Sebaceous Gland Carcinoma

To describe the histopathologic spectrum and patient characteristics of eyelid tumors in Beijing Tongren Hospital. It was a claims database analysis. A total of 2639 eyelid tumors verified histopathologically from January 1997 to December 2006 were included in the study. Of the 2639 eyelid tumors, the 5 most common eyelid benign lesions were inflammatory lesion, melanocytic nevus, papilloma, dermoid cyst and epidermoid cyst, and epithelial cyst. The 5 leading eyelid malignant tumors were basal cell carcinoma, sebaceous gland carcinoma, lymphoma, squamous cell carcinoma and melanoma. The mean age at diagnosis was 61 years for basal cell carcinoma and sebaceous gland carcinoma, 57 years and 52 years for squamous cell carcinoma and melanoma, respectively, and 48 years for lymphoma. There was no significant sex predilection in basal cell carcinoma and sebaceous gland carcinoma. Melanoma and lymphoma occurred more commonly in women, whereas squamous cell carcinoma occurred more commonly in men. Basal cell carcinoma and sebaceous gland carcinoma were the most common malignant eyelid tumors, and lymphoma ranked third and had an increasing trend. The malignant tumors occurred predominantly in the elderly of 60 years and above.

Background: Eyelid tumors present with a diverse histopathological spectrum, varying across geographic and ethnic groups. In Asia, sebaceous gland carcinoma (SGC) often rivals basal cell carcinoma (BCC) in incidence. This study evaluates the clinicopathological profile of eyelid tumors from Northeast India. Objective: To analyse the histopathological distribution, demographic profile, and malignant versus benign ratio of surgically excised eyelid tumours over six years at a tertiary care centre. Methods: A retrospective review was conducted on histopathologically diagnosed eyelid tumors excised between March 2008 and February 2014. Clinical and demographic data were retrieved. Routine H&E staining was performed, with immunohistochemistry as needed. Tumours were classified according to the WHO 5th edition classification. Results: Of 132 excised eyelid lesions, 124 were neoplastic (81.5% benign, 18.5% malignant), and 8 were inflammatory chalazia. Benign tumors included epidermal cyst (23.8%), dermoid cyst (21.8%), haemangioma (14.9%), and squamous papilloma (11.9%). Among malignancies, basal cell carcinoma (BCC) predominated (39.1%), followed by squamous cell Carcinoma (SCC) (30.4%), Sebaceous gland carcinoma (SGC) (21.7%), and malignant melanoma (8.6%). Malignant tumors showed a female preponderance. Comparative analysis with regional and global studies demonstrated higher proportions of SGC and SCC in this cohort. Conclusion: Benign lesions remain predominant in eyelid tumors. However, sebaceous carcinoma and squamous cell carcinoma constitute a significant malignant burden in this Northeast Indian population. Early biopsy and histopathological diagnosis are essential for timely intervention.

The eyelids are affected by wide spectrum of benign and malignant lesions. Basal cell carcinoma (BCC) is the most common malignancy encountered while other malignant lesions such as sebaceous cell carcinoma and squamous cell carcinoma are rare. Data regarding geographical variation in trends of malignant eyelid tumors are presented in the current study. Prospective, longitudinal, observational study was conducted from December 2011 to October 2013. Patients with mass or growth involving eyelid managed by surgical intervention were selected for the study. Excised tissue masses were sent for histopathological examination. Fifty-two cases of extraocular tumors were operated during the study period, out of which 25 cases (48%) were of eyelids. Sixteen cases (64%) were benign, and remaining 9 cases (36%) were malignant eyelid neoplasms. Benign lesions exhibited female preponderance with male:female ratio of 1:2.25. No significant difference was noted in cases of malignant lesions with male:female ratio of 1:1.25. Most common benign tumor observed was sebaceous cyst. Sebaceous gland carcinoma (4 cases) was the most common malignant neoplasm followed by squamous cell carcinoma (2 cases) and BCC, orbital melanoma, and adenocarcinoma (1 case each). Sebaceous gland carcinoma is more common in North India as compared to BCC and squamous cell carcinoma.

