showed overlying thinned-out epidermis, beneath which were seen sheets, cords and nodules of tumor cells lying in the pool of extracellular mucin (). At places, the cells showed cords, papillae and tubule formation, the tumor cells showed mild atypia and occasional mitotic figures; no necrosis was seen (), and all the surgical margins were free from the tumor. A diagnosis of mucinous adenocarcinoma was made. A wide range of immunohistochemistry panels were run to confirm the diagnosis. The tumor cells were strongly positive for cytokeratin 7 (CK7), cytokeratin 5/6 (CK5/6), tumor protein 63 (p63), estrogen receptor (ER), progesterone receptor (PR) and were negative for cytokeratin 20 (CK20) (). To investigate the possibility that this tumor did not represent a metastatic mucinous adenocarcinoma, the patient underwent a complete metastatic work-up which included, computed tomography (CT) of chest and abdomen, Positron emission tomography (PET) scan, esophago-gastro-duodenoscopy and sigmoidoscopy; no abnormalities were detected. The final diagnosis of a Primary mucinous adenocarcinoma of the eyelid was given.\nConsidering the age of the patient and the long duration and gradually increasing size of the swelling, the patient was scheduled for a wide local excision with free surgical margins and referred to the King Fahad Hospital in Al-Madinah Al-Munawwarah.\nFor the past year, the patient has been on a regular follow-up schedule and is clinically free from the disease at present.
A 39-year-old Japanese male presented with a 3 months history of a skin tumor on the left side of the jaw. Past medical history revealed lung tuberculosis at age 20 years old. Physical examination showed a dome-shaped, slightly erythematous nodule measuring approximately 2 cm in diameter (Fig. ). Preoperative examination revealed no lymph node or distant metastasis. Punch biopsy was performed, and it was diagnosed as mucinous adenocarcinoma of the skin.\nThe tumor was excised with 5-mm surgical margin and was reconstructed with local rotational flap. The definitive histopathology showed small cellular nests of adenocarcinoma lying in pools of extracellular mucin that were separated by fibrocollagenous septae without involvement of underlying muscle. (Figure a,b) The immunohistochemical staining revealed that the tumor cells were positive for CK7, epithelioid membrane antigen (EMA), MUC1, MUC2, estrogen receptor (ER), and progesterone receptor (PR).\nThe patient again noticed a small tumor on the left side of the jaw in the area of the previous operation site 2 years after the primary operation. However, the patient had chosen not to be examined by a physician and left it alone for 4 years. Because of the rapid growth of the tumor, the patient visited our clinic. At this point, the tumor measured approximately 6 cm in diameter (Fig. a). Preoperative examination revealed invasion of the mandible and one left neck lymph node metastasis. The lesion was excised with at least 1-cm border of normal skin including the mandible (Fig. ). A left radical neck dissection was performed, and the mandible was reconstructed with a free scapula flap. The definitive pathology revealed MCS recurrence with no residual tumor cells in the excised normal skin area. One of 20 regional lymph nodes contained metastasis. Postoperatively, the patient was free of tumor and was followed up by the physician in charge every 3 months for 5 years and every 6 months for the next 5 years. The patient was disease-free for ten consecutive years on physical examination, chest X-ray, neck echogram, and ordinary blood test. Although the patient did not have any symptoms, the chest X-ray at the 11th year follow-up revealed multiple lung metastases (Fig. a,b). Additional chest computed tomography (CT), magnetic resonance imaging (MRI), and RI showed cervical vertebrate (Th5) tumor, and biopsy revealed metastasis of MCS. The patient received radiotherapy for pain control and died 3 year after the diagnosis of metastasis.