A 56-year-old patient presents with a smooth, round, slightly scaly lump on the forehead, 2mm in maximum dimension. The clinical diagnosis was query basal cell carcinoma and it was excised.
Microscopic findings were of sebaceoma and following immunohistochemistry staining shows loss of nuclear positivity of the DNA mismatch repair enzymes MSH2 and MSH6, which is usually associated with high-degree microsatellite instability (MSI), and raises the possibility of Muir Torre syndrome associated tumour.
The patient underwent investigations, including colonoscopy, and was found to have a fungating lesion in the sigmoid colon.
The patient had a left-sided hemicolectomy and the microscopic findings were of a moderately differentiated adenocarcinoma. It also has the same loss of nuclear positivity of the DNA mismatch repair enzymes MSH2 and MSH6, which further raises the possibility of Muir Torre syndrome associated tumour.
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