Sebaceous carcinoma of the uterine cervix: a case report

Impact of surgery and adjuvant treatment on the outcome of extraocular sebaceous carcinoma: a systematic review and individual patient's data analysis of 206 cases

BACKGROUND

Extraocular sebaceous carcinoma (EOSC) is an aggressive malignancy of the sebaceous gland. Surgery is considered the cornerstone of treatment, but there is lack of clarity about extent and adjuvant treatment.

METHODS

We conducted a systematic review and analysis of individual patient data of all published cases of EOSC to look into demography, pattern of care, importance of type of surgery, and other adjuvant treatment and survival outcome. A search of PubMed and Google Scholar was done with the key words sebaceous carcinoma, extraocular sebaceous carcinoma, and Muir-Torre syndrome till December 2017. The data were compiled in an Excel chart and analyzed using SPSS IBM software.

RESULTS

Data of 206 patients were retrieved. Median age at presentation was 65 years (range: 11-96 years). Surgery was performed in all except 13 patients. Of these 13, eight were deemed inoperable for extensive disease, and five had metastatic disease. Median PFS and OS for the entire cohort were 84 months (95% CI: 10-158 months) and 92 months (95% CI: 59-126 months). Univariate analysis revealed significantly poor survival for patients with a metastatic disease, regional nodal metastasis, and those with Mohs micrographic or incomplete surgery.

CONCLUSION

EOSC is a disease of elderly patients with good prognosis. Complete surgery with regional lymph node dissection is standard treatment. The role of adjuvant radiotherapy is debatable but can be considered in patients with incomplete surgery or high-risk factors.

A case of sebaceous carcinoma arising in a benign cystic teratoma of the ovary and review of the literature

Objective:

To present an extremely rare case of sebaceous carcinoma arising in a mature cystic teratoma of the ovary.

Clinical presentation and intervention:

A 66-year-old woman presented with abdominal discomfort and a pelvic mass. Abdominal and pelvic ultrasound, as well as CT scan, revealed a 27 cm complex right pelvic mass, which was diagnosed histologically as a sebaceous carcinoma arising in a mature cystic teratoma. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, peritoneal washings, appendicectomy and infracolic omentectomy.

Conclusion:

This case adds to the rare reports in the literature of sebaceous carcinoma occurring in a mature cystic teratoma. The clinical behaviour and optimal management of this entity are not well established. The patient has been well for 32 months following surgery with no evidence of recurrent disease clinically.

Hyperplasia of ectopic sebaceous glands in the uterine cervix: case report

Occurrence of ectopic sebaceous glands in the uterine cervix is a rare, unusual, and an incidental finding. Microscopically, sebaceous elements are typically situated high in the submucosa without an accompanying hair follicle (so-called free sebaceous glands). They are suggested to give rise to rare cases of sebaceous carcinoma in this location but are otherwise of little clinical significance. We report marked hyperplasia of ectopic sebaceous glands in the ectocervix, which produced detectable lesions on colposcopy. Histopathological examination showed foci of ectopic sebaceous glands located in the submucosa consisting of numerous, variably sized, clustered sebaceous lobules. Each sebaceous lobule was composed of a peripheral layer of germinative cells and centrally located, mature sebocytes with a multivacuolated cytoplasm and round or scalloped nuclei. In one area, there were over 20 sebaceous lobules that were partly connected to a sebaceous duct. To our knowledge, similar changes in ectopic sebaceous glands in the uterine cervix have not been reported till date.

Epidermalization of cervix and vagina: an unsolved dilemma

BACKGROUND

Epidermoid metaplasia of the uterine cervix and vagina has previously been described, yet few well-documented cases exist. The tendency of the cervical and vaginal epithelium to undergo reactive changes as, for example, adenosis, squamous hyperplasia, hyperkeratosis, and parakeratosis is well known. Such changes can be secondary to uterine prolapse or to other causes that produce continuous irritation. The presence of ectodermal appendages (e.g., sebaceous glands and/or hair follicles), on the other hand, is less common. This is an interesting phenomenon, specially taken into consideration that the embryologic origin of the cervix and upper third of the vagina is from the mullerian duct.

CASE

We present and discuss the case of a 70-year-old patient that, on routine gynecologic examination, showed whitish areas on the upper vagina and cervix. Biopsies from such areas demonstrated melanin pigment in the basal squamous epithelium, hyperkeratosis, and hair follicles with associated sebaceous glands.

CONCLUSIONS

The presence of ectodermal structures in the cervix and upper vagina can be seen and is still an unresolved issue. To the authors, this phenomenon probably represents metaplastic changes instead of a developmental abnormality.

Ectopic sebaceous glands in the vagina

We report a case of ectopic sebaceous glands in the upper third of the posterior wall of the vagina of a 49-year-old woman. This is, to our knowledge, the first fully documented case report of their occurrence in the vagina. The review of the literature and possible embryologic origin are discussed.

Sebaceous carcinoma and the T-antigen

Carcinomas of sebaceous glands are uncommon. They are traditionally classified into ocular and extraocular sebaceous carcinomas (SC). Ocular SC tend to be more common and more aggressive than extraocular SC. However, the latter can occasionally follow a fatal course. Histologically, SC should be classified into 1) SC in situ; 2) SC, infiltrating, low-grade with or without pagetoid spread; 3) SC, infiltrating, high-grade, with or without pagetoid spread; and 4) SC with extraocular and extracutaneous involvement, including metastases. Immunohistochemistry plays a minor role in the diagnosis of SC. Thomsen-Friedenreich (T) antigen can be a helpful tool in differentiating SC (strong T-antigen reactivity in basaloid cells) from other mimicking neoplasms (basaloid cells are T-antigen negative). The histologic differential diagnosis, pathogenesis, and management of SC are reviewed.