Sebaceous carcinomas are rare malignant tumours which arise from sebaceous glands. They are subclassified into ocular and extraocular subtypes and most commonly occur in the head and neck region. Tumours below the neck occur infrequently, and most commonly resemble benign skin lesions such as pyogenic granulomata and molluscum contagiosum, or malignant skin tumours like basal and squamous cell carcinomas (SCCs). We report a case of an 86-year-old lady presenting with a fungating breast tumour which began as a “mole” and exhibited insidious growth over five years to reach a maximum size of 10 cm. An excision biopsy was performed by the breast surgery team and histopathological analysis revealed a sebaceous carcinoma arising from the skin adnexa. On subsequent follow up, the patient was found to have a 19 mm mass in the left breast and a 20 mm mass in the right breast, which was P5 and P3 on clinical palpation, respectively. Core biopsies of left and right breast lesions showed invasive lobular carcinoma and invasive ductal carcinoma with lobular features respectively; the patient was started on primary letrozole treatment. The patient also went on to have a 2 cm wide local excision of the sebaceous carcinoma scar which was excised down to the pectoralis fascia. This is a unique presentation of a sebaceous gland carcinoma presenting as a fungating breast tumour. These tumours have a high metastatic potential and local recurrence rate, and can co-exist with primary carcinoma of the breast.

Introduction: Eye lid and adnexal tumours are one of the major problems we see in the oculoplastic department. Malignant eye lid tumours are rare in comparison to benign and diversity in its clinical presentation makes it difficult to diagnose earlier. Eyelid malignancies can mimic a host of benign neoplasms and other less aggressive neoplastic or non-neoplastic inflammatory conditions and need differentiation before definitive therapy is planned. Out of 90% of all skin cancer occurring in head and neck region 10% occurs in the eyelid. A histopathological study confirms the diagnosis that can be correlated with patient history and other clinical data. Objectives: To study the clinicopathological correlation and its outcome in patients with malignant eyelid and adnexal tumours presenting at Biratnagar eye hospital. Methodology: Details of the cases of histopathologically proven malignant eyelid and adnexal tumours presenting to the department of oculoplasty from July 2016 to August 2019 were recorded. The duration of disease, presenting symptoms, risk factors, demographic data, clinicopathological correlation with its accuracy and mode of treatment were analyzed using SPSS 17. Results: Out of total 28 patients, male were 53.6% and female were 46.4%. The mean age of presentation was 60.5±11.8 years. 53.6% tumors were located in upper lid, 39.9% were located in lower lid and 7.1 % were located in medial canthus. Basal cell carcinoma and sebaceous gland carcinoma were the most common type of malignancies (35.7% each) followed by 28.6% of squamous cell carcinoma of eyelid. The clinicopathological correlation revealed 75% of clinical accuracy. Different types of reconstructions were done according to the size and site of the defect. Modified Hughes procedure for lower eyelid defect was the most common procedure performed (32.1%), followed by 14.3% Cutler beard, 28.6% Cutler beard with post auricular cartilage graft, 10.7% Glabellar flap rotation 7.1% had combined procedure and 4.3% direct closure . Conclusion: Sebaceous cell carcinoma and Basal cell carcinoma were the most common malignant tumors followed by squamous cell carcinoma. The upper lid was the most common site for such malignancy. Histopathological examination was useful for the establishment of complete and accurate diagnosis, which led to further management and follow up protocol for malignant eyelid tumours.

