Prognostic factors for local recurrence, metastasis and survival for sebaceous carcinoma of the eyelid: observations in 100 patients.

BACKGROUND/AIMS: To validate the predictive value of the American Joint Committee on Cancer (AJCC) 8th-edition classification for local recurrence, metastasis and survival in patients with eyelid sebaceous carcinoma. METHODS: We performed a retrospective review of 100 consecutive patients with eyelid sebaceous carcinoma. Eyelid carcinomas were staged according to the AJCC 7th-edition and 8th-edition criteria. Associations between T and N categories and disease-related outcomes including local recurrence, lymph node metastasis, distant metastasis and survival were evaluated. RESULTS: 60 women and 40 men had a median age of 67 years (range, 41-94 years). The proportions of patients who experienced local recurrence, lymph node metastasis, distant metastasis and death from disease were 6%, 21%, 7% and 6%, respectively. Two-year and 5-year disease-specific survival (DSS) rates were 93.8% and 92.0%, respectively. There were significant correlations between (1) T2c or worse category and lymph node metastasis (p=0.04) and distant metastasis (p=0.01), (2) T3b or worse category and local recurrence (p=0.01) and death from disease (p=0.01) and (3) N1 category at presentation and distant metastasis (p<0.01) and death from disease (p<0.01). The AJCC 8th-edition classification showed a better homogeneity of the T-category distribution (p<0.01) and a slightly higher discrimination ability for lymph node metastasis (C=0.734 vs C=0.728) than the 7th-edition. CONCLUSIONS: T and N categories per AJCC 8th-edition classification are predictive of local recurrence, metastasis and DSS outcomes for eyelid sebaceous carcinoma. Surgeons should perform strict surveillance testing for nodal and systemic metastases in patients with T2c or worse T category and/or N1 disease at presentation.

Expression of Anti-apoptotic Protein BAG3 in Human Sebaceous Gland Carcinoma of the Eyelid.

BACKGROUND: Bcl-2-associated athanogene 3 (BAG3), a co-chaperone of heat shock protein 70 (HSP70), has been shown to play a role in anti-apoptosis of various malignant tumors. In this study, the expression of BAG3 was examined in human sebaceous gland carcinoma of the eyelid. MATERIALS AND METHODS: The expression of BAG3 was evaluated by immunohistochemistry of surgical samples from 5 patients with sebaceous gland carcinoma in the eyelid. RESULTS: BAG3 was positive diffusely in the cytoplasm in all patients. The average positive rate of BAG3 was 73.0±26.0% in tumor cells of all patients. CONCLUSION: BAG3 was highly expressed in sebaceous gland carcinoma of the eyelid. BAG3 may play an important role in the pathogenesis and progression of sebaceous gland carcinoma of the eyelid.

Intraoral sebaceous carcinoma metastatic to the lung and subcutis: Case report and discussion of the literature.

BACKGROUND: Intraoral sebaceous carcinoma is a rare form of sebaceous carcinoma with only 9 published cases in the world literature to date. We present a 10th case of intraoral sebaceous carcinoma located in the anterior maxillary gingiva with metastases to the lung and subcutis and discuss 3 possible etiologies for this unique presentation. METHODS: We analyze the clinical presentation, pathology, histology, and genetic testing for a single case study and review relevant literature. RESULTS: The histologic findings of the lung tumor and surgical excisions of the tumors in the gingiva and subcutis suggest the gingiva is the primary site. There is no evidence for the genetic abnormalities consistent with Muir-Torre syndrome. CONCLUSION: The histologic findings suggest the oral cavity is the most likely site of tumor origin. This is the first case of intraoral sebaceous carcinoma reported to arise in the gingiva as well as to spread to cutaneous sites.

Sentinel lymph node biopsy in malignant eyelid tumor: hybrid single photon emission computed tomography/computed tomography and dual dye technique.

