Metastatic Retroperitoneal Leiomyosarcoma to the Right Lower Eyelid Presenting as a Chalazion

Abstract

Purpose: Leiomyosarcoma (LMS) is an aggressive tumor with a high metastatic rate that rarely metastasizes to the periocular region.

Methods: A 50-year-old male with a previous two-year history of primary stage IV LMS presented with metastatic retroperitoneal LMS, which was initially incorrectly described as an eyelid chalazion refractory to medical management. An excisional biopsy sent to pathology revealed metastatic retroperitoneum LMS. There was resolution of ocular irritation following biopsy, and an oncology referral was made.

Conclusion: This case of metastatic LMS to the eyelid mimicking a chalazion is rare, as only six other cases have been described previously. Our case contributes to this discussion by highlighting the importance of considering metastatic disease and performing a full-thickness biopsy in a patient presenting with a non-resolving eyelid chalazion. Recognizing tumor spread to the eyelid can be an important step in the diagnosis, surveillance, and management of metastatic LMS.

Keywords: Leiomyosarcoma; Chalazion; Eyelid; Metastatic; Oculoplastic Surgery.

Figure 1

(A) External photography of the right adnexa demonstrating a firm, elevated lesion that involves the eyelid margin. (B & C) Venous phase contrast-enhanced computerized tomography of the abdomen demonstrating a large soft tissue mass within the right retroperitoneum in coronal (B) and transverse (C) views represented by a yellow overlay.

Figure 2

Biopsied eyelid lesion. (A) Subepithelial spindle cell proliferation extending to the margins. (B) The presence of a fascicular growth pattern is common in sarcomas. (C) There are notable pleomorphic cells, which include atypical hyperchromatic cells along with apoptotic tumor cells and nuclear debris. Immunohistochemical staining of the biopsied lesion. (D & E) Demonstration of positive desmin (D) and smooth muscle actin stain (E). (F) Negative staining of pan cytokeratin that is common to other epithelial-based tumors, e.g., squamous cell carcinoma.