1
|
Zhou KY, Deng LJ, Luo SY, Wang QX, Fang S. Expression of Early Growth Response 3 in Skin Cancers. Appl Immunohistochem Mol Morphol 2024; 32:169-175. [PMID: 38478384 DOI: 10.1097/pai.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/13/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To assess the expression of early growth response 3 (EGR3) in normal skin and different types of skin tumors: cutaneous squamous cell carcinoma (cSCC), basal cell carcinoma (BCC), melanoma (MM), and cutaneous adnexal tumors containing sebaceous carcinoma (SC), trichoepithelioma (TE) and clear cell hidradenoma (CCH). BACKGROUND EGR3, expressed in multiple organs, including skin, plays an important role in cell differentiation and tumor growth. Previous studies have shown that EGR3 suppresses tumor growth and is downregulated in various malignancies. However, its distribution in normal skin and its expression especially in skin tumors have not been studied. MATERIALS AND METHODS Samples of normal cases (n = 4), cSCC (n = 12), BCC (n = 12), MM (n = 12), SC (n = 4), TE (n = 4), and CCH (n = 4) were collected from patients treated in our department between 2018 and 2023. Immunohistochemistry was used to investigate the expression of EGR3. The results were analyzed with the description of the staining pattern and the histochemical score. RESULTS Immunohistochemical staining showed that EGR3 was uniquely expressed in normal skin in the granular layer and upper part of the stratum spinosum, as well as in sebaceous glands and hair follicles, but not in sweat glands. In skin cancers, BCC, SC, and TE showed positive EGR3 staining, whereas cSCC, MM, and CCH were negative. CONCLUSIONS EGR3 has a specific expression pattern in normal skin and in skin tumors, which is important for the differential diagnosis of skin tumors, in particular for cSCC and sebaceous gland carcinoma.
Collapse
Affiliation(s)
- Kai-Yi Zhou
- Department of Dermatology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | | | | | | |
Collapse
|
2
|
Wakefield C, Russell-Goldman E. Androgen Receptor Immunohistochemistry is Superior to PRAME for the Differentiation of Sebaceous Carcinoma From Primary Cutaneous Basaloid Mimics. Am J Dermatopathol 2024; 46:195-203. [PMID: 38488347 DOI: 10.1097/dad.0000000000002496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
ABSTRACT Cutaneous sebaceous neoplasia comprises a spectrum of disease ranging from benign adenomas to malignant carcinomas. The hallmark of these lesions is sebaceous differentiation. However, poorly-differentiated sebaceous carcinoma (SC), which lacks significant overt sebaceous differentiation, can show morphologic overlap with a variety of other basaloid cutaneous neoplasms. The accurate classification of SC is essential not only for diagnosis, but also because of the potential association with Muir-Torre syndrome. Androgen receptor (AR) is a sensitive, but not entirely specific immunohistochemical marker that has been used for the diagnosis of SC. PReferentially expressed Antigen in MElanoma (PRAME) demonstrates strong cytoplasmic labeling of mature sebocytes and has been reported to be expressed in a variety of sebaceous neoplasms, including in the basaloid cell component. Therefore, we sought to compare the diagnostic use of cytoplasmic PRAME expression with that of AR for the distinction of SC from a cohort of basaloid cutaneous mimics; namely basal cell carcinoma, basaloid squamous cell carcinoma, pilomatricoma, cutaneous lymphadenoma, and extra-mammary Paget disease. We report that cytoplasmic PRAME expression is uncommon in poorly differentiated SC, and although specific, it shows very low sensitivity (22%). In contrast, AR was moderately sensitive (66%) and highly specific (92%) for the distinction of SC from basaloid mimics. These attributes, in addition to the nuclear expression of AR in the sebocytic and basaloid components of SC, suggest that AR is superior to PRAME for the diagnosis of SC.
Collapse
Affiliation(s)
- Craig Wakefield
- Pathologists, Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | | |
Collapse
|
3
|
Sasaki-Saito N, Goto K, Aoki M, Nishihara K, Hiraki T, Yoshikawa S, Matsushita S. Apocrine carcinoma with marked sebocyte-like cytological features: A report of two cases. J Cutan Pathol 2024; 51:92-98. [PMID: 37743579 DOI: 10.1111/cup.14539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
Apocrine carcinoma cases with sebaceous differentiation have not been reported and can be misdiagnosed as sebaceous carcinoma. We present two cases of apocrine carcinoma with marked sebocyte-like cytological features. Tumors were observed in the left axilla of a 68-year-old man (Case 1) and the right axilla of a 72-year-old man (Case 2). Both patients presented with multiple lymph node metastases. Histopathology revealed densely distributed solid nests of tumor cells containing foamy cytoplasm and enlarged round nuclei with prominent nucleoli. The tumor cells diffusely expressed adipophilin, PRAME (cytoplasmic pattern), androgen receptor, BerEP4, and GCDFP15 but did not express p63 in both cases. PIK3CA E726K and H1047R mutations were detected in Cases 1 and 2, respectively. Tumor location in the axilla, the presence of eosinophilic granular cytoplasm, prominent nucleoli, and PIK3CA mutations, immunoreactivity for BerEP4 and GCDFP15, and lack of p63 immunoexpression findings matched apocrine carcinoma characteristics, but not sebaceous carcinoma. Thus, apocrine carcinoma can demonstrate intracytoplasmic lipid accumulation and rarely exhibit sebocyte-like cytological features. Apocrine carcinoma should be distinguished from sebaceous carcinoma due to the former's higher metastatic potential and lack of association with Muir-Torre syndrome.
Collapse
Affiliation(s)
- Natsuko Sasaki-Saito
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Keisuke Goto
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
- Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, Japan
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
- Department of Pathology, Itabashi Central Clinical Laboratory, Tokyo, Japan
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
- Department of Diagnostic Pathology, Chutoen General Medical Center, Kakegawa, Japan
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
- Department of Diagnostic Pathology, Osaka National Hospital, Osaka, Japan
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Megumi Aoki
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Katsuhiko Nishihara
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Tsubasa Hiraki
- Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, Japan
| | - Shusuke Yoshikawa
- Department of Dermatology, Shizuoka Cancer Center Hospital, Sunto, Japan
| | - Shigeto Matsushita
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| |
Collapse
|
4
|
Dowell-Esquivel C, Lee R, DiCaprio RC, Nouri K. Sebaceous carcinoma: an updated review of pathogenesis, diagnosis, and treatment options. Arch Dermatol Res 2023; 316:55. [PMID: 38112896 DOI: 10.1007/s00403-023-02747-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/10/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023]
Abstract
Sebaceous carcinoma (SC) is a very rare and aggressive form of skin cancer that arises from the sebaceous glands. SC can occur anywhere on the body, but most commonly affects the head and neck, especially the upper eyelid. SC is the third most common malignancy of the eyelid and has the potential to metastasize and be fatal; therefore, it is vital for dermatologists to remain acquainted with this malignancy and its most current treatment options. Most commonly presenting as a painless lump or thickening of skin on the eyelid, SC has an insidious progression that may not prompt the patient to seek medical attention immediately. To avoid the potential of metastasis, early diagnosis and treatment is paramount. To assess if the cancer has spread, ophthalmology, imaging, and sentinel lymph node biopsy are recommended. This article provides a comprehensive review of SC's pathogenesis, current diagnostic methods, and treatments, including wide local excision, Mohs micrographic surgery, orbital exenteration, radiation, and other topicals. The prognosis of SC depends on several factors, including size, location, stage, and treatment method. After treatment of the neoplasm, diligent post-treatment surveillance remains the cornerstone of patient care. Continued dermatologic follow-ups are essential for early detection of reoccurrence, ensuring timely intervention and optimal long-term outcomes. In conclusion, this comprehensive review aims to equip dermatologists and other physicians with a nuanced understanding of SC, enabling them to provide effective care to support patients encountering this malignancy.
