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 Table of Contents  
CASE REPORT
Year : 2023  |  Volume : 3  |  Issue : 1  |  Page : 158-160

Eyelid metastasis after rectal adenocarcinoma


1 Department of Oculoplasty, MN Eye Hospital, Chennai, Tamil Nadu, India
2 Academic Director, MN Eye Hospital, Chennai, Tamil Nadu, India
3 Pathologist, Premier Diagnostic Centre, Chennai, Tamil Nadu, India
4 DNB Resident, MN Eye Hospital, Chennai, Tamil Nadu, India

Date of Submission16-Jun-2022
Date of Acceptance18-Sep-2022
Date of Web Publication20-Jan-2023

Correspondence Address:
Pratheeba D Nivean
MN Eye Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1409_22

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  Abstract 


Colorectal carcinoma being one of the most common gastrointestinal carcinomas in humans has few metastatic sites. An unusual presentation of eyelid metastasis in a patient with rectal adenocarcinoma has been discussed in this case report. The patient presented with eyelid secondaries with no other secondaries elsewhere in the body.

Keywords: Carcinoma rectum, lid metastasis, unusual metastatic sites


How to cite this article:
Nivean PD, Madhivanan N, Chelladurai V, Priya SD. Eyelid metastasis after rectal adenocarcinoma. Indian J Ophthalmol Case Rep 2023;3:158-60

How to cite this URL:
Nivean PD, Madhivanan N, Chelladurai V, Priya SD. Eyelid metastasis after rectal adenocarcinoma. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Feb 1];3:158-60. Available from: https://www.ijoreports.in/text.asp?2023/3/1/158/368140



Colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancer-related death.[1] CRC is more common in western countries, but the incidence is gradually increasing in developing countries. There are rapid advancements in the diagnosis and treatment of colorectal carcinoma. The common sites of metastasis are the lungs and liver. Eyelid metastasis from a rectal adenocarcinoma has not been reported. We present this case due to its rarity.


  Case Report Top


A 50-year-old male came to the ophthalmic outpatient department with symptoms of itching and a mass in the left upper lid that increased in size over the past one and half months. The patient was a known case of adenocarcinoma rectum and had undergone surgical treatment and chemotherapy a few months back. On examination, the patient's best corrected visual acuity in the right eye was 6/6 and left eye 6/6; both eyes' near vision was N12. Intraocular pressure by non-contact tonometry was 10 and 13 mm Hg in the right and left eye, respectively. A 2 × 1.5 cm solid mass, pale pink in color with engorged vessels over it in the lateral one-third aspect of the left upper lid with loss of eyelashes and alteration in the lid margin architecture was observed. [Figure 1]. A positron emission tomography (PET) scan was done, which showed no secondaries elsewhere in the body. The patient was advised of an excisional biopsy. The procedure was however done with 3 mm margin clearance along with lid reconstruction in the left upper lid. The histopathological report was suggestive of metastatic adenocarcinoma from the carcinoma (CA) rectum [Figure 2]. Diagnostic confirmation was done by positive immunohistochemical markers that include CK, CK 20, CDX 2, and CEA. The patient was sent for an oncologist's opinion. The patient was advised observation and follow-up.
Figure 1: External photograph of the patient before (a) and after (b) excision biopsy

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Figure 2: 10× (a) and 40× (b) magnification of tumor cells composed of round-to-polygonal epithelial cells with eosinophilic cytoplasm, nuclear atypia, and prominent nucleoli

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  Discussion Top


Mutations in tumor suppressor genes and DNA repair genes cause CRC.[2] Depending on the origin of the mutation, CRC can be classified as sporadic, inherited, or familial. Sporadic CRC is due to the point mutation of the genes responsible for carcinogenesis, and it is the most common cause of up to 70%. Familial CRC is associated with an adenomatous polyp, and it accounts for 15%. Inherited CRC is 5% and is caused by inherited mutations that affect one of the alleles of the mutated gene, and a point mutation in the other allele will trigger the tumor.[3]

Risk factors for developing CRC are lifestyle, age, and sedentary habits. CRC is more common after 50 years of age (except for familial and inherited types). Obesity, alcohol, smoking, and red meat consumption are some of the risk factors.[4]

Dysbiosis has been reported to cause CRC. Bacteroides, Fusobacterium, and E. coli are normal inhabitants of the colon and are responsible for the immune regulation of the body. Alteration in the gut microflora can predispose to CRC.[5] Chronic inflammation caused by pathogenic bacteria could promote carcinogenesis. It is hypothesized that proinflammatory bacteria could inhibit or exacerbate normal host responses, thus leading to abnormal apoptosis, cell proliferation, and inflammation. Another proposed mechanism is the release of bacterial secondary metabolites, free radicals, and toxins, which can damage host DNA and induce cell transformation. Probiotics have been given as part of a therapeutic regimen.

The tumor spreads through direct invasion, cavities, blood, or venous drainage.[6] Colon cancers cause abdominal metastasis. Rectal carcinomas communicate more closely with Batson's venous plexus.[7] Therefore, the sites of metastasis are extra-abdominal and the common ones are the lungs and liver. Metastasis is largely influenced by host factors and tumor factors, including chemotactic, vascular permeability, and cytokine profiles.

