Primary basal cell carcinoma of the caruncle: case report and review of the literature

ABSTRACT We present a rare case of primary caruncle basal cell carcinoma (BCC), a condition with limited occurrences. Our patient, an 80-year-old woman without prior ocular pathological history, presented a 2x2mm pedunculated blackish nodular lesion on the caruncle of her left eye, without local conjunctival or cutaneous involvement. Histological analysis following complete excision confirmed the presence of basal cell carcinoma within the caruncle. Over a span of 30 months, no recurrence has been observed. While scant cases are documented in the literature, we conducted a review of these instances. Despite its infrequent manifestation, this condition should be taken into account when evaluating caruncular tumors, given its tendency to invade the orbit. Complete excision with free surgical margins is the treatment of choice, and adjuvant radiotherapy or chemotherapy might be considered.

Sebaceous breast carcinoma

ABSTRACT Breast sebaceous carcinoma is one of the rarest breast neoplasms, with less than 30 cases reported worldwide. Due to the rarity, the new WHO classification of breast tumors grouped these tumors among the ductal carcinoma. A detailed description of these cases is relevant due to the insufficient knowledge about the prognosis of this neoplasm. We report the clinical, histological, and immunohistochemical characteristics of a case of sebaceous carcinoma of the breast in an 81-year-old woman with a right breast nodule. The tumor was composed of nests of a varying mixture of sebaceous cells with abundant slightly vacuolated cytoplasm, surrounded by smaller oval-to-fusiform cells with eosinophilic cytoplasm without vacuolization. No lymph node metastases were present. The immunohistochemical reactions were positive for GATA3, EMA, CD15, and GCDFP15 (focal staining), and negative for RE, RP, and HER-2. The tumor was classified as triple-negative. Morphologically, the differential diagnoses included skin sebaceous carcinoma, lipid-rich carcinoma, apocrine carcinoma, and glycogen-rich clear cell carcinoma. Most of the previously reported cases were positive for RE and RP, which generally was associated with a better prognosis. However, some cases presented a more aggressive behavior with distant and lymph node metastases.

Clinical analysis of 14 children with cerebriform sebaceous nevus / 中华皮肤科杂志

Objective:To investigate clinical manifestations and histopathological features of and surgical timing for cerebriform sebaceous nevus.Methods:Clinical data were collected from 14 children with cerebriform sebaceous nevus in Beijing Children′s Hospital from June 2014 to December 2019, and clinical manifestations, histopathological features and surgical timing were analyzed retrospectively.Results:Of the 14 children, 10 were males and 4 were females. They presented with skin lesions at birth, which were solitary and located on the head and face. These skin lesions gave a cerebriform appearance, with an average diameter of 4.79 cm. Systemic examination showed no abnormality in any children. Histopathological examination showed obvious papillomatous epidermal hyperplasia, large number of mature sebaceous glands and immature hair follicles. The 14 children underwent surgeries at an average age of 1.94 years. No recurrence was observed during the follow-up of 6 months to 6 years after surgery.Conclusion:Cerebriform sebaceous nevus is characterized by a unique cerebriform appearance, mostly occurs on the head and face, and is liable to attract attention, which usually leads to an earlier surgical selection.

Histopathological study of canine sebaceous tumors and their association with PCNA expression by immunohistochemistry / Estudo histopatológico de tumores sebáceos caninos e sua associação com a expressão de PCNA por imuno-histoquímica

Sebaceous tumors are common in dogs. These tumors include both benign and malignant lesions. Immunohistochemical evaluation of these tumors can aggregate information regarding the origin and degree of malignancy of the lesions. Focusing on this matter, sixty-one samples including normal skin and sebaceous tumors were selected from dogs of various breeds and ages, with no predilection for sex, from the archive of Veterinary Pathology Service of Federal Fluminense University, Niterói/RJ, Brazil. The samples underwent to histological processing, routine staining and immunohistochemistry with anti-PCNA (proliferating cell nuclear antigen). Descriptive statistical analysis was performed, the Wilcoxon-Mann-Whitney test was used to compare the distribution of anti-PCNA labelling in different groups of variables. In case there were more than two groups, the Analysis of Variance (ANOVA) test was performed. The mean age of the affected animals was 10.56 years. The most affected breeds were Caniches and Cocker Spaniels, as well as mixed breed animals. There was immunostaining of PCNA in both benign and malignant tumors, as well as in hyperplasic lesions with varying intensity. Most of the tumors were neoplasms which represented 67.27% of the total sample; within these, 75.00% were benign. The most frequent neoplasm was sebaceous adenoma (37.74%). Results indicated no statistical difference in the distribution of anti-PCNA labelling between the groups of sex, age, reproductive status, localization, size of tumor, and histopathological diagnosis. Although there are not many studies analyzing anti-PCNA labelling in sebaceous tumors, several of them pointed out to the predictive value in other neoplasms. With this matter in mind, we intended to evaluate the expression of anti-PCNA in canine sebaceous tumor and a possible association with the malignancy of the lesions.

