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Long-Term Outcomes of Circumostial Injection of Mitomycin C (COS-MMC) in Dacryocystorhinostomy.

gland carcinoma, squamous cell carcinoma, Merkel cell carcinoma, and basal cell carcinoma. A 65-year-old woman was referred by her general practitioner for incision and curettage of a right upper eyelid chalazion which was slowly increasing in size over a period of 6 months. The medical history included a previously treated endometrial adenocarcinoma. The patient denied any past ocular or family history of note. A cystic lesion of the right upper eyelid extending on to the palpebral conjunctiva was identified on clinical examination. This had macroscopic features of a meibomian cyst. The presumed chalazion was incised via a tarsal conjunctival incision. Given the rather solid consistency of contents, a sample was sent for histopathological examination which showed a sebaceous adenoma (Fig.). A detailed review of histopathology records revealed a previously excised skin keratoacanthoma suggesting MuirTorre syndrome which was confirmed with genetic evaluation identifying a heterozygous mutation of the hMSH2. Reexcision with clear margins resulted in complete excision of the eyelid tumor and patient was referred for genetic counseling. This was also offered to first degree relatives. Muir-Torre syndrome is characterized by the coexistence of sebaceous neoplasia or keratoacanthoma and at least 1 visceral malignancy. Colorectal adenocarcinoma and genitourinary are the most common associated internal malignancies, but several other malignancies have also been reported. The manifestation of a sebaceous lesions (adenoma or carcinoma) on the eyelid or elsewhere should alert the ophthalmologist to enquire for a history of previous or concurrent visceral cancers, particularly colorectal or endometrial that could suggest Muir-Torre syndrome. These tumors can simulate other benign and malignant eyelid lesions delaying their diagnosis. In addition, this may be the first presentation for an at-risk individual who may develop internal malignancies at later stage. This case highlights the value of histopathological examination in apparently benign periocular lesions with atypical natural history, recurrence or nonresponsive to treatment, which may be masking a more serious local or systemic condition.