Collapse
Affiliation(s)
- Caitlin Dowell-Esquivel
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Dermatology Research Clinic, 1150 NW 14th Street, Miami, FL, 33136, USA.
| | - Raphael Lee
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Dermatology Research Clinic, 1150 NW 14th Street, Miami, FL, 33136, USA
| | - Robert C DiCaprio
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Dermatology Research Clinic, 1150 NW 14th Street, Miami, FL, 33136, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Dermatology Research Clinic, 1150 NW 14th Street, Miami, FL, 33136, USA
| |
Collapse
|
5
|
Assiri SA, Altwairqi RG, Alotaibi R, Ibrahim M. External auditory canal sebaceous carcinoma. BMJ Case Rep 2023; 16:e255038. [PMID: 37775279 PMCID: PMC10546117 DOI: 10.1136/bcr-2023-255038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/01/2023] Open
Abstract
The incidence of sebaceous carcinoma (SC) in the outer one-third of the external auditory canal is considered extremely rare, and only eight case reports have been published. We present a case of a male patient in his late 70s known case of hypertension on indapamide. His medical history included a postspinal tumour that had been treated with surgery and radiation more than 40 years ago and current complaints of right ear pain and purulent discharge. A right ear soft granular tissue mass was found. Complete debulking of the right ear mass was done in conjunction with middle ear exploration, moderately differentiated SC diagnosis was made based on the histopathological analysis. The patient was free of recurrence but then died of an unrelated pulmonary infection. SC should be suspected in elderly patients who present with long-term complaints of a mass with or without otalgia, and these patients should be examined for the presence of such tumours especially if they report a history of radiation. Additionally, more research is warranted to investigate the association of diuretics with SC.
Collapse
Affiliation(s)
- Sara A Assiri
- Otolaryngology-Head and Neck Surgery Department, King Faisal Medical Complex, Taif, Makkah, Saudi Arabia
| | - Rahaf Ghazi Altwairqi
- Otolaryngology-Head and Neck Surgery Department, Al Hada Military Hospital, Taif, Makkah, Saudi Arabia
| | | | - Mohammed Ibrahim
- Otorhinolaryngology-Head and Neck Surgery Department, Al Hada Military Hospital, Taif, Makkah, Saudi Arabia
| |
Collapse
|
6
|
Ye J, Li Q. Primary Sebaceous Carcinoma of the Eyebrow: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:1715-1720. [PMID: 37404366 PMCID: PMC10317532 DOI: 10.2147/ccid.s412663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/10/2023] [Indexed: 07/06/2023]
Abstract
Sebaceous carcinoma (SC) is an uncommon but aggressive malignancy and has a specific anatomic preference for the ocular region, especially the eyelids. However, periocular SC originated from the eyebrow is rare, which may cause poorer outcomes due to a greater likelihood of orbital invasion and excessive tumor volume. In the present case, we exhibited a 68-year-old male presenting with a large solid mass in his right eyebrow region developing in ten months. Based on the patient's history, clinical conditions, orbital computed tomography (CT) and magnetic resonance imaging (MRI) scan results, a malignant tumor was suspected preliminarily. Excisional biopsy was performed, and the histopathologic examination and immunohistochemistry (IHC) staining of the tumor revealed SC. The patient declined the enlarged surgery recommended next and ended up with death caused by the distant metastasis of SC. The case highlighted the fact that despite its rarity, SC should be considered as a differential diagnosis of tumors located in the eyebrow region and histopathologic evaluation must be performed to reach a definite diagnosis. Ophthalmologists are supposed to have a comprehensive understanding of the clinicopathological characteristics of this disease and help patients accept the appropriate treatments promptly via properly and adequate communication if necessary.
Collapse
Affiliation(s)
- Jiangping Ye
- Department of Ophthalmology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Qiaoyun Li
- Department of Pathology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| |
Collapse
|
7
|
Papadimitriou I, Vakirlis E, Sotiriou E, Bakirtzi K, Lallas A, Ioannides D. Sebaceous Neoplasms. Diagnostics (Basel) 2023; 13:diagnostics13101676. [PMID: 37238164 DOI: 10.3390/diagnostics13101676] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Sebaceous neoplasms describe a group of tumors with sebaceous differentiation commonly seen in lesions located primarily in the face and neck. The majority of these lesions are benign, while malignant neoplasms with sebaceous differentiation are uncommon. Sebaceous tumors present a strong association with the Muir-Torre Syndrome. Patients suspected with this syndrome should undergo neoplasm excision, followed by histopathologic and additional immunohistochemistry and genetics examinations. Clinical and dermoscopic features of the sebaceous neoplasms, as well as management procedures collected from the literature analysis regarding sebaceous carcinoma, sebaceoma/sebaceous adenoma, and sebaceous hyperplasia are described in the current review. A special note is made for describing the Muir-Torre Syndrome in patients presenting multiple sebaceous tumors.
Collapse
Affiliation(s)
- Ilias Papadimitriou
- First Department of Dermatology and Venereology, School of Health Science, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece
| | - Efstratios Vakirlis
- First Department of Dermatology and Venereology, School of Health Science, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece
| | - Elena Sotiriou
- First Department of Dermatology and Venereology, School of Health Science, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece
| | - Katerina Bakirtzi
- First Department of Dermatology and Venereology, School of Health Science, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology and Venereology, School of Health Science, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece
| | - Demetrios Ioannides
- First Department of Dermatology and Venereology, School of Health Science, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece
| |
Collapse
|
8
|
Pagetoid Spread in Basal Cell Carcinoma: Potential for Misdiagnosis. Am J Dermatopathol 2023; 45:254-258. [PMID: 36921301 DOI: 10.1097/dad.0000000000002386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
ABSTRACT Basal cell carcinomas are one of the most common cutaneous carcinomas and show classical histologic features of basaloid nests with peripheral palisading. Pagetoid and intraepidermal spread has not been described in basal cell carcinoma to the best of our knowledge. We report 5 cases of basal cell carcinoma with classic histologic patterns and overlying basaloid nests and single intraepidermal tumor cells. A panel of immunostains were performed that included CK7, MOC31, CEA-m, EMA, androgen receptor, and Bcl2. Most of our cases were positive for both MOC31 and CK7, and all cases were negative for CEA-m and EMA excluding extramammary Paget disease, one of the most common differential diagnoses. These cases expand the spectrum of findings that can be seen in basal cell carcinoma and can help prevent misdiagnoses of basal cell carcinomas as more aggressive tumors.
Collapse
|
9
|
Sebaceous Carcinoma of the Penis: A Rare, Dangerous Clinical Entity and the Importance of Immunohistochemistry in Diagnosis. Case Rep Dermatol Med 2023; 2023:6944296. [PMID: 36741940 PMCID: PMC9897908 DOI: 10.1155/2023/6944296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 02/07/2023] Open
Abstract
We report a very rare case of pathologically confirmed sebaceous carcinoma of the glans penis with multiple areas of lymphovascular and perineural invasion and multiple lymph node metastases. The importance of immunohistochemical staining in diagnosis is also reviewed.