Tumores sebáceos são comuns em cães. Tais tumores incluem lesões benignas e malignas. A avaliação imunohistoquímica desses tumores pode agregar informações sobre a origem e o grau de malignidade das lesões. Para este fim, sessenta e uma amostras, incluindo pele normal e tumores sebáceos foram selecionadas de cães de várias raças e idades, sem predileção por sexo, do arquivo do Serviço de Patologia Veterinária da Universidade Federal Fluminense, Niterói/RJ, Brasil. As amostras passaram por processamento histológico, coloração de rotina e imuno-histoquímica com anti-PCNA (proliferating cell nuclear antigen). Foram realizadas análises estatísticas descritivas além dos testes de Wilcoxon-Mann-Whitney para comparar a distribuição da marcação de anti-PCNA entre grupos de variáveis. Para variáveis com mais de dois grupos, aplicou-se a Análise de Variância (ANOVA). A idade média dos animais afetados foi de 10.56 anos. As raças mais afetadas foram Caniches e Cocker Spaniel, e ainda animais sem raça definida. Houve imunomarcação de PCNA em tumores benignos, malignos, e ainda em lesões hiperplásicas com intensidade variada. A maioria dos tumores eram neoplásicos representando 67.92% do total; destes, 75.00% eram benignos. O adenoma sebáceo foi a neoplasia mais frequente (37.74%). Não foram encontradas diferenças significativas nas distribuições de anti-PCNA entre os grupos das variáveis sexo, idade, status reprodutivo, localização e tamanho do tumor e diagnóstico histopatológico. Embora não haja estudos com anti-PCNA em tumores sebáceos caninos, numerosas publicações apontam seu valor preditivo em outras neoplasias. Com isso, a finalidade deste estudo foi avaliar a expressão de anti-PCNA em tumores sebáceos caninos e sua possível associação com a malignidade das lesões.

Histopathological study of canine sebaceous tumors and their association with PCNA expression by immunohistochemistry / Estudo histopatológico de tumores sebáceos caninos e sua associação com a expressão de PCNA por imuno-histoquímica

Sebaceous tumors are common in dogs and include benign and malignant lesions. The increase in immunohistochemical evaluation of sebaceous tumors aggregates information regarding the origin and degree of malignancy of the lesions. The objective of this study was to evaluate PCNA immunohistochemical expression of  sebaceous tumors in dogs. Sixty-one samples include normal skin and sebaceous tumors were selected from dogs of various breeds and ages, no gender predilection, sent to the Veterinary Pathology Service of Universidade Federal Fluminense, Niterói/RJ, Brazil. Samples passed through histological processing, routine staining and immunostaining from PCNA. Descriptive statistical analysis, Wilcoxon-Mann-Whitney and Fishers exact test were performed. The mean age of the affected animals was 10.56 years. There was no sexual predilection. Breeds more frequently affected were: Poodles, mixed-breed dogs and Cocker Spaniels. Most of the tumors were neoplasms (67.27%), and 75.67% of those were benign. Sebaceous adenoma was the most frequent neoplasm (56.75%). PCNA immunoexpression was present in hyperplasia, benign and malignant tumors. No previous studies were found using PCNA antibody in sebaceous tumors of dogs. Thus, more studies are needed to provide greater clarity regarding the role of these markers on normal skin and sebaceous tumors of dogs, as well as their use as prognos

