Purpose

To report a case of a unique histological subtype of a rare unreported spindle cell sarcoma of the right upper eyelid that has metastasised from a primary lesion in the left thenar eminence.

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Methods

Review of patient notes including clinical examination, CT / MRI / PET imaging, histopathology findings, external photographs, and management.

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Results

A 43-year-old diabetic Asian male with previously treated undifferentiated spindle cell sarcoma that started in the left thenar eminence presented with a four-month history of progressively worsening right upper eyelid thickening, swelling, redness and sticky discharge. This was initially managed as blepharitis. He subsequently developed bloody discharge and was therefore referred to oculoplastics. Multiple 3 mm punch biopsies of the right upper lid and conjunctival map biopsy confirmed metastatic undifferentiated spindle cell sarcoma. Systemic staging with CT and PET demonstrated widespread metastatic disease, including lung, soft tissue, and cardiac involvement. The patient underwent palliative radiotherapy. However, his condition deteriorated and he sadly died from heart failure secondary to cardiac metastases four months following ocular diagnosis.

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Conclusion

This is a rare case of metastatic spindle cell sarcoma of the eyelid. To our knowledge, this is the first case of eyelid metastasis of this histological subtype to be reported in the literature. Early recognition and prompt biopsy are essential for accurate diagnosis and appropriate management in atypical or resistant cases of blepharitis with a history of such aggressive malignancy.

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Additional Authors

First name	Last name	Base Hospital / Institution
David	Hughes	Royal Hallamshire Hospital
Hardeep	Mudhar	Royal Hallamshire Hospital
Jennifer HY	Tan	Royal Hallamshire Hospital
Haider	Zaki	Royal Hallamshire Hospital

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