BACKGROUNDPrimary sebaceous carcinoma of lacrimal gland (SCLG) is extremely rare. Due to its clinical characteristics, it is often misdiagnosed. It is known to be aggressive so delay in diagnosis can increase the chance of local recurrence and metastasis. We report a case of primary SCLG.CASE SUMMARYA 75-year-old man was referred with a painful swelling in the right eyelid. Computed tomography scan demonstrates a 2.6 cm mass in upper outer quadrant of right orbit. After the incisional biopsy of the mass, he was diagnosed with squamous cell carcinoma of lacrimal gland. A right orbital exenteration, cervical lymph node dissection was performed. There was no involvement of the overlying periorbital skin, eyelid, or conjunctiva. Histological examination of the exenteration specimen showed tumor arising from the lacrimal gland, which had been entirely replaced by sebaceous carcinoma with sarcomatous and squamous differentiation. Neoplastic cells which were large and contained prominent nucleoli. Focal tumor remained in the posterior resection margin. Patient underwent adjuvant radiotherapy, total dose of 56 Gy with dose-per-fraction 2 Gy to primary lesion. There has been no sign of recurrence until 2-years follow-up.CONCLUSIONWe report a rare case of sebaceous carcinoma arising from the lacrimal gland. Accurate diagnosis of SCLG is important for appropriate treatment and prognosis prediction.

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Purpose:The study was aimed to review and understand the meaning of cancer cachexia. Methods: Using the keywords "cachexia" and "cancer cachexia" 30 oncology research published from 1974 to 2009 were selected for the review. Results: The mechanism of cancer cachexia has not been fully understood, but various pathogenesis appears to be involved in the development cachexia including altered metabolism of carbohydrate, lipid, and protein associated with cytokines and hormone. As a result, muscle strength, food intake and resting energy expenditure (REE) are reduced. Most medications for the treatment of cachexia show debating results except some drugs such as megace. Supportive care including nutritional education, nursing care, and social support are found another effective treatment options. Conclusion: The results of this study would help oncology nurses to understand the mechanism of cancer cachexia and its management.

Multiple primary cancers, i.e., the occurrence of multiple malignant neoplasms in a single patient, were first reported by Billorth in 1889. The incidence is low but increasing gradually due to developments in cancer diagnosis, early detection, and prolongation of life. In Korea, double primary cancers are occasionally reported. However, the simultaneous presence of four primary cancers in a single patient is rare. Recently, we experienced the case of a 68-year-old male diagnosed with quadruple primary cancers involving the esophagus, tonsils, liver and buccal mucosa. Here, we report this very rare case of four metachronous primary neoplasms and provide a brief review of the related literature.

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