First report of caruncular invasive apocrine adenocarcinoma with intracranial extension treated with a multimodal approach: a case report and literature review

A 51-year-old male presented with a rapidly growing right caruncular nodular lesion. Excisional biopsy performed elsewhere showed an apocrine adenocarcinoma of the caruncle with positive margins. Clinically, there was no obvious residual disease, mapping biopsies were negative, and cryotherapy of the surgical base was performed.The tumor recurred both anteriorly in the lower fornix and deeper in the anterior orbit a year later. These were surgically excised with adjuvant radiotherapy (60 Gy in 30 fractions). Unfortunately, the tumor continued to recur posteriorly to progressively first involve optic canal and cavernous sinus, then planus sphenoidale (with loss of right eye vision), and then intracranially with each recurrence treated with stereotactic radiosurgery. Six years from last treatment, the latest MRI revealed the involvement of Meckel's cave and optic chiasm, which is now being treated with hormonal treatment. This is the first case of invasive apocrine adenocarcinoma of the caruncle with intracranial extension treated multimodally with surgery, radiotherapy, repeated stereotactic radiosurgery, and hormone therapy.