Tumores sebáceos são comuns em cães. Tais tumores incluem lesões benignas e malignas. A avaliação imunohistoquímica desses tumores pode agregar informações sobre a origem e o grau de malignidade das lesões. Para este fim, sessenta e uma amostras, incluindo pele normal e tumores sebáceos foram selecionadas de cães de várias raças e idades, sem predileção por sexo, do arquivo do Serviço de Patologia Veterinária da Universidade Federal Fluminense, Niterói/RJ, Brasil. As amostras passaram por processamento histológico, coloração de rotina e imuno-histoquímica com anti-PCNA (proliferating cell nuclear antigen). Foram realizadas análises estatísticas descritivas além dos testes de Wilcoxon-Mann-Whitney para comparar a distribuição da marcação de anti-PCNA entre grupos de variáveis. Para variáveis com mais de dois grupos, aplicou-se a Análise de Variância (ANOVA). A idade média dos animais afetados foi de 10.56 anos. As raças mais afetadas foram Caniches e Cocker Spaniel, e ainda animais sem raça definida. Houve imunomarcação de PCNA em tumores benignos, malignos, e ainda em lesões hiperplásicas com intensidade variada. A maioria dos tumores eram neoplásicos representando 67.92% do total; destes, 75.00% eram benignos. O adenoma sebáceo foi a neoplasia mais frequente (37.74%). Não foram encontradas diferenças significativas nas distribuições de anti-PCNA entre os grupos das variáveis sexo, idade, status reprodutivo, localização e tamanho do tumor e diagnóstico histopatológico. Embora não haja estudos com anti-PCNA em tumores sebáceos caninos, numerosas publicações apontam seu valor preditivo em outras neoplasias. Com isso, a finalidade deste estudo foi avaliar a expressão de anti-PCNA em tumores sebáceos caninos e sua possível associação com a malignidade das lesões.

Sebaceoma on the scalp simulating a malignant pigmented neoplasia

Abstract The correct identification of pigmented nodular lesions of the scalp is often challenging. Despite the importance of clinical patterns and dermoscopy, important adjuvant tools that are usually helpful, their interpretation sometimes is not clear-cut. Here, the authors discuss a case of sebaceoma mimicking a malignant pigmented neoplasia, with conclusive histopathology.

Characteristic analysis of sebaceous nevus using dermoscopy and reflectance confocal microscopy / 中华皮肤科杂志

Objective To investigate dermoscopic and reflectance confocal microscopic (RCM)features of sebaceous nevus in patients of different ages.Methods A total of 83 patients histopathologically diagnosed with sebaceous nevus were enrolled from Department of Dermatology of Wuhan No.1 Hospital between January 2016 and December 2016,and divided into 4 age groups (＜ 10 years,10-20 years,21-59 years,≥ 60 years) according to the age.The dermoscopic and RCM features were collected and analyzed.Results Among the age group of ＜ 10 years (21 cases),dermoscopic images of skin lesions showed that uniform,globular or plaque-shaped yellowish-red structures arranged in a cobblestone-like pattern were independently distributed in an orange background,with vascular proliferation and dilatation,while RCM images showed sebaceous gland hypoplasia and juvenile hair follicles.Among the age group of 10-20 years (28 cases),dermoscopy showed aggregated,non-hair follicle,round or oval yellow structures of varying sizes with telangiectases,while RCM showed botryoidal sebaceous glands at the dermal-epidermal junction and superficial dermis,which were characterized by tube-like or handle-like structure in the center,aggregated fish roe-like or frogspawn-like sebaceous gland lobules in the surrounding area and verrucous or papillomatous hyperplasia in the epidermis.The age groups of 21-59 years (30 cases) and 10-20 years showed the similar imaging manifestations.The main imaging manifestation of the age group of ≥ 60 years (4cases) was papillomatous hyperplasia.Conclusions Sebaceous nevus is a dynamic developmental disease,and its imaging characteristics obviously differ among different age stages.Sebaceous nevus has characteristic structures under dermoscopy and RCM,which can serve as efficient noninvasive diagnostic methods for sebaceous nevus.

Syndrome in question

AbstractMuir-Torre syndrome is a rare genodermatosis characterized by the occurrence of at least one sebaceous tumor associated with visceral neoplasia, but with no predisposing factors. The sebaceous neoplasm may appear before, during or after the diagnosis of colorectal cancer. As it is regarded as a subtype of nonpolyposis hereditary colorectal cancer, it is important to evaluate the patient's first-degree relatives. The clinical course of the neoplasm is usually more indolent and the syndrome has a good prognosis. We report the case of a patient who, after a ten-year diagnosis of colorectal cancer, presented with multiple sebaceous neoplasms.