Collapse
|
10
|
Oulès B, Deschamps L, Sohier P, Tihy M, Chassac A, Couvelard A, Frouin E, Battistella M. Diagnostic Accuracy of GATA6 Immunostaining in Sebaceous Tumors of the Skin. Mod Pathol 2023; 36:100101. [PMID: 36788082 DOI: 10.1016/j.modpat.2023.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/19/2023]
Abstract
The accurate diagnosis of skin adnexal neoplasms is sometimes challenging but is necessary because medical management and follow-up may differ between tumors. GATA6 transcription factor has been identified as a new marker of the upper folliculosebaceous compartment (lower infundibulum, junctional zone and isthmus, and upper sebaceous gland) in the human skin. We aimed to determine the diagnostic accuracy of GATA6 immunostaining to diagnose sebaceous tumors compared with that to diagnose other adnexal and nonadnexal cutaneous neoplasms. We conducted a retrospective, evaluator-nonblinded study comparing the reference standard (diagnosis by an expert dermatopathologist) with GATA6 immunostaining to identify sebaceous tumors in a cohort containing 234 different tumors. The GATA6 expression score was significatively higher in sebaceous than that in nonsebaceous tumors. In addition, tumors originating from the upper hair follicle showed positive results for GATA6 staining; however, they showed lower GATA6 expression scores. Detection of sebaceous tumors using GATA6 positivity had a sensitivity of 95.7% (95% confidence interval [95% CI], 85.8-99.2), specificity of 80.8% (95% CI, 74.5-85.8), positive predictive value of 55.6% (95% CI, 44.7-65.9), and negative predictive value of 98.7% (95% CI, 95.4-99.8). GATA6 showed similar sensitivity to adipophilin, the reference marker; however, the specificity of GATA6 was higher, as observed in a cohort of 106 tumors enriched in squamous cell carcinomas with clear-cell histology. In addition, GATA6 positivity was assessed in 39 sebaceous carcinomas and compared with epithelial membrane antigen (EMA), CK7, and androgen receptor (AR) staining results. Although CK7 staining displayed lower diagnostic performances, GATA6 staining showed comparable results as EMA and AR. Finally, we found GATA6 expression in skin metastases of gastrointestinal origin, whereas GATA6 was absent in metastases originating from breast or lung cancers. Overall, our work identified GATA6 immunostaining as a new diagnostic tool for sebaceous tumors.
Collapse
Affiliation(s)
- Bénédicte Oulès
- Cutaneous Biology Lab, Institut Cochin, INSERM U1016, UMR 8104, Paris, France; Department of Dermatology, Hôpital Cochin, AP-HP Centre-Université Paris Cité, Paris, France; Faculté de Médecine Paris Centre Santé, University Paris Cité, Paris, France
| | - Lydia Deschamps
- Department of Pathology, Hôpital Bichat, AP-HP Nord-Université Paris Cité, Paris, France; CARADERM, French Network of Rare Cutaneous Cancers, Lille, France
| | - Pierre Sohier
- Cutaneous Biology Lab, Institut Cochin, INSERM U1016, UMR 8104, Paris, France; Faculté de Médecine Paris Centre Santé, University Paris Cité, Paris, France; CARADERM, French Network of Rare Cutaneous Cancers, Lille, France; Department of Pathology, Hôpital Cochin, AP-HP Centre-Université Paris Cité, Paris, France
| | - Matthieu Tihy
- Department of Pathology, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - Anaïs Chassac
- Department of Pathology, Hôpital Bichat, AP-HP Nord-Université Paris Cité, Paris, France
| | - Anne Couvelard
- Faculté de Médecine Paris Centre Santé, University Paris Cité, Paris, France; Department of Pathology, Hôpital Bichat, AP-HP Nord-Université Paris Cité, Paris, France; Centre de Recherche sur l'Inflammation, INSERM UMR1149, Faculté de Médecine Bichat, Paris, France
| | - Eric Frouin
- CARADERM, French Network of Rare Cutaneous Cancers, Lille, France; Department of Pathology, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Maxime Battistella
- Faculté de Médecine Paris Centre Santé, University Paris Cité, Paris, France; CARADERM, French Network of Rare Cutaneous Cancers, Lille, France; Department of Pathology, Hôpital Saint Louis, AP-HP Nord-Université Paris Cité, Paris, France; Onco-dermatology and Therapies Lab, Human Immunology, Pathophysiology, Immunotherapy, INSERM U976, Paris, France.
| |
Collapse
|
11
|
Vissers G, Corthouts J, Van Haverbeke C, Declercq S, Mertens M. Misdiagnosis of sebaceous carcinoma. Acta Chir Belg 2022; 122:127-132. [PMID: 32375578 DOI: 10.1080/00015458.2020.1765674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Sebaceous carcinoma is an aggressive malignant tumour. To prevent mutilating surgery and improve patient outcomes, early diagnosis and prompt treatment are necessary. When the tumour invades surrounding tissues, treatment may become complex. METHODS We present a case report illustrating complex resection and reconstruction of a sebaceous carcinoma after initial misdiagnosis. RESULTS A 74-year-old man with a sebaceous carcinoma to his right upper eyelid had a delay in treatment due to initial misdiagnosis. Upon the correct diagnosis, computed tomography scan showed tumour invasion of the medial rectus muscle and tumour spread to the right parotid gland. An orbital exenteration, partial parotidectomy and selective cervical lymphadenectomy were performed. Frozen section examination showed false-free margins, as additional paraffin embedded sections showed uncomplete tumour resection. Adjuvant radiotherapy was offered to the patient. The treatment was complicated by radio necrosis, necessitating surgical reconstruction by a paramedian forehead flap. Final reconstruction of the right orbit was accomplished by a personalised epithesis. CONCLUSIONS Sebaceous carcinoma is a tumour that is often misdiagnosed. The aim of this case report is to emphasize the possible consequences of its misdiagnosis. An overview of characteristic clinical findings is provided to help reduce the number of misdiagnoses.
Collapse
Affiliation(s)
- Gino Vissers
- Department of Plastic Surgery, ZNA Middelheim Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Jérôme Corthouts
- Department of Plastic Surgery, ZNA Middelheim Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | | | - Sabine Declercq
- Department of Pathology, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Marianne Mertens
- Department of Plastic Surgery, ZNA Middelheim Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| |
Collapse
|
12
|
Plaza JA, Chung C, Salim S, Gru A, Sangueza M. Sebaceous Carcinomas: A Clinicopathological Comparison of Ocular and Extraocular Variants. Am J Dermatopathol 2021; 43:763-772. [PMID: 34651592 DOI: 10.1097/dad.0000000000001812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Sebaceous carcinomas (SC) are rare tumors and are currently classified into ocular and extraocular variants. Both variants of SC have very different clinical behavior and different histomorphologic appearance; however, published data are confounding as literature describes prognosis of both variants is similar or even that extraocular variants are more aggressive. In this study we evaluated the clinical and the histopathology of ocular and extraocular SC to confirm the difference between them. We performed a retrospective review of SC in which we studied the clinical and histomorphologic features of 106 cases, including 39 cases of ocular SC and 67 cases of extraocular SC. Only 2/67 cases of extraocular SC had multiple recurrences and none of them metastasized as opposed to our cases of ocular SC wherein 21/39 cases were locally aggressive with multiple recurrences and 5 cases metastasized. Histologically, both neoplasms showed major distinct morphologic features including poor differentiation in cases of ocular SC and well-differentiated tumors in the extraocular anatomic sites. To the best of our knowledge, this is the first case series of SC that compares the clinicopathologic features of ocular and extraocular variants. Awareness of such discrepancy is key to understand this disease and to possibly diagnose and manage these patients accordingly.