Recurrent sebaceous gland carcinoma of eyelid previously diagnosed as basal cell carcinoma: case report

Background/Aims: We present a case of 2 concomitant tumours, i.e., a sebaceous carcinoma (SC) and a small lymphocytic lymphoma (SLL), in the lacrimal gland of a patient with Muir-Torre syndrome. Methods: Clinical history, orbital examination, diagnostic biopsy, excisional biopsy, and histopathologic analysis were utilized. Results: An 89-year-old female presented to the eye casualty with corneal ulcer, anterior uveitis, proptosis, and restricted ocular motility. She has a clinical history of breast cancer, colon carcinoma, and SC of the eyelid, which had been resected completely 2 years before. Clinical examination, imaging, and diagnostic biopsy confirmed orbital SC recurrence. Exenteration and subsequent histopathologic analysis of the specimen revealed lymphocytic infiltrates consistent with SLL within the lacrimal gland. Conclusion: We report for the first time a case of a patient with Muir-Torre syndrome who developed an orbital recurrent SC with an incidental finding of a lacrimal gland B non-Hodgkin lymphoma consistent with SLL. Clinicians should be aware of the possibility of this coexistence of multiple cancer types in patients with sebaceous carcinoma and Muir-Torre syndrome.

Objectives:This study was an evaluation of demographic and histopathologic features of eyelid lesions.Methods:The medical records of 261 patients (296 eyelid lesions) who attended a single clinic between 1997 and 2011 were examined retrospectively. The incidence of benign and malignant lesions, the pathological classification, and age and sex data were investigated.Results:A total of 204 benign lesions (68.9%) and 92 malignant neoplasms (31.1%) were found. Among these, the most frequently seen types of benign neoplasms were xanthelasma (28.4%), papilloma (14.7%), chalazion (8.8%), nevus (6.4%), moll cyst (5.9%), and capillary hemangioma (4.9%). The most frequently seen malignant neoplasms were basal cell carcinoma (72.8%), squamous cell carcinoma (13%), and sebaceous gland carcinoma (5.4%). The study group was made up of 149 (57%) female patients and 112 (43%) male patients. The majority of benign lesions were seen in women, whereas malignant neoplasms were observed more often in male patients. The mean age of patients with benign lesions and malignant neoplasms was 38.1±21.7 and 62.7±15.3 years, respectively. Benign lesions involved the upper eyelid more frequently than the lower, while malignant lesions were seen more frequently in the lower eyelid, with the exception of sebaceous gland carcinoma.Conclusion:The majority of eyelid lesions were benign and malignant neoplasms were seen more frequently in the older population. Basal cell carcinoma was the most common malignant eyelid tumor. The most common site of malignant tumor origin was the lower eyelid, with the exception of sebaceous gland carcinoma.

MUC1 and Sialoglycan Expression Associated with Cytotoxic T Lymphocyte Infiltration in Eyelid Malignant Tumors

The purpose of this study was to identify prognostic factors predicting outcomes in sebaceous gland carcinomas. We conducted a retrospective medical chart review of patients with sebaceous carcinomas of periorbital (n = 33) and extraorbital sites (n = 13). Patients with periorbital tumors had higher recurrence rates than did patients with extraorbital tumors (64% vs 23%; p = .032). Patients who were older than 60 years (p = .035) and had lower eyelid tumors (p < .0001) had a lower disease-free survival rate than did patients with upper eyelid tumors. Patients with sebaceous carcinomas had a high rate (60%) of occult lymph node metastases. Periorbital tumors are associated with poorer outcomes than are extraorbital tumors. Lower eyelid carcinomas have the worst prognosis and should be treated more aggressively. Our findings of a high incidence of occult neck disease and a high rate of regional recurrence in patients with sebaceous carcinomas support the consideration of prophylactic elective neck dissections for treating such patients.

