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Sebaceous carcinoma of the eyelid is an uncommon tumour with unusual modes of presentation. It can remain occult at the primary site, without producing any mass, masquerading as chronic blepharoconjunctivitis, while setting up metastases in the regional lymph nodes especially in the pre-auricular group. We report here a case that not only masqueraded as chronic blepharoconjunctivitis with nodal metastases from an 'unknown primary' in the neck, but whose tumour spread in a pagetoid manner along the nasolacrimal duct producing a nasal tumour that was believed to be the 'unknown primary'. This case emphasizes the need for ophthalmologists, ENT surgeons and pathologists to keep sebaceous carcinoma in mind while evaluating patients with chronic blepharoconjunctivitis and cervical node metastases from 'unknown primary'. Histological clues for picking up a sebaceous carcinoma at a metastatic site include a tumour with comedo or ductal growth pattern and intracytoplasmic lipid.

Tumors of the fronto-orbitomaxillary segment are complex and pose a significant challenge for radical resection and subsequent reconstruction. With evolution in surgical reconstructive techniques, better reconstruction of these complex defects is now possible and facilitates more aggressive surgical management. The anterolateral thigh (ALT) flap has features particularly suited for this reconstruction. We review our single institutional experience with this technique. Sixteen consecutive patients with defects of the fronto-orbitomaxillary segment (from radical resection of craniofacial tumors of this region) were reconstructed using the free ALT flap. The demographic features, radiology, histology, and surgical technique as well as the perioperative events were reviewed retrospectively from a prospective database of all craniofacial resections performed. There were 9 males and 7 females with a mean age of 35 years. Eleven had previously undergone surgery. Dura was resected in 6 and inadvertently breached in another 2. Gross total resection was achieved in 14 (87.5%) of the 16 patients, of which 8 had microscopically negative margins. Thirteen musculocutaneous flaps and 3 chimeric flaps were performed. The mean duration of surgery was 9.4 hours. The average total blood loss was 2000 mL. There was no perioperative mortality. Major complications occurred in 2 patients in the form of venous thrombosis on the next day of surgery. These were detected and salvaged promptly by urgent re-exploration and redo of venous anastomosis, ultimately requiring skin grafting for partial flap loss. In our experience, the free ALT flap is a suitable reconstructive choice for complex craniofacial defects and has favorable results.

Intracranial tuberculomas are less common lesions; sellar, suprasellar, or parasellar involvement is further rarer with only few case reports in the literature. We describe a case of 44-year-old female, discussing the imaging findings that were managed successfully for tubercular hypothalamic-pituitary abscesses.

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