Collapse
Affiliation(s)
- Jose A Plaza
- Director of Dermatopathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Catherine Chung
- Dermatopathologist, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sadia Salim
- Dermatopathologist, Inform Diagnostic Irving, Irving, TX
| | - Alejandro Gru
- Director of Dermatopathology, Divisions of Dermatopathology and Hematopathology, University of Virginia, Charlottesville, VA; and
| | - Martin Sangueza
- Director of Pathology, Hospital Obrero, La Paz, Bolivia, South America
| |
Collapse
|
13
|
Clear Cell Proliferations of the Skin: A Histopathologic Review. Am J Dermatopathol 2021; 43:607-636. [PMID: 34411018 DOI: 10.1097/dad.0000000000001881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Cutaneous clear cell proliferations encompass a heterogenous group of several primary cutaneous neoplasms and metastatic tumors with different histogenesis. Many of these clear cell proliferations may seem strikingly similar under the microscope resulting in challenging diagnosis. In many of these clear cell lesions, the reason for the clear or pale appearance of proliferating cells is unknown, whereas in other ones, this clear cell appearance is due to intracytoplasmic accumulation of glycogen, mucin, or lipid. Artifacts of tissue processing and degenerative phenomenon may also be responsible for the clear cell appearance of proliferating cells. Awareness of the histopathologic findings as well as histochemical and immunohistochemical techniques are crucial to the accurate diagnosis. This review details the histopathologic features of clear cell cutaneous proliferations, classifying them according their type of differentiation and paying special attention to the histopathologic differential diagnosis among them.
Collapse
|
14
|
Ansai SI, Umebayashi Y, Katsumata N, Kato H, Kadono T, Takai T, Namiki T, Nakagawa M, Soejima T, Koga H, Sugaya M. Japanese Dermatological Association Guidelines: Outlines of Guidelines for Cutaneous Squamous Cell Carcinoma 2020. J Dermatol 2021; 48:e288-e311. [PMID: 33963604 DOI: 10.1111/1346-8138.15889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 01/04/2023]
Abstract
In consideration of the development of treatment options for squamous cell carcinoma (SCC), the Japanese Skin Cancer Society issued the first guidelines of SCC in 2007 and revised them in 2015. Here, we report the English version of the 2020 edition of the Japanese SCC guidelines. The first half of this article is an overview of SCC including actinic keratosis and Bowen's disease, and the second half discusses three clinical questions: (i) treatment of actinic keratosis; (ii) determination of the resection margin of the primary lesion; and (iii) treatment of radically incurable cases, as contemporary problems encountered in treating SCC. In these evaluations, all processes were implemented according to the Grading of Recommendations, Assessment, Development, Evaluation system. Also, items of recommendation concerning each clinical question were determined by a multidisciplinary expert panel consisting of dermatologists, plastic/reconstructive surgeons, radiologists, and oncologists through a comprehensive literature search and systematic reviews.
Collapse
Affiliation(s)
- Shin-Ichi Ansai
- Division of Dermatology and Dermatopathology, Nippon Medical School Musashi Kosugi-Hospital, Kawasaki, Japan
| | - Yoshihiro Umebayashi
- Department of Dermatology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Noriyuki Katsumata
- Department of Medical Oncology, Nippon Medical School Musashi Kosugi-Hospital, Kawasaki, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takafumi Kadono
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshihiro Takai
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Takeshi Namiki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Nakagawa
- Department of Plastic and Reconstructive Surgery, Shizuoka Prefectural Cancer Center, Nagaizumi, Japan
| | | | - Hiroshi Koga
- Department of Dermatology, Shinshu University, Matsumoto, Japan
| | - Makoto Sugaya
- Department of Dermatology, International University of Health and Welfare, Narita, Japan
| | | |
Collapse
|
15
|
Donnell SA, LeBlanc RE, Yan S, Parra O, Momtahen S, Sriharan A, Linos K. Comparison of adipophilin and recently introduced PReferentially expressed Antigen in MElanoma immunohistochemistry in the assessment of sebaceous neoplasms: A pilot study. J Cutan Pathol 2021; 48:1252-1261. [PMID: 33949693 DOI: 10.1111/cup.14043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We and others have noticed consistent staining of sebaceous glands with PReferentially expressed Antigen in MElanoma (PRAME). We aimed to determine whether PRAME was as sensitive, specific, and interpretable as adipophilin for distinguishing sebaceous neoplasms (SNs) from other neoplasms. METHODS Twenty SNs and 32 control cases were stained for PRAME and adipophilin. Extent of staining was scored as follows: 0, no staining; 1, <5% positivity; 2, 5% to 50% positivity; and 3, >50% positivity. Intensity was scored as negative, weak, moderate, or strong. A composite score was determined by adding the scores for extent and intensity. RESULTS PRAME had positive composite scores in all 20 SNs in the more differentiated areas, whereas adipophilin had positive composite scores in 19/20 cases. PRAME showed positivity in the basaloid cells in 15/16 cases, whereas adipophilin was positive in 14. Among controls, PRAME and adipophilin had positive composite scores in 3/32 cases and 6/32 cases, respectively. CONCLUSIONS PRAME and adipophilin are comparable in terms of distribution and intensity for staining sebocytes. In the basaloid cells, PRAME expression is often more diffuse and easier to detect than adipophilin. In comparing the SNs to the controls, PRAME was more sensitive and more specific than adipophilin. PRAME could be used as an additional marker of sebaceous differentiation in everyday practice.
Collapse
Affiliation(s)
- Sarah A Donnell
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Robert E LeBlanc
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Shaofeng Yan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Ourania Parra
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Shabnam Momtahen
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Aravindhan Sriharan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| |
Collapse
|
16
|
Boecker W, Reusch M, Mielke V, Reusch U, Hallermann C, Loening T, Tiemann M, Buchwalow I. Twenty-Eight Cases of Extraocular Sebaceous Carcinoma: A Correlative Clinicopathological and Immunohistochemical Analysis of Extraocular Sebaceous Carcinomas and Benign Sebaceous Gland Tumors. Am J Dermatopathol 2021; 43:93-102. [PMID: 32568835 DOI: 10.1097/dad.0000000000001667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ABSTRACT Extraocular sebaceous carcinoma (ESC) is a rare appendiceal skin tumor. In contrast to ocular sebaceous carcinoma, information about the exact cellular architecture of these lesions is scarce and the histogenesis of ESC is unknown. Here, we extend our previous study and investigate 28 extraocular carcinomas in comparison to 54 benign sebaceous tumors and 8 cases of normal sebaceous glands using a broad spectrum of antibodies against p63, several keratins, adipophilin, EMA, Ki67, androgen receptor, and mismatch repair proteins. This observational study demonstrates that p63- and K5/14-positive basaloid cells are key cells in normal sebaceous gland and in all sebaceous tumors and that these basaloid cells give rise to EMA+, adipophilin+ sebocytes, and K5/14+, K7±, K10± ductal structures. Finally, about half of ESC is associated with superficial in situ neoplasia, which provides evidence that at least part of these carcinomas arises from flat superficial in situ carcinoma. In contrast to the normal sebaceous gland, about half of all sebaceous tumors lack keratin K7. MMR protein IHC-profiles role will be discussed.