To the Editor: We thank Drs Kramer and Chen1 for their interest in our article published in this Journal. The authors raise a valid question as to why the term in situ carcinoma cannot be applied to cutaneous sebaceous neoplasms. They also rightfully cite the definition of carcinoma in situ, which is a malignant epithelial neoplasm confined within the epithelium of origin. But the main question is: What is the origin for cutaneous sebaceous carcinoma? Whereas in periorbital sebaceous lesions, it is accepted that sebaceous lesions arise from meibomian glands and glands of Zeis, sebaceous glands elsewhere in the skin practically never appear to give rise to a sebaceous carcinoma. In our files we have over 100 unequivocal extraocular sebaceous carcinomas, and in none of them is there evidence that the tumor has arisen from a preexisting sebaceous gland in a manner analogous, for example, to an invasive squamous carcinoma for which intraepithelial precursor lesions including actinic keratosis and Bowen disease (squamous cell carcinoma in situ) are typically found. We have seen a limited number of intraepidermal sebaceous carcinomas (Fig. 1), not extending beyond the epidermal basement membrane and lacking any association with sebaceous gland. Such lesions qualify as sebaceous carcinoma in situ and their features indicate that they have originated from epidermis, and that the original basement membrane at the dermoepidermal interface is intact. It is our view that the term “sebaceous carcinoma in situ” is valid only for a vanishing minority of sebaceous neoplasms and in most of these it is not possible to determine their precise origin (viz. sebaceous gland vs. epidermis) let alone assessing accurately whether the original basement membrane has been breached. Therefore, we would discourage the use of the term “sebaceous carcinoma in situ” for other sebaceous tumors.FIGURE 1: Sebaceous carcinoma in situ. The tumor is wholly intraepidermal and does not extend beyond the preexisting basement membrane (A). There are more and less differentiated areas (B).Our article2 intended to highlight the existence of a small group of cutaneous sebaceous proliferations wherein the distinction between malignant and benign may be difficult and we accept that opinions on their classification may vary. The current approach in dermatopathology is to classify sebaceous lesions as benign or malignant. However, in sebaceous tumors attempting to classify accurately all lesions into either of these 2 categories may be an oversimplification of the problem. Some sebaceous tumors have a symmetrical silhouette similar to other benign adnexal tumors and they behave in a benign fashion despite having clearly malignant cytologic features. It is important to state that a similar situation can be seen infrequently in other adnexal tumors such as trichoblastomas and pilomatricomas. We disagree with Drs Kramer and Chen that the 5 cases we reported are better classified as sebaceous adenoma. Sebaceous adenoma has completely different architectural and cytologic features. It has a distinctly multilobular architecture with several contiguous lobules usually showing connection to the overlying epidermis and replacing the squamous cells. The lobules vary in shape, sometimes even within a single lesion and there is a pushing, sharply demarcated interface with the adjacent stroma. The lateral-most lobules often show a polarity imparting a wart-like appearance to the lesion at low power. The individual lobules consist of peripheral layers of small basaloid germinative cells (usually more than 2 layers) while more centrally are found maturing sebocytes having multivacuolated cytoplasm and scalloped nuclei. Cytologic atypia and abnormal mitoses are absent. None of our 5 cases had such a multinodular architecture or epidermal connection and in all cases immature germinative cells predominated over mature sebocytes, thus limiting the differential diagnosis to sebaceoma or sebaceous carcinoma. We would also point out that the extreme view of Dr Ackerman as cited by Drs Kramer and Chen that all sebaceous adenomas are in fact carcinomas is not shared by many, us included. Using the criteria outlined above, we have collectively diagnosed over 200 sebaceous adenomas over the last 15 years and in no case did the follow-up suggest a clinically malignant behavior. Dmitry V. Kazakov, MD, PhD Sikl's Department of Pathology, Charles University, Medical Faculty Hospital, Pilsen, Czech Republic Heinz Kutzner, MD Dermatohistopathologische Gemeinschaftspraxis, Friedrichshafen, Germany Dominic V. Spagnolo, MMBS Division of Tissue Pathology, PathWest Laboratory Medicine WA, Nedlands, WA, Australia Arno Rütten, MD Dermatohistopathologische Gemeinschaftspraxis, Friedrichshafen, Germany Petr Mukensnabl, MD Michal Michal, MD Sikl's Department of Pathology, Charles University, Medical Faculty Hospital, Pilsen, Czech Republic

Introduction: sebaceous carcinoma is an uncommon and aggressive malignant cutaneous tumor. this neoplasm is thought to arise from sebaceous glandsin the skin and, therefore, may originate anywhere in the body where these glands are found. this region is a common site of origin because the periocular region is rich in this type of gland. However, axilla has rich sebaceous gland as well which may give rise to carcinoma. case report: We hereby present a case of a 55-year-old female with sebaceous cell carcinoma of the axilla. conclusion: though extra ocular sebaceous cell carcinoma is rare aggressive tumor.

