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Sebaceous carcinoma 9.6.17

  1. 1. ACADEMIC REVIEW Sebaceous carcinoma
  2. 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
  3. 3. Clinical findings: -Ulceroproliferative growth over left maxillary region -3x2 cm -raised and everted margin Clinical diagnosis: Squamous cell carcinoma – left maxillary region
  4. 4. Gross examination
  5. 5. Scanner view
  6. 6. Scanner view
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. Sebaceous carcinoma
  11. 11. 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
  12. 12. Gross features • Nodules that enlarge slowly, occasionally grows rapidly • Some become ulcerated
  13. 13. 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
  14. 14. 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
  15. 15. Sebaceous carcinoma
  16. 16. 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
  17. 17. 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
  18. 18. Differential diagnoses • Basal cell carcinoma with sebaceous differentiation • Clear cell variant of squamous cell carcinoma
  19. 19. Immunoprofile Positive for Pankeratin, EMA, AR EMA – enhances cytoplasmic bubbliness Negative for S-100 and CEA

Editor's Notes

  • 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
  • ×