Collapse
Affiliation(s)
- Werner Boecker
- Gerhard-Domagk-Institute of Pathology, University of Muenster, Münster, Germany
- Dermatopathology Laboratory, Hamburg, Germany
- Gerhard-Seifert Referenzzentrum, Hamburg, Germany; and
| | | | | | | | | | | | | | - Igor Buchwalow
- Gerhard-Domagk-Institute of Pathology, University of Muenster, Münster, Germany
- Institute for Hematopathology, Hamburg, Germany
| |
Collapse
|
17
|
Miura K, Akashi T, Namiki T, Hishima T, Bae Y, Sakurai U, Murano K, Shiraishi J, Warabi M, Tanizawa T, Tanaka M, Bhunchet E, Kumagai J, Ayabe S, Sekiya T, Ando N, Shintaku H, Kinowaki Y, Tomii S, Kirimura S, Kayamori K, Yamamoto K, Ito T, Eishi Y. Engrailed Homeobox 1 and Cytokeratin 19 Are Independent Diagnostic Markers of Eccrine Porocarcinoma and Distinguish It From Squamous Cell Carcinoma. Am J Clin Pathol 2020; 154:499-509. [PMID: 32556098 DOI: 10.1093/ajcp/aqaa066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The diagnostic utility of En1 in the histopathologic differentiation of eccrine porocarcinoma (EPC) from invasive squamous cell carcinoma (SCC) was investigated. METHODS Expression of En1 and CK19 in 16 cases of EPC was immunohistochemically examined and compared with that in 32 cases of SCC. RESULTS In all 16 EPCs, En1 was expressed in 3% to 100% of tumor cells. In 20 of the 32 SCCs, En1 was expressed in 3% to 90% of tumor cells. A total of 13 of the 16 EPCs and five of the 32 SCCs were judged as En1 positive, with a cutoff value of 25%. In addition, 11 of the 16 EPCs and four of the 32 SCCs were CK19 positive. The frequencies of En1- and CK19-positive cases were significantly higher in EPCs than in SCCs. In a logistic regression analysis for predicting EPC, En1 and CK19 were independent markers. When expression patterns of En1 and CK19 were combined, none of the 32 SCCs was both positive. In contrast, 15 of the 16 EPCs were positive for either En1 or CK19. CONCLUSIONS A combination of En1 and CK19 expression can improve the accuracy of histologic diagnosis of EPC.
Collapse
Affiliation(s)
- Keiko Miura
- Division of Surgical Pathology, University Hospital, Tokyo, Japan
| | - Takumi Akashi
- Division of Surgical Pathology, University Hospital, Tokyo, Japan
- Department of Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Namiki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yuan Bae
- Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Urara Sakurai
- Department of Pathology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Keimei Murano
- Department of Dermatology, Soka Municipal Hospital, Saitama, Japan
| | | | - Masahiro Warabi
- Department of Pathology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Toru Tanizawa
- Department of Pathology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Michio Tanaka
- Department of Pathology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Ekapot Bhunchet
- Department of Pathology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Jiro Kumagai
- Department of Pathology, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan
| | - Shinya Ayabe
- Division of Surgical Pathology, University Hospital, Tokyo, Japan
| | - Takahiro Sekiya
- Division of Surgical Pathology, University Hospital, Tokyo, Japan
| | - Noboru Ando
- Division of Surgical Pathology, University Hospital, Tokyo, Japan
| | - Hiroshi Shintaku
- Division of Surgical Pathology, University Hospital, Tokyo, Japan
| | - Yuko Kinowaki
- Division of Surgical Pathology, University Hospital, Tokyo, Japan
| | - Shohei Tomii
- Division of Surgical Pathology, University Hospital, Tokyo, Japan
| | - Susumu Kirimura
- Division of Surgical Pathology, University Hospital, Tokyo, Japan
| | - Kou Kayamori
- Department of Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kurara Yamamoto
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Ito
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
18
|
Abstract
Ber-EP4 has been the traditional immunostain used for the detection of basaloid skin tumors. Recently, MOC-31 has shown be superior to Ber-EP4 in the detection of basosquamous basal cell carcinoma (BCC) and many centers are now using both Ber-EP4 and MOC-31 antibodies together to detect these lesions. The objective of this study was to compare the utility of using both Ber-EP4 and MOC-31 immunostains in the detection of basaloid skin tumors and to better characterize the previously unknown staining properties of MOC-31 in cutaneous lesions. To do this, 76 basaloid skin tumors stained with both Ber-EP4 and MOC-31 were obtained. Diagnoses included basosquamous BCC, Merkel cell carcinoma, adenoid cystic carcinoma, microcystic adnexal carcinoma, sebaceous carcinoma, trichoepithelioma, trichoblastoma, sebaceous adenoma, sebaceoma, and follicular induction overlying dermatofibroma. The distribution and intensity of Ber-EP4 and MOC-31 staining in these lesions was scored. These scores were analyzed using a truth table, χ test, and Pearson correlation tests. The overall mean and SD of the scores were also obtained. Overall, we found Ber-EP4 and MOC-31 to be statistically equivalent immunostains for the diagnosis of basaloid skin tumors. We recommend the use of only one of these antibodies and favor MOC-31 for the detection of basaloid skin tumors. We also describe MOC-31 staining properties in different cutaneous lesions.
Collapse
|
19
|
Ohno K, Okada T, Nakamura T, Koyama H. Sebaceous carcinoma of the breast predominantly characterized by intraductal growth: a case report. Surg Case Rep 2020; 6:41. [PMID: 32095941 PMCID: PMC7040145 DOI: 10.1186/s40792-020-0799-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 01/28/2020] [Indexed: 02/07/2023] Open
Abstract
Background Sebaceous carcinoma (SC) is frequently classified as periocular or extraocular. Extraocular SC is rare and mainly occurs in the head and neck, the major salivary glands, or oral mucosa. SC of the breast, lung, and ovary is particularly rare, and the few cases of SC of the breast predominantly exhibit intraductal growth. Case presentation A 47-year-old Japanese woman was referred to our hospital with accumulated polymorphic calcification in the left breast which was detected using mammography. Ultrasonography revealed an irregular 13-mm mass in the left breast, and analysis of a core needle biopsy revealed noninvasive ductal carcinoma. Total mastectomy and sentinel lymph node biopsy were performed. Histopathology demonstrated that carcinoma in situ (CIS) represented a significant lesion, and the cytoplasm of tumor cells was clear with numerous minute vacuoles. Immunohistochemical analysis demonstrated that most tumor cells expressed adipophilin. Together, these findings led to a diagnosis of SC, mainly comprising CIS. Conclusions We encountered a rare case of SC of the breast with predominant CIS.