Sebaceous carcinoma is a rare malignant tumour of skin. It commonly occurs in the head and neck region. The standard of care for localized disease is wide local excision followed by radiotherapy. Occasionally, sebaceous carcinoma can be associated with Muir-Torre syndrome, which is characterized by sebaceous lesions and carcinomas in the visceral organs. Metastatic sebaceous carcinoma is even rarer, with very little evidence about the role of chemotherapy in the treatment of metastatic disease. Here, we report a case of recurrent sebaceous carcinoma metastatic to the rectum (initially mimicking rectal cancer and Muir-Torre syndrome) in which the disease responded to multiple lines of chemotherapy. We also review the available literature on chemotherapy in this disease and discuss the role of tumour profiling and genotype-guided selection of chemotherapeutics in such rare tumours.

Sebaceous carcinoma (SC) is a prevalent neoplasm of the eyelid, ranking second to basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in incidence. In some Asian regions, the incidence of SC is as high as 50% with a high risk of invasion and recurrence. Diagnosis of SC is still challenging owing to its atypical histological features and variable immunohistochemical profiles, especially in poorly differentiated ones. Therefore, it is critical to identify more precise immunohistochemical makers for the prediction of SC. In this study, we performed a double-blind, retrospective analysis using tissue microarrays to evaluate the diagnostic accuracy of TRPS1, GATA3, and adipophilin in a cohort with 98 SCs, 56 BCCs, and 55 SCCs. Receiver operating characteristic curves analysis and DeLong’s test were used to confirm the applicability of these markers. Binary logistic regression was applied to construct a cancer classification model, with model validity confirmed through likelihood ratio tests (Δ-2LL = 255.937, p < 0.001) and pseudo-R² metrics (Cox & Snell R² = 0.706, Nagelkerke R² = 0.803, McFadden R² = 0.578). Variable contributions were assessed via hierarchical likelihood ratio tests and Wald analyses, revealing significant discriminative power of TRPS1 score (OR = 524.410, p < 0.001) and other predictors. Our results revealed that the combination of above three markers significantly enhanced the diagnostic performance compared to individual ones. Notably, TRPS1 and GATA3 demonstrated superior discriminatory power in distinguishing SC from BCC and SCC to adipophilin. In poorly differentiated SCs, TRPS1 exhibited a markedly higher diagnostic efficacy than GATA3 and adipophilin. In addition, TRPS1 exhibited higher AUC values than GATA3 and adipophilin in differentiating primary and recurrent SCs, although the difference was not significant. Collectively, our findings indicate that the TRPS1/GATA3/adipophilin-based model demonstrated excellent discriminatory efficacy for eyelid malignancies (Kappa = 0.784, micro-average F1 = 0.882, AUC-ROC = 0.964 [95%CI:0.934–0.994]), achieving clinical-grade performance.

Malignant lesions of the eyelid are the most common eye cancers. Although rarely lethal, late diagnosis can lead to serious visual morbidity. Definitive diagnosis of neoplastic lesions is pathological. Indications and types of eyelid lesions in a single high-volume ophthalmic reference center in Sao Paulo, Brazil, were analyzed. The surgical pathological reports of patients who underwent eye removal procedures between January 2000 and December 2012 were retrieved from the electronic database of the Ophthalmology Department and retrospectively reviewed. Data regarding the final anatomopathological diagnosis, sex, and age were analyzed via the χ2 test with Yates' correction. Of the 1,113 eyelid tumors resected over the 13-year study period, 324 (29%) lesions were malignant. The most prevalent lesions were basal cell, squamous cell, and sebaceous gland carcinomas. The median ages of patients (females, n=165, 51%; males, n=159, 49%) with a diagnosis of basal cell, squamous cell, and sebaceous gland carcinomas were 65, 75, and 70 years, respectively. This is the largest retrospective cohort analysis of eyelid tumors in a Latin American population. These findings are in agreement with those from large centers in other countries and regions.