A case of Muir-Torre syndrome presenting as keratoacanthoma and sebaceous adenoma / 中华皮肤科杂志

A 44-year-old male presented with a neoplasm on the buccal side of the right nasolabial fold for more than two months.Dermatological examination showed a hemispherical bulge sized 1.5 cm × 1.5 cm with central crater-like ulceration on the buccal side of the right nasolabial fold,as well as a crescent-shaped elevation measuring 1.5 cm × 2.5 cm above the hemispherical lesion.Histopathology of the hemispherical lesion revealed irregularly downward proliferation of epidermis,crater-like holes filled with eosinophilic keratinous plug in the center which were surrounded by collar-shaped epithelial cell projections.Small neutrophil abscesses were found in the clumps of epithelial cells,and massive lymphocyte infiltration with a clear bottom boundary was observed around the proliferating epithelial cells.Histopathologic examination of the crescent lesion showed multiple irregularly-shaped lobular-like structures of various sizes with sebaceous glands at different degrees of maturity in the mid dermis,which were surrounded by proliferating connective tissue.Immunohistochemical studies showed that the squamous cells stained positive for cytokeratin (CK),CK5,CK14,CK17,carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA) in the keratoacanthoma,and the sebaceous cells for CK,CK5,CK14 and EMA in the sebaceous adenoma.The pathological diagnosis was keratoacanthoma and sebaceous adenoma.The patient was diagnosed with moderately and poorly differentiated rectal adenocarcinoma in 2008.A diagnosis of Muir-Torre syndrome presenting as keratoacanthoma and sebaceous adenoma was finally made.

Diagnostic value of high frequency ultrasound in the sebaceous gland carcinoma of eyelid / 中华超声影像学杂志

Objective To evaluate the diagnostic value of high frequency ultrasound in sebaceous gland carcinoma of eyelid (SC).Methods The ultrasonic characteristic for 11 cases with eyelid SC were respectively analyzed by using 13 MHz high frequency ultrasound and 22 MHz ultra-high frequency ultrasound.Results Through 13 MHz high frequency ultrasound,in 7 patients who exhibited Pagetoid invasion the lid shin thickness of tumor side displays no significant alteration in a comparison with normal side.Furthermore,the color Doppler flow imaging (CDFI) evealed a branch-like blood flow surrounding the masses in all cases,but the blood flow of seven patients with Pagetoid invasion had no difference compared with the healthy side.On 22 MHz ultra-high frequency ultrasound examination,slit-like low echo was found in 9 ;transition zone of tumor infiltration can be identified in 9 ; the echo of tumors with Pagetoid invasion was lower than the healthy side and the skin thickness of tumors with Pagetoid invasion was thicker (0.6 ±0.1) mm than the healthy side.CDFI revealed that mesh-basket like blood flow was rich in all patients,the small branch blood vessels arrived at subcutaneous,and vasa vasorum were found in some patients.The region with Pagetoid invasion was rich in blood flow.The sonography findings on 13 MHz and 22 MHz high frequency ultrasound examination were compared with chisquare test.There were significant differences on homogeneous echo,slit-like low echo,transition zone of tumor infiltration,infiltration skin thickness,blood distribution,central blood vessels,vasa vasorum,blood flow in the region with Pagetoid invasion (x2 =12.571,15.231,15.231,4.701,22.000,15.231,4.899,10.267,P＜0.05).Conclusions Slit-like low echo in the mass is a main finding of eyelid sebaceous gland cercinoma on the 22 MHz ultra-high frequency ultrasound.The ultra-high frequency ultrasound can accurately reveal the skin depth infiltrated by the eyelid sebaceous gland cercinoma and this method can provide solid guidance for clinical treatment strategies.

Inguinal ulcerated sebaceous carcinoma: an unusual presentation / Carcinoma sebaceo inguinal ulcerado: apresentacao incomum

Sebaceous carcinoma is a rare and aggressive skin tumor. It can be located in any area of the body, the most commonly involved area being the periorbital region. It does not entail a typical clinical presentation, which explains the often late diagnosis. The aim of this report is to outline the rarity of the disease and its atypical clinical description, since to this day, inguinal ulcers with clinical manifestation have not been reported. We present and discuss a case of sebaceous carcinoma with an unusual clinical presentation, in an elderly male patient. The precise approach to genital ulcers, as shown in this case, is a diagnostic challenge that requires a great deal of effort on the part of the clinician.

