Interactive Case Study - February 2026

Chronically Irritating Nodule of the Upper Eyelid

Sarah Muir, BSA, BA

Agnes I. Udoh MD, MBA

Liliana Rincon Alzate, MD

A 76-year-old woman presented to the clinic for evaluation of a chronically irritating lesion on the left upper eyelid. The patient reported that the lesion had been gradually worsening since onset and was now significantly symptomatic with eyelid pain. An excisional biopsy of the 1.1 cm nodule showed the following histomorphology (Figure 1 and 2). Immunohistochemical stains for ER, PR, synaptophysin, chromogranin, and INSM1 (Figures 3, 4, 5, 6, 7, and 8).

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5X H and E

40X H and E

10 X H and E

ER immunostaining

PR immunostaining

Synaptophysin immunostaining

Chromogranin immunostaining

INSM1 immunostaining

Which of the following is the best diagnosis:

Basal cell carcinoma

Chalazion

Endocrine Mucin-Producing Sweat Gland Carcinoma

Sebaceous carcinoma

Tubular Apocrine Adenoma

Which of the following immunohistochemical profiles is most characteristic of Endocrine Mucin-Producing Sweat Gland Carcinoma (EMPSGC) of the skin?

CK20 (+), CDX2 (+), CK7 (-)

CK20 (+), Chromogranin (-), Synaptophysin (-)

CK7 (-), CK20 (-), Chromogranin (+), Synaptophysin (+)

CK7 (+), Chromogranin (+), Synaptophysin (+)

p63 (+), CK5/6 (+), EMA (-)

Cameron, M. C. et al. Basal cell carcinoma. J Am Acad Dermatol 80, 303–317 (2019).
Chuang, I.-C. & Jang, C.-S. Endocrine mucin-producing sweat gland carcinoma: Reappraisal of patient demographics and tumour immunophenotypes. Indian J Dermatol Venereol Leprol 88, 544 (2022).
Meltzer, O. A. & Joseph, J. M. Delayed treatment of endocrine mucin–producing sweat gland carcinoma initially diagnosed as a chalazion. JAAD Case Rep 5, 789–791 (2019).
Kim, E. S., Afshin, E. E. & Elahi, E. The lowly chalazion. Surv Ophthalmol 68, 784–793 (2023).
Pe’er, J. Pathology of eyelid tumors. Indian J Ophthalmol 64, 177 (2016).
Agni, M. et al. An Update on Endocrine Mucin-producing Sweat Gland Carcinoma. American Journal of Surgical Pathology 44, 1005–1016 (2020).
Cazzato, G. et al. Endocrine Mucin-Producing Sweat Gland Carcinoma: Case Presentation with a Comprehensive Review of the Literature. Dermatopathology 10, 266–280 (2023).
Au, R. T. M. & Bundele, M. M. Endocrine mucin‐producing sweat gland carcinoma and associated primary cutaneous mucinous carcinoma: Review of the literature. J Cutan Pathol 48, 1156–1165 (2021).
Froehlich, M. H. et al. Endocrine mucin-producing sweat gland carcinoma: a systematic review and meta-analysis. Journal of Dermatological Treatment 33, 2182–2191 (2022).
Mudhar, H. S., Zembowicz, A., Hyrcza, M. D. & Kaliki, S. WHO Classification of Tumours online. Eye and orbit tumours (5th ed.) // Tumours of the eyelid // Adnexal tumours of the eyelid // Malignant tumours of the eyelid // Endocrine mucin-producing sweat gland carcinoma. International Agency for Research on Cancer https://tumourclassification.iarc.who.int/chaptercontent/65/38.
Mulay, K., Aggarwal, E. & White, V. A. Periocular sebaceous gland carcinoma: A comprehensive review. Saudi Journal of Ophthalmology 27, 159–165 (2013).
Nair, A., Bhargava, R. & Furniturewala, A. Endocrine mucin-producing sweat gland carcinoma of the eyelid: A clinical and histological conundrum. Indian J Ophthalmol 66, 1042 (2018).
Choi, J. et al. Apocrine tubular adenoma on the palm: A case report. Medicine 100, e28002 (2021).
Eiger-Moscovich, M. et al. Tubular apocrine adenoma of the eyelid - A case report and literature review. Saudi J Ophthalmol 33, 304–307 (2019).
Fernandez‐Flores A, Cassarino DS. Endocrine mucin‐producing sweat gland carcinoma: a study of three cases and CK8, CK18 and CD5/6 immunoexpression. Journal of cutaneous pathology. 2015;42(8):578-586. doi:10.1111/cup.12512
Zembowicz A, Garcia CF, Tannous ZS, Mihm MC, Koerner F, Pilch BZ. Endocrine mucin-producing sweat gland carcinoma : Twelve new cases suggest that it is a precursor of some invasive mucinous carcinomas. The American journal of surgical pathology. 2005;29(10):1330-1339. doi:10.1097/01.pas.0000170348.40057.60

Acknowledgements

Author Profiles

Sarah Muir, BSA, BA

University of Texas Medical Branch

Sarah Muir is a third-year medical student at the University of Texas Medical Branch John Sealy School of Medicine. She is completing her core clerkship rotations in Galveston and across Texas. She received her Bachelor of Science and Arts degree in neuroscience and her Bachelor of Arts degree as part of the Plan II Honors Program from the University of Texas at Austin in May 2021.

Agnes I. Udoh MD, MBA

University of Texas Medical Branch

Agnes Udoh is a third-year pathology resident at the university of Texas medical branch at Galveston, Texas.

She gained her medical degree from Madonna University, Nigeria and went on to obtain an MBA from the Rice University Jones School of Business in Houston, Texas.

Her interests include cytopathology, dermatopathology and breast pathology.

Liliana Rincon Alzate, MD

University of Texas Medical Branch

Dr. Liliana Rincon an Assistant Professor of the pathology department at the university of Texas Medical branch in Galveston, TX. She is a board-certified dermatopathologist and surgical pathologist. She performed her residency and Dermatopathology fellowship with the University of Texas Medical Branch and a Surgical pathology fellowship at Houston Methodist Hospital.

Question:

Interactive Case Study - February 2026

Acknowledgements

Author Profiles

Chronically Irritating Nodule of the Upper Eyelid

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