The other unusual sites reported are the boned,[8] penis, thyroid,[9] adrenal gland,[10] skin,[11] biliary gland,[12] pituitary gland,[13] and breasts.[14] However, there are no reports of eyelid metastasis from rectal adenocarcinoma in the literature. The source for eyelid metastasis could be vascular.

Our patient had a well-defined mass in his upper eyelid which had a prominent vasculature and loss of lashes, and the lid margin was altered. The differential diagnosis for such swellings is sebaceous gland carcinoma, squamous cell carcinoma, sebaceous adenoma, and keratoacanthoma. PET scan is generally considered the first-line modality to find extrahepatic metastasis, but in our case, the PET scan did not show any hyper-reactivity probably due to the small size of the swelling.

Eyelid secondaries have been reported after systemic lymphoma, and they were found to be more aggressive.[15] Perineural invasion is said to be the cause of such secondaries and authors recommend additional radiation to prevent local recurrence. Eyelid malignancies are common, but eyelid secondaries are less common according to the literature.[16],[17] Mansour et al. have reported the common primary sites from where the secondaries develop in the lid. The order of frequency is breasts followed by the skin, gastrointestinal tissue, and genito-urinary tract.[18]


  Conclusion Top


Eyelid metastasis though rare should be kept as one of the differentials in the metastasis of rectal adenocarcinoma. Suspicious lid swellings should be removed with margin clearance to avoid post-operative recurrences. Aberrant skeletal metastases from rectal adenocarcinoma are very rare, and they have a bad prognosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mármol I, Sánchez-de-Diego C, Pradilla Dieste A, Cerrada E, Rodriguez Yoldi MJ. Colorectal carcinoma: A general overview and future perspectives in colorectal cancer. Int J Mol Sci 2017;18:197.  Back to cited text no. 1
    
2.
Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell 1990;61:759-67.  Back to cited text no. 2
    
3.
Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N Engl J Med 2003;348:919-32.  Back to cited text no. 3
    
4.
Robertson DJ. ABC of colorectal cancer. Gastroenterology 2012;143:868-9.  Back to cited text no. 4
    
5.
David LA, Maurice CF, Carmody RN, Gootenberg DB, Button JE, Wolfe BE, et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature 2014;505:559-63.  Back to cited text no. 5
    
6.
Kauffman CL, Sina B. Metastatic inflammatory carcinoma of the rectum: Tumor spread by three routes. Am J Dermatopathol 1997;19:528-32.  Back to cited text no. 6
    
7.
Hugen N, van de Velde CJ, de Wilt JH, Nagtegaal ID. Metastatic pattern in colorectal cancer is strongly influenced by histological subtype. Ann Oncol 2014;25:651-7.  Back to cited text no. 7
    
8.
Connelly TM, Piggott RP, Waldron RM, O'Grady P. Unusual osseous metastases from rectal adenocarcinoma: A case report and review of the literature. J Gastrointest Surg 2015;19:1177-86.  Back to cited text no. 8
    
9.
Cheung WY, Brierley J, Mackay HJ. Treatment of rectal cancer metastases to the thyroid gland: Report of two cases. Clin Colorectal Cancer 2008;7:280-2.  Back to cited text no. 9
    
10.
Murakami S, Terakado M, Hashimoto T, Tsuji Y, Okubo K, Hirayama R. Adrenal metastasis from rectal cancer: Report of a case. Surg Today 2003;33:126-30.  Back to cited text no. 10
    
11.
Saladzinskas Z, Tamelis A, Paskauskas S, Pranys D, Pavalkis D. Facial skin metastasis of colorectal cancer: A case report. Cases J 2010;3:28.  Back to cited text no. 11
    
12.
Seshadri RA, Majhi U. Endobiliary metastasis from rectal cancer mimicking intrahepatic cholangiocarcinoma: A case report and review of literature. J Gastrointest Cancer 2009;40:123-7.  Back to cited text no. 12
    
13.
Ratti M, Passalacqua R, Poli R, et al. Pituitary gland metastasis from rectal cancer: Report of a case and literature review. Springerplus 2013;2:467.  Back to cited text no. 13
    
14.
Sanchez LD, Chelliah T, Meisher I, Niranjan S. Rare case of breast tumor secondary to rectal adenocarcinoma. South Med J 2008;101:1062-4.  Back to cited text no. 14
    
15.
Shome D, Bell D, Esmaeli B. Eyelid carcinoma in patients with systemic lymphoma. J Ophthalmic Vis Res 2010;538-43.  Back to cited text no. 15
    
16.
Arnold AC, Bullock JD, Foos RY. Metastatic eyelid carcinoma. Ophthalmology 1985;92:114-9.  Back to cited text no. 16
    
17.
Weiner JM, Henderson PN, Roche J. Metastatic eyelid carcinoma Am J Ophthalmol 101;1986:252-4.  Back to cited text no. 17
    
18.
Mansour AM, Hidayat AA. Metastatic eyelid disease. Ophthalmology 1987;94:667-70.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2]



 

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