Collapse
Affiliation(s)
- Koichi Ohno
- Department of Breast and Endocrine Surgery, Suwa Red Cross Hospital, 5-11-50, Kogan-douri, Suwa, Nagano, 392-8510, Japan.
| | - Toshihiro Okada
- Department of Breast and Endocrine Surgery, Suwa Red Cross Hospital, 5-11-50, Kogan-douri, Suwa, Nagano, 392-8510, Japan
| | - Toshitsugu Nakamura
- Department of Diagnostic Pathology, Suwa Red Cross Hospital, 5-11-50, Kogan-douri, Suwa, Nagano, 392-8510, Japan
| | - Hiroshi Koyama
- Koyama Clinic, 1-2557-1, Jonan, Suwa, Nagano, 392-0017, Japan
| |
Collapse
|
20
|
Cytologic Grading of Cutaneous Sebaceous Neoplasms: Does it Help to Differentiate Benign From Malignant? Am J Dermatopathol 2019; 41:722-732. [PMID: 31584883 DOI: 10.1097/dad.0000000000001434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Both architectural and cytologic characteristics are used to distinguish benign from malignant sebaceous neoplasms; however, specific cytopathologic features of sebocytes have not been well defined. The authors assessed architectural and cytological features of 63 sebaceous neoplasms [15 sebaceous hyperplasias, 12 sebaceomas, 16 sebaceous adenomas (SA), 14 sebaceous carcinomas (SC), and 6 ocular sebaceous carcinoma (OSC)] to investigate whether cytological grading may facilitate classification of lesions. Among other criteria, nuclear pleomorphism (size, nucleolar appearance, membrane irregularity, crowding, mitoses, and chromatin pattern) was assessed and 3 theoretical nuclear grades established. Immunohistochemistry for CK10, p16, adipophilin and ki67 was performed on 7 cases of each type of tumor. Most sebaceous neoplasms, except OSC, showed a bland architectural silhouette. However, SA, SC, and OSC revealed larger nuclei (≥14 μm in ≥50% of cases), evident to multiple nucleoli, membrane irregularity, coarse to clumped chromatin, and nuclear grade ≥2 (latter in ≥56% of cases); by contrast, sebaceous hyperplasia and sebaceomas showed smaller nuclei (≤10 μm in ≥50% of cases), smooth borders, inconspicuous nucleoli, fine chromatin, and grade 1 nuclei (latter in 100% of cases). In the setting of a well-circumscribed architecture, cytologic features gain importance in the classification of sebaceous neoplasms. Interestingly, cytologic similarities found in SA and SC may indicate a close relationship of both neoplasms.
Collapse
|
21
|
Cells to Surgery Quiz: August 2019. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.06.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
22
|
Cavalieri S, Busico A, Capone I, Conca E, Dallera E, Quattrone P, Licitra L, Pruneri G, Bossi P, Perrone F. Identification of potentially druggable molecular alterations in skin adnexal malignancies. J Dermatol 2019; 46:507-514. [DOI: 10.1111/1346-8138.14889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/21/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Stefano Cavalieri
- Head and Neck Medical Oncology Unit Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
| | - Adele Busico
- Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
| | - Iolanda Capone
- Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
| | - Elena Conca
- Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
| | - Elena Dallera
- Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
| | - Pasquale Quattrone
- Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology Unit Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
- University of Milan Milan Italy
| | - Giancarlo Pruneri
- Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
- University of Milan Milan Italy
| | - Paolo Bossi
- Head and Neck Medical Oncology Unit Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
| | - Federica Perrone
- Department of Pathology Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
| |
Collapse
|
23
|
Tetzlaff MT, North J, Esmaeli B. Update on sebaceous neoplasia: the morphologic spectrum and molecular genetic drivers of carcinoma. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.mpdhp.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
24
|
de Lima RB, Jung JE, Ioshii SO, Kami RM. Sebaceous carcinoma in a mature teratoma of the ovary. AUTOPSY AND CASE REPORTS 2019; 8:e2018060. [PMID: 30775330 PMCID: PMC6360825 DOI: 10.4322/acr.2018.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/10/2018] [Indexed: 11/24/2022] Open
Abstract
The finding of a sebaceous carcinoma in a mature teratoma is rare in human pathology, with fewer than 10 cases currently reported in the literature. In this article, we report a case of sebaceous carcinoma in a mature teratoma of the ovary in a 59-year-old patient and discuss its histological findings.
Collapse
Affiliation(s)
| | | | - Sérgio Ossamu Ioshii
- Hospital Erasto Gaertner, Department of Pathology. Curitiba, PR, Brazil.,Pontificia Universidade Católica (PUC), Hospital Erasto Gaertner, Department of Pathology. Curitiba, Paraná, Brazil
| | | |
Collapse
|
25
|
Boecker W, Reusch M, Mielke V, Reusch U, Loening T, Tiemann M, Buchwalow I. Spatial analysis of p63, K5 and K7 defines two groups of progenitor cells that differentially contribute to the maintenance of normal sebaceous glands, extraocular sebaceous carcinoma and benign sebaceous tumors. J Dermatol 2019; 46:249-258. [PMID: 30663115 DOI: 10.1111/1346-8138.14765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/29/2018] [Indexed: 01/18/2023]
Abstract
The histogenesis of extraocular sebaceous carcinomas is - in contrast to ocular sebaceous carcinomas - unclear, and information about the exact cellular architecture of these lesions and even of the normal sebaceous gland is still scarce. This study attempts to elucidate the histogenesis of sebaceous tumors, using multicolor immunofluorescence stainings to analyze 21 cases of sebaceous tumors (six each of extraocular sebaceous carcinoma, sebaceous adenoma and sebaceoma, and three cases of steatocystomas) and eight cases of normal sebaceous glands for p63, several keratins, androgen receptor, adipophilin, epithelial membrane antigen (EMA) and Ki-67. The data of this observational study provide evidence for the existence of two subpopulations of progenitors in normal sebaceous glands: (i) p63+ K5+ progenitors which generate the K10+ luminal cells of sebaceous ducts; and (ii) p63+ K5+ K7+ progenitors which finally generate K7+ adipophilin+ EMA+ sebocytes. Without exception, all types of sebaceous tumors contained p63+ K5+ cells. Furthermore, these tumors showed a cellular hierarchy and differentiation to adipophilin+ and/or EMA+ mature sebocytes and to K10+ ductal cells through intermediary cells. Notably, a considerable number of sebaceous tumors lack the K7 pathway of cell maintenance in the normal sebaceous lobule. Based on our data, we propose a cellular algorithmic model of the hierarchy of normal sebaceous glands and of sebocytic tumors in which p63+ K5+ cells play a major role.
Collapse
Affiliation(s)
- Werner Boecker
- Gerhard-Domagk-Institute of Pathology, University of Muenster, Muenster, Germany.,Dermatopathology Laboratory, Hamburg, Germany.,Gerhard-Seifert Reference Center for Gyneco-, Oral- and Breast Pathology, Hamburg, Germany
| | | | | | | | - Thomas Loening
- Dermatopathology Laboratory, Hamburg, Germany.,Gerhard-Seifert Reference Center for Gyneco-, Oral- and Breast Pathology, Hamburg, Germany
| | | | | |
Collapse
|
26
|
Pinheiro JAF, Lopes JMPB. Periocular Sebaceous Carcinoma With Apocrine Differentiation: A Case Report and Review of the Literature. Int J Surg Pathol 2018; 27:432-436. [PMID: 30522363 DOI: 10.1177/1066896918816806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 61-year-old man presented with a dome-shaped tumor in the right eyelid. Histology revealed a cutaneous neoplasm with lobular growth pattern. It was composed of large basaloid cells, cells with sebaceous differentiation, and glandular structures with apocrine features. The immunohistochemical study revealed diffuse expression of CK7, EMA, and androgen receptors in the neoplastic cells. Gross cystic disease fluid protein-15 highlighted the luminal cells, consistent with apocrine differentiation. These findings fit with a sebaceous carcinoma with focal glandular apocrine differentiation ("sebo-apocrine" carcinoma). Metastasis to regional lymph nodes were diagnosed 12 months after the surgical procedure. After 3 years of follow-up, the patient is alive, with evidence of persistent locoregional metastasis, but no evidence of distant metastasis. Most cutaneous adnexal tumors present only one cell type of differentiation, but hybrid/combined tumors can occur. Despite "sebo-apocrine" tumors are not unexpected, due to their common origin in the follicular-sebaceous apocrine unit, they are very rarely reported.