PURPOSE: To study the utility of hybrid single photon emission computed tomography / computed tomography (SPECT/CT) scan and dual-dye technique in identification of the sentinel lymph node (SLN) in patients with an advanced malignant eyelid tumor. DESIGN: Nonrandomized prospective interventional study. METHODS: setting: A tertiary eye care center. study population: Patients with an advanced malignant eyelid tumor without clinically involved regional lymph nodes. intervention: SLN biopsy was performed using dual-dye technique (a combination of radiotracer and vital blue dye) following localization by SPECT/CT. main outcome measures: Localization of SLN in the regional node basin by hybrid SPECT/CT scan; SLN identification rate using dual-dye technique; SLN positivity rate; false-negative rate; and complications, if any, of SLN biopsy. RESULTS: Sixteen patients of biopsy-proven eyelid malignancy (7 squamous cell carcinomas [43.75%], 5 sebaceous cell carcinomas [31.25%], and 4 malignant melanomas [25%]) were included in the study. Preoperative localization of SLN was performed using SPECT/CT in 12 patients. SLN biopsy using dual-dye technique was performed in 16 patients. SPECT/CT accurately localized SLN in 11 out of 12 patients. The preauricular region was the most common site of SLN. SLN identification rates for dual-dye, radiotracer, and blue dye techniques were 100% (16/16 patients), 100% (16/16 patients), and 87.5% (14/16 patients), respectively. SLN showed metastasis in 2 patients (12.5%). On follow-up, 1 patient developed cervical lymph node metastasis, thus giving a false-negative rate of 7.14%. There were no complications associated with SLN biopsy. CONCLUSION: Accurate preoperative localization of SLN in relation to adjacent anatomic structures using SPECT/CT aids in intraoperative identification of SLN. SLN biopsy should be considered in patients with eyelid tumors at significant risk for metastasis who have clinically negative nodal basins. Dual-dye technique is safe and feasible in advanced eyelid tumors. Blue dye technique can be used for SLN biopsy in settings where nuclear medicine facilities are not available, albeit with a lower SLN identification rate. Detection of metastasis in SLNs in ∼12% of cases emphasizes the utility of SLN biopsy in accurate staging and treatment of eyelid malignancies.

A rare combination of sebaceoma with carcinomatous change (sebaceous carcinoma), trichoblastoma, and poroma arising from a nevus sebaceus.

We report a case of a 48-year-old Malay female who presented with multiple tumors arising from a large nevus sebaceus on her right parieto-temporal scalp. Histologically, the tumors corresponded to a sebaceoma with carcinomatous change, a poroma and a trichoblastoma. Immunohistochemical staining of the sebaceous tumor with p53 showed strong within the areas of carcinomatous change, while there was negative to weak staining within the sebaceoma-like areas. A discussion on the potential secondary neoplasms from a nevus sebaceus ensues, with a review of this literature on multiple tumors from a nevus sebaceus.

Primary sebaceous carcinoma of the lacrimal gland.

Primary sebaceous carcinoma is an exceptionally rare tumor of the lacrimal gland and less than 10 cases have been so far published in the literature. Two adult patients aged 38 and 81 years, respectively, who suffered unilateral painful massive swelling of the lacrimal gland are described. The disease in the first patient initially manifested as ipsilateral parotid gland metastasis and the primary tumor could be detected 3 months later. Both tumors were rock hard and fixed on palpation, caused partial upper eyelid ptosis, displaced the globe anteromedially and impaired ocular motility. Magnetic resonance imaging studies showed mostly homogeneous, well-delineated and moderately contrast-enhancing lacrimal gland fossa tumors without bone destruction. The management consisted of incisional biopsy for the diagnosis, immediately followed by exenteration. The younger patient further underwent radical neck dissection, parotidectomy and orbital and neck radiotherapy, which provided him a 2-year disease-free survival. Histopathological examination showed poorly differentiated sebaceous carcinoma destructing completely the lacrimal gland with predominantly comedo pattern. Despite its rarity and lack of specific clinical and imaging signs, sebaceous carcinoma should be considered in rapidly evolving painful and hard lacrimal gland fossa tumors. Also noteworthy is the early propensity of this tumor to spread to regional draining lymph nodes and the parotid gland in particular.

Fine needle aspiration cytology in diagnosis of metastatic sebaceous gland carcinoma of the eyelid to the lymph nodes with clinicopathological correlation.

OBJECTIVE: The diagnosis of metastasis to the lymph node, especially with an inconspicuous primary lesion, poses a challenge to clinicians as well as to pathologists. We report the cytologic findings of sebaceous gland carcinoma (SGC) of the eyelid metastatic to the lymph node with confirmation by oil red O stain whenever required. STUDY DESIGN: We reviewed cases and slides with cytologic diagnosis of metastatic SGC in lymph nodes. RESULTS: Fifteen patients presented with metastasis to the preauricular (n = 15), submandibular (n = 6) and anterior cervical nodes (n = 3). The mean age was 56.4 years and the male:female ratio was 2:3. The upper lid was involved in 53.3% of cases. Fine needle aspiration cytology performed on the lymph nodes showed large polygonal cells with abundant vacuolated cytoplasm, numerous histiocytes and fat globules in the background. Oil red O staining was performed on air-dried smears in 7/15 cases and showed bright orange positivity in intracytoplasmic vacuoles and extracytoplasmic globules, confirming metastasis from SGC. Tissue was obtained from eyelid lesions for histopathologic diagnosis in 12 out of 15 cases. Out of 12 patients, 7 showed pagetoid spread at the primary site, with the tumor showing moderate differentiation in 6 cases. CONCLUSION: Cytologic diagnosis of metastatic SGC is straightforward in most cases; however, use of oil red O stain supports the diagnosis, especially in cases with a silent primary tumor site.

