2. PATIENT DETAILS
Mr. Thulukanam
76 years / Female
MR/17/201855
Dept: GS -III
Biopsy No: 1288/17
Date of report: 01.06.2017
Nature of specimen: Excision biopsy - Squamous cell
carcinoma of left maxillary region
14. IMPRESSION
Differential diagnosis
• Sebaceous carcinoma
• Squamous cell carcinoma
Lateral surgical margin alone shows tumor
Superior, inferior, medial and deep resected margin are
free of tumor.
Advice:
IHC – Adipophilin, AR, EMA, P63
15. Sebaceous carcinoma
• Rare
• Malignant neoplasm demonstrating exclusive
sebocytic differentiation
• Adults - 62yrs ( sixth or seventh decade)
• Female predominance (2:1)
• Tumours of eyelids seen in Asians
16. Clinical features
• Periocular and extraocular presentations
• May follow radiation therapy
• Presents as painless mass
• Can be multifocal in the ocular adnexae
• Can be mistaken clinically for chalazion, blepharitis or
cicatricial pemphigoid
• Muir – Torre syndrome
18. Clinical features
• Extraocular – mistaken for basal cell carcinoma or
squamous cell carcinoma
• Skin of head and neck, trunk, genitals and
extremities
• Rare cases seen in mouth, salivary glands, lungs and
breasts
19. Gross features
• Nodules that enlarge slowly, occasionally grows
rapidly
• Some become ulcerated
20. Histopathology
• Well differentiated tumours show tumour cells in
well defined lobules with well circumscribed borders
• The cells appear basaloid and central part of tumour
lobule shows sebaceous differentiation –
multivesicular and vacuolated clear abundant
cytoplasm with oval vesicular nuclei and distinct
nucleoli
• Central portions of the tumor cell nests may be
necrotic –’comedo’ necrosis
21. Histopathology
Moderately differentiated
Number of differentiated cells will be less
Poorly differentiated
• High N:C ratio, nuclear pleomorphism, prominent
nucleoli, brisk mitotic activity and amphobilic or
basophilic cytoplasm
• Infiltrative borders
• Intracellular vacuolations may not be seen
24. Grading of sebaceous carcinoma
Based on growth patterns
• Grade I: well demarcated, roughly equally sized
cellular lobules
• Grade II: Admixture of well- defined nests with
infiltrative profiles or confluent cell groups
• Grade III: Highly invasive growth or medullary sheet
–like pattern
25. Variants
• Basaloid sebaceous carcinoma
Small cells with scant cytoplasm, nuclear palisading
Manifests as Grade III with sparse sebocytic elements
and difficult to identify
• Squamoid Sebaceous carcinoma
Shows prominent squamous metaplasia, often with
keratin pearl formation
• Sarcomatoid
Some may demonstrate spindle cell areas
• Pseudo – neuroendocrine organoid growth focally
resembling pattern of carcinoid tumors
26. Differential diagnoses
• Basal cell carcinoma with sebaceous differentiation
• Clear cell variant of squamous cell carcinoma
adipophilin, perilipin – recognise proteins present on the surface of intracellular lipid droplets
mutiple curtaneos tumour with sebaceous and hair follicle differentiation esp multiple sebaceomas and multiple internal malignancies. meibomian gland, glands of zeis. periocular more aggressive. extraocular less aggressive
CD10 expression supports hair follicle derivation
admixture of dark staining germinative cells and differentiated sebaceous cells