Collapse
|
27
|
Bowen Disease With Sebaceous Differentiation: A Case Report and Immunohistochemical Analysis of Adipophilin and Cytokeratin 1. Am J Dermatopathol 2018; 40:841-845. [DOI: 10.1097/dad.0000000000001175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
28
|
Hierarchical Cluster Analysis of Cytokeratins and Stem Cell Expression Profiles of Canine Cutaneous Epithelial Tumors. Vet Pathol 2018; 55:821-837. [DOI: 10.1177/0300985818785680] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The diagnosis of cutaneous epithelial tumors (CETs) in dogs is based on predominant histological differentiation patterns. However, the expression of a broad panel of antigens has not been comprehensively examined with immunohistochemistry. The present study aims to establish a comprehensive expression profile and identify useful diagnostic markers for each CET type. Cytokeratin (CK), stem cell, and other associated markers were immunohistochemically examined in 110 canine CETs. Among these, CK16 was useful for differentiating between basal and squamous cell carcinomas. Acantholytic squamous cell carcinomas were positive for CK8, CK18, and CK19, suggesting their close association with the apocrine duct. Unlike their benign counterparts, sebaceous carcinomas coexpressed CK5/6 and adipophilin. Smooth muscle actin (SMA) and p63 immunostaining were useful for accurately distinguishing between glandular and ductal differentiation in apocrine tumors. A case of apocrine carcinoma and malignant myoepithelioma was identified using anti-SMA antibodies. Stem cell expression profiles (CK8, CK15, CK19, and CD34) of hair follicle tumors were discrete and indicative of their anatomic origins. The effectiveness of immunohistochemistry for tumor diagnosis was further confirmed by hierarchical cluster analysis, through which selected markers were able to sort CETs into specific groups: CK5/6, CK8, CK14, CK16, CK18, CK19, p63, adipophilin, and SMA sorted tumors of epidermal, apocrine, or sebaceous origin; while CK8, CK14, CK15, CK16, CK19, CD34, and p63 sorted hair follicle tumors in agreement with their histological differentiation. In conclusion, the present study provides comprehensive immunohistochemical information, which could complement histomorphological features for the future classification of canine CETs.
Collapse
|
29
|
Yunoki T, Miyakoshi A, Otsuka M, Hayashi A. Clinicopathological features of considerable reduction in androgen receptor expression in sebaceous gland carcinoma of the eyelid. Int Ophthalmol 2018; 39:1703-1708. [DOI: 10.1007/s10792-018-0990-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/12/2018] [Indexed: 12/30/2022]
|
30
|
Soares CD, Morais TML, Carlos R, Jorge J, de Almeida OP, de Carvalho MGF, Altemani AMM. Sebaceous adenocarcinomas of the major salivary glands: a clinicopathological analysis of 10 cases. Histopathology 2018; 73:585-592. [DOI: 10.1111/his.13664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 05/30/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Ciro D Soares
- Department of Oral Diagnosis; Area of Pathology; Piracicaba Dental School; University of Campinas; Piracicaba SP Brazil
| | - Thayná M L Morais
- Department of Oral Diagnosis; Area of Pathology; Piracicaba Dental School; University of Campinas; Piracicaba SP Brazil
| | - Roman Carlos
- Pathology Division; Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi; Guatemala City Guatemala
| | - Jacks Jorge
- Department of Oral Diagnosis; Area of Pathology; Piracicaba Dental School; University of Campinas; Piracicaba SP Brazil
| | - Oslei Paes de Almeida
- Department of Oral Diagnosis; Area of Pathology; Piracicaba Dental School; University of Campinas; Piracicaba SP Brazil
| | | | - Albina M M Altemani
- Department of Pathology; Faculty of Medical Sciences; University of Campinas; Campinas SP Brazil
| |
Collapse
|
31
|
Cicinelli MV, Kaliki S. Ocular sebaceous gland carcinoma: an update of the literature. Int Ophthalmol 2018; 39:1187-1197. [DOI: 10.1007/s10792-018-0925-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 04/13/2018] [Indexed: 02/07/2023]
|
32
|
The Use of BEREP4 Immunohistochemistry Staining for Detection of Basal Cell Carcinoma. J Skin Cancer 2017; 2017:2692604. [PMID: 29464122 PMCID: PMC5804366 DOI: 10.1155/2017/2692604] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/03/2017] [Accepted: 11/29/2017] [Indexed: 11/21/2022] Open
Abstract
Basal Cell Carcinoma (BCC) is the most common type of malignant cancer found in the world today with a 3–10% increase in incidence each year. The American Cancer Society reported that 8 out of 10 patients with skin cancer are suffering from BCC with over 2 million new cases each year. BCC needs to be detected at the early stages to prevent local destruction causing disabilities to patients and increasing treatment costs. Furthermore, BCC patients who have undergone surgery are still at risk for recurrence, especially when the surgery performed fails to remove all the BCC cells, even when conventional histopathological testing after surgery has reported a surgically free margin. This review aims to evaluate studies on the use of BerEP4 immunohistochemistry staining on pathological sections of various types of BCC as well as its shortfalls. BerEP4 is a monoclonal antibody which detects specific epithelial-glycoprotein-adhesion-molecules (EpCAM) found on BCC cells. Various studies have shown that BerEP4 has a high sensitivity and specificity in detecting only BCC cells. The use of BerEP4 immunohistochemistry testing for the routine examination of cases of BCC is expected to be able to increase and improve early diagnosis as well as prevent recurrence after surgery.
Collapse
|
33
|
Kogame T, Ohe S, Yamazaki F, Okamoto H, Kiyohara T. Extraocular sebaceous carcinoma accompanied by invasive squamous cell carcinoma: The first case report and consideration of histogenesis. J Dermatol 2017; 45:501-504. [PMID: 29266386 DOI: 10.1111/1346-8138.14196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/24/2017] [Indexed: 11/29/2022]
Abstract
A 61-year-old man presented with a dome-shaped nodule, 1.2 cm in size, with a central crater covered by keratinous material near the left lateral malleolus. Histological findings demonstrated a basophilic circular cone in the center, surrounded and sharply demarcated by a broad eosinophilic area. The central conical mass was composed mainly of atypical basaloid cells intermingled with scattered atypical sebaceous cells with scalloped nuclei and microvesicular cytoplasms, suggesting sebaceous carcinoma. The peripheral area consisted of atypical keratinizing squamoid cells without sebaceous cells, suggesting invasive squamous cell carcinoma. Atypical sebaceous cells were positive for adipophilin. Atypical basaloid cells were positive for 34βE12 and CAM5.2. Peripheral squamoid cells were positive for 34βB4 and 34βE12 throughout, and were positive for LHP1 in the superficial layer. We herein describe the first case of extraocular sebaceous carcinoma accompanied by invasive squamous cell carcinoma, which might have arisen from biphasic differentiation of cancer stem cells.