O carcinoma sebáceo é um tumor cutâneo raro e agressivo. Pode localizar-se em qualquer área do corpo sendo a região periorbital a mais comumente envolvida. Ele não tem uma apresentação clínica típica, o que explica o diagnóstico frequentemente tardio. O objetivo deste relato é apresentar a raridade da doença e uma descrição clínica atípica, uma vez que, até a presente data, não foi relatada úlcera inguinal como manifestação clínica. Apresentamos e discutimos um caso de carcinoma sebáceo, com uma apresentação clínica incomum em um paciente idoso do sexo masculino. A abordagem de úlceras genitais, como mostrado no presente caso, é um desafio diagnóstico que requer uma grande quantidade de esforço por parte do clínico.

Sebaceous carcinoma of the eyelid - different diagnostic times, different outcomes: case reports / Carcinoma de glândulas sebáceas palpebral - diferentes momentos de diagnósticos, diferentes resultados cirúrgicos: relatos de casos

Sebaceous carcinoma of the eyelid is a very rare slow-growing tumor and is considered an aggressive eyelid neoplasm. It can reach mortality rate of about 6 percent. Diagnosis is often delayed because of its ability to masquerade as other periocular lesions, both clinically and histologically. We present three cases of sebaceous carcinoma, with different surgical outcomes, showing the importance of early diagnosis.

Carcinoma sebáceo é um tumor raro de crescimento lento considerado uma das mais agressivas neoplasias palpebrais. Pode alcançar taxa de mortalidade de aproximadamente 6 por cento. O diagnóstico tardio é comum devido a sua habilidade de se confundir com outras lesões perioculares tanto clinicamente quanto histologicamente. Relatamos três casos de carcinoma sebáceo da pálpebra com diferentes resultados cirúrgicos, enfatizando a importância do diagnóstico precoce.

Você conhece esta Síndrome? / Do you know this syndrome?

A síndrome de Brooke-Spiegler é uma doença autossômica dominante, caracterizada pelo aparecimento de neoplasias de anexos cutâneos, habitualmente tricoepiteliomas e cilindromas. Ocorre, em geral, na segunda e terceira décadas de vida. A histopatologia revela uma ampla gama de tumores, com diferenciação écrina, apócrina, folicular e sebácea. O tratamento pode ser feito por excisão cirúrgica, laser, crioterapia, eletrofulguração e dermabrasão. Em razão do risco de malignidade, há necessidade de um bom acompanhamento clínico e aconselhamento genético.

Brooke-Spiegler syndrome is an autosomal dominant inherited disease with predisposition to cutaneous adnexal neoplasms, most commonly cylindromas and trichoepitheliomas. Its onset is in the second or third decades of life. The histopathological exams of the lesions revealed a plethora of benign adnexal neoplasms, showing apocrine, follicular, and sebaceous differentiation. The treatment can be performed by excisional surgery, laser, cryotherapy, electrofulguration and dermabrasion. Due to the risk of malignancy, there is the need for clinical follow-up and genetic counseling.

Carcinoma sebáceo palpebral: Presentación de un caso / Palpeebral sebaceous carcinoma: A case report

Se presenta a un paciente de 26 años de edad, con diagnóstico clínico de chalación gigante del párpado inferior del ojo derecho de 6 meses de evolución, con un gran componente inflamatorio y bordes ulcerados que no había respondido a la terapéutica médica ni quirúrgica. El resultado de la biopsia tomada de este lesión fue, carcinoma epidermoide infiltrante, por lo que decidimos hacer la cirugía con margen oncológico, que requirió de un colgajo libre del párpado superior con fines estéticos y funcionales. El estudio histológico de la tumoración evidenció un carcinoma sebáceo. La evolución posoperatoria de este paciente, al año de operado, ha sido satisfactoria.

A 26-year-old patient wich clinical diagnosis of giant chalazi on of the lower eyelid of the right eye with 6 months of evolution and with a great inflamatory component and ulcerated edges that had not responded to mechical and surgical therapeutics is presented. The result of the biopsy was infiltrating epidermoid carcinoma, so it was decided to perform surgery with oncological margin that required a free flap of the upper eyelid with aesthetic functional ends. The histological study of the tumor proved the existance of a sebaceous carcinoma. The posoperative evolution of the patient after a year has been satisfactory.