Ten cases of sebaceous carcinoma arising in nevus sebaceus.

Although nevus sebaceus is known to develop various types of secondary neoplasms, it rarely causes carcinoma and only 14 cases of secondary sebaceous carcinoma have been reported. In this study, 10 cases of sebaceous carcinoma arising in nevus sebaceus were collected. The clinicopathological features and results of immunohistochemical examinations with adipophilin, perilipin and p53 were summarized. Sebaceous carcinoma arising in nevus sebaceous predominantly occurred on the scalp (8/10) of elderly women (mean age, 67.7 years). No case was associated with Muir-Torre syndrome. We found several pathological features of sebaceous carcinoma; that is, made up mainly of germinative cells, moderate nuclear atypia without pleomorphism and many mitoses (4-28/10 high-power field). Adipophilin and perilipin antibodies highlighted lipid drops in the cytoplasm of the malignant cells in all cases. Overexpression of p53 was seen in all cases. In two cases there were coexisting benign-looking sebaceous lesions at the periphery of the main cancer nodule, and in these lesions p53 showed low positivity compared with the clearly malignant area. There was co-occurrence of another neoplasm in three cases with trichoblastoma, sebaceoma and syringocystadenoma papilliferum, respectively. All cases were treated by excision of the malignant lesion, with or without inclusion of the nevus sebaceus. In a follow-up period of 1-7 years, there was no case of recurrence, lymph node metastases or distant metastases. With these specific pathological and immunohistochemical findings using adipophilin, perilipin and p53, we have to consider the possibility that there is a tendency to underdiagnose secondary sebaceous carcinomas in nevus sebaceus. These clinicopathological features of sebaceous carcinomas developing in the nevus sebaceus seem to indicate different biological entities from de novo sebaceous carcinoma.

[Torre-Muir syndrome. Sebaceous gland tumors indicate colon carcinoma and other internal malignant tumors]. / Das Torre-Muir-Syndrom. Talgdrüsentumoren signalisieren Kolonkarzinome und andere interne Malignome.

The Torre-Muir syndrome belongs to a group of hereditory cancers and expresses itself in the occurrence of cutaneous gland tumors and (often multiple) carcinoma of the colon. The syndrome is probably a phenotypical manifestation of the "cancer family" syndrome, in which familial carcinoma of the colon also occurs. A case of Torre-Muir syndrome in a 43-year-old man is described. Because of the dermatological features, the colon carcinoma was diagnosed in time. Family investigations revealed another case of complete Torre-Muir syndrome, as well as a remarkable frequency of colon carcinoma in one family branch. Inheritance is autosomal dominant. The characteristic morphological features of the sebaceous gland neoplasias makes an early, often life-saving, diagnosis possible.

Fine needle aspiration biopsy cytology of major salivary glands.

Fine needle aspiration biopsy of the major salivary glands was performed on 160 patients. In 146 patients with satisfactory samples, the cytologic diagnosis was correlated with clinical follow-up and histologic findings. There were 122 benign lesions, including 47 tumors. There were 24 malignant lesions, 10 of which were primary and 14 metastatic. The overall accuracy was 98%. The sensitivity of the technique was 87.5%. There was no false-positive diagnosis. There were three false-negative diagnoses due to sampling errors and inexperience during the initial period of the study. This study documents that needle aspiration biopsy cytology of the salivary glands is accurate, simple, rapid, inexpensive, well tolerated and harmless to the patient.

Torre-Muir syndrome. An association with isolated sebaceous carcinoma.

Three cases of Torre-Muir syndrome are described in which isolated sebaceous carcinomas were associated with internal malignancy. The first was a 66-year-old woman who had a sebaceous carcinoma in association with carcinoma of the uterus, two adenocarcinomas of colon, carcinoma of renal pelvis and bladder, and a squamous cell carcinoma of the skin. The second was a 78-year-old woman who had a sebaceous carcinoma associated with carcinomas of the colon, ovary, and pancreas. The third patient had a sebaceous carcinoma associated with breast cancer. The subject is discussed and the previously reported cases reviewed.