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Dermpath-India

Pathology of Sebaceous Carcinoma 

  Dr Sampurna Roy MD       

 

Path Quiz Case 12: Case history and  images

Diagnosis : Sebaceous Carcinoma

 

                                                                                                                      

 

Sebaceous carcinoma is an aggressive tumour with both local recurrence and distant metastasis.

It has been noted that this lesion commonly occurs in the Asian population.

Sebaceous carcinoma is rarely associated with Muir-Torre syndrome. 

These tumours have been divided into 2 groups : Ocular and Extraocular.

Ocular sebaceous carcinoma is more common.

Ocular cases may mimic chalazion. 

The tumour arises from the glands in the periocular region (Meibomian glands, Glands of Zeis). 

Extraocular sebaceous carcinoma is usually noted in the head and neck area.

Grossly, the tumour presents as nodules, papules and plaques.

Microscopic features:

Histology reveals irregular lobular growth pattern composed of sebaceous and undifferentiated cells.

These cells show variation in the shape and size of nuclei.
The undifferentiated cells show eosinophilic cytoplasm with fine lipid globules.

Some large lobules show areas of atypical keratinizing cells.

There is pagetoid spread of malignant cells in the conjunctival epithelium or epidermis of the skin of the lid.

Differential Diagnosis- Extramammary Paget's disease .

This is rarely seen in extraocular sebaceous carcinoma.

The pagetoid cells contain no mucopolysaccharides but stain positively for fat with oil red O .

[NOTE:

Identification of pagetoid growth pattern in biopsy material is essential to recognize the presence of an underlying sebaceous carcinoma. ]

Special stains:   Image

To highlight the presence of tumour cells with sebaceous differentiation one would require special histochemical techniques, such as oil red O, Sudan IV stains on fresh tissue and EMA immunostains on paraffin embedded tissue.

 

Differential diagnosis: Squamous cell carcinoma ; Basal cell carcinoma with sebaceous differentiation.

 

Criteria for Malignancy in Sebaceous Neoplasia:

Lazar AJF, Lyle S, Calonje E. Sebaceous neoplasia and Torre–Muir syndrome. Current diagnostic pathology 2007;13(4):301-319.

- Sebaceous tumors showing an infiltrative border or cytologic atypia should regarded as malignant.

- Tumor necrosis in basaloid areas is a strong indicator of malignancy, but should not be confused with areas of holosection in sebaceous adenomas.

- Mitoses are not a strict criteria for malignancy as sebaceomas can sometimes show conspicuous mitotic activity. An unusual number of mitoses or   atypical mitotic forms must be interpreted within the overall appearance of the tumor.

- Pagetoid intraepithelial migration indicates malignancy, but is not commonly encountered in non-ocular cases. 

- All sebaceous tumors of the eyelid should be regarded as malignant unless they clearly meet criteria for a benign category.

- Sebaceous tumors associated with the Muir-Torre syndrome can sometimes show unusual cytologic and architectural features. It is important to remark on the atypical features and inability to strictly classify a lesion as benign so that appropriate clinical follow-up can be initiated.

 

 

Further reading:

Excision and Delayed Reconstruction With Paraffin Section Histopathological Analysis for Periocular Sebaceous Carcinoma.

Sebaceous carcinoma of the vulva. 

Sebaceous carcinoma.
A histochemical and immunohistochemical study of extra-ocular sebaceous carcinoma.

Adnexal carcinomas of the skin. II. Extraocular sebaceous carcinomas.
Sebaceous carcinoma of the eyelid. Errors in clinical and pathological diagnosis.

Sebaceous carcinoma with apocrine differentiation: A rare entity with aggressive behavior.

Hypermethylation of the CDKN2A gene promoter is a frequent epigenetic change in periocular sebaceous carcinoma and is associated with younger patient age.

Sebaceous carcinoma of the lip.

Rippled pattern extraocular sebaceous carcinoma: a rare case report with brief review of literature.

 

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 


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