A. Clinical photograph of patient showing yellowish ulcerated mass of the posterior lamella of the left upper eyelid. B. PET/CT of the region showing hypermetabolic left upper eyelid mass that had a maximum standard uptake value (SUV) of 10.6 abutting the nasolacrimal apparatus with thickening of the skin extending onto the nasal sidewall and postseptal extension involving the attachment of the medial rectus muscle, and the Tenon's capsule thought to be orbital extension of the tumor.

A. H & E stained section of the lesion showing papillomatous conjunctival epithelium infiltrated by SebCCa cells with cytoplasmic vacuolations. B. Enlarged view of malignant SebCCa cells with mitotic figures (arrows)(400X) C. Enlarged view of foamy histiocytes present in the deep orbital portion of the tumor (400X) Inset photograph showing a multinucleated giant cell (arrow) D. Cytokeratin (high molecular weight) immunostaining of the lesion showing tumor cells in the center (arrows) and within the epithelium (arrowheads)(2X) E. Enlarged view of cytokeratin stained positive SebCCa cells within the epithelium (200X) F. CD68 immunostaining of the lesion showing a dense mass of CD 68 positive histiocytes in the subepithelial stroma (2X) G. Enlarged view of CD 68 positive macrophages (400X)