Collapse
Affiliation(s)
- Toshiaki Kogame
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Ohe
- Department of Dermatology, Kansai Medical University, Osaka, Japan
| | | | - Hiroyuki Okamoto
- Department of Dermatology, Kansai Medical University, Osaka, Japan
| | - Takahiro Kiyohara
- Department of Dermatology, Kansai Medical University, Osaka, Japan.,Department of Dermatology, Kansai Medical University Medical Center, Osaka, Japan
| |
Collapse
|
34
|
Tetzlaff MT. Immunohistochemical markers informing the diagnosis of sebaceous carcinoma and its distinction from its mimics: Adipophilin and factor XIIIa to the rescue? J Cutan Pathol 2017; 45:29-32. [DOI: 10.1111/cup.13073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/09/2017] [Accepted: 10/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Michael T. Tetzlaff
- Department of Pathology, Section of Dermatopathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| |
Collapse
|
35
|
|
36
|
Tjarks BJ, Pownell BR, Evans C, Thompson PA, Kerkvliet AM, Koch MRD, Jassim AD. Evaluation and comparison of staining patterns of factor XIIIa (AC-1A1), adipophilin and GATA3 in sebaceous neoplasia. J Cutan Pathol 2017; 45:1-7. [PMID: 28873247 DOI: 10.1111/cup.13037] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/27/2017] [Accepted: 08/31/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Reliable nuclear immunohistochemical stains for sebaceous neoplasms have not been readily available. Positive nuclear staining has been reported for GATA3 and factor XIIIa (AC-1A1). We sought to determine the diagnostic utility of these nuclear stains by comparing their staining pattern to adipophilin, a consistently positive cytoplasmic stain. METHODS Cases with the diagnosis of sebaceous hyperplasia, sebaceous adenoma, sebaceous epithelioma/sebaceoma, sebaceous carcinoma, and nonsebaceous neoplasms (basal cell carcinoma and squamous cell carcinoma) were examined. Intensity and extent of staining of the basal cells and mature sebocytes were evaluated for each stain. RESULTS Factor XIIIa (AC-1A1) was 87.3% sensitive and 95.1% specific for all sebaceous neoplasms sand showed high inter-observer reliability. Adipophilin was 83.2% sensitive and 87.8% specific. GATA3 was the least sensitive (80.9%) and specific (75.6%) marker. When factor XIIIa was compared against composite staining of all three markers its staining was still uniquely significant (P = .0210). CONCLUSION Factor XIIIa (AC-1A1) is a sensitive and specific nuclear marker for sebaceous differentiation. Its diagnostic utility exceeds that of adipophilin. Factor XIIIa should be included in the expanding group of immunohistochemical and special stains which can be utilized to aid in the diagnosis of sebaceous neoplasms.
Collapse
Affiliation(s)
- Brian J Tjarks
- Department of Pathology, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Brandy R Pownell
- Department of Pathology, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota
| | | | - Paul A Thompson
- Department of Pathology, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota.,Sanford Research, Sioux Falls, South Dakota
| | - Amy M Kerkvliet
- Department of Pathology, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota.,Sanford Health Pathology Clinic, Sioux Falls, South Dakota
| | - Michael R D Koch
- Department of Pathology, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota.,Sanford Health Pathology Clinic, Sioux Falls, South Dakota
| | - Ali D Jassim
- Department of Pathology, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota.,Sanford Health Pathology Clinic, Sioux Falls, South Dakota
| |
Collapse
|
37
|
Tzorakoleftheraki SE, Iliadis A, Kostopoulos I, Koletsa T. TdT expression in normal and neoplastic sebaceous cells. Histopathology 2017; 71:985-988. [DOI: 10.1111/his.13304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/02/2017] [Indexed: 12/16/2022]
Affiliation(s)
| | - Alexandros Iliadis
- Pathology Department; Faculty of Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Ioannis Kostopoulos
- Pathology Department; Faculty of Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Triantafyllia Koletsa
- Pathology Department; Faculty of Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| |
Collapse
|
38
|
Schmitz EJ, Herwig-Carl MC, Holz FG, Loeffler KU. Sebaceous gland carcinoma of the ocular adnexa - variability in clinical and histological appearance with analysis of immunohistochemical staining patterns. Graefes Arch Clin Exp Ophthalmol 2017; 255:2277-2285. [PMID: 28741159 DOI: 10.1007/s00417-017-3738-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 06/10/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The purpose of the study was to evaluate the characteristics of sebaceous gland carcinoma (SGC) of the ocular adnexae, which is due to a high variability in clinical, histological and immunohistochemical characteristics often challenging to diagnose. METHODS Records of six patients with SGC were reviewed, who underwent surgical excision and who were histologically diagnosed with SGC. For comparison, there were specimens from four patients with basal cell carcinoma (BCC) and four patients with squamous cell carcinoma (SCC). Histological and immunohistochemical analysis included stains for HE, cytokeratins (CKpan, Cam5.2), epithelial membrane antigen (EMA), androgen receptor (AR441), perforin and adipophilin. RESULTS SGC's were located in the upper (n = 2) or lower (n = 4) eyelid and were associated with various presenting clinical signs including chalazion-like lesions with pyogenic granuloma (n = 1), papillomatous conjunctival tumors (n = 3), a hyperkeratotic exophytic neoplasm (n = 1) and an ulcerating crusted lesion resembling chronic blepharitis (n = 1). The treatment was tumor resection, followed (if necessary) by adjuvant therapy with topical Mitomycin C (n = 2). Histologic characteristics included basophilic pleomorphic cells with vacuolated cytoplasm, prominent nucleoli, mitotic figures and in some cases pagetoid spread (n = 2). CKpan, EMA and Cam5.2 showed strong positive immunoreactivity in all specimens (SGC, BCC, SCC). Perforin immunostaining showed a varying, but overall weak, non-specific cytoplasmatic staining reaction in all lesions. AR441 positivity was noted with variable intensity in almost all lesions and in particular in pagetoid spread in contrast to non-tumor cells. Adipophilin showed an annular staining of lipid granules in immature sebaceous cells in SGC in contrast to a more granular staining pattern in BCC and SCC. CONCLUSION SGCs display a variety of clinical signs and may mimic many other lesions. Tumor resection, followed by histological and immunohistochemical analysis, leads to the diagnosis and initiation of the proper treatment regimen. Herein, immunohistochemistry showed an unequivocal profile in SGC and did not allow for an exact differentiation from BCC and SCC by immunohistochemical means only. An extended evaluation of HE stains remains essential. However, immunohistochemistry can make relevant contributions to the diagnosis of SGC, especially in cases of inconclusive histology, by positive staining for adipophilin in immature sebaceous cells or by AR441 labeling in cases of pagetoid spread.
Collapse
Affiliation(s)
- Eva Janine Schmitz
- Department of Ophthalmology, University Eye Hospital Bonn, University of Bonn, Ernst-Abbe Str. 2, 53127, Bonn, Germany. .,Department of Ophthalmology, Division of Ophthalmic Pathology, University of Bonn, Ernst-Abbe Str. 2, 53127, Bonn, Germany. .,Belenus Eye Center, Am Bahnhof 4-12, 57072, Siegen, Germany.
| | - Martina C Herwig-Carl
- Department of Ophthalmology, University Eye Hospital Bonn, University of Bonn, Ernst-Abbe Str. 2, 53127, Bonn, Germany.,Department of Ophthalmology, Division of Ophthalmic Pathology, University of Bonn, Ernst-Abbe Str. 2, 53127, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University Eye Hospital Bonn, University of Bonn, Ernst-Abbe Str. 2, 53127, Bonn, Germany
| | - Karin U Loeffler
- Department of Ophthalmology, University Eye Hospital Bonn, University of Bonn, Ernst-Abbe Str. 2, 53127, Bonn, Germany.,Department of Ophthalmology, Division of Ophthalmic Pathology, University of Bonn, Ernst-Abbe Str. 2, 53127, Bonn, Germany
| |
Collapse
|
39
|
Abstract
BACKGROUND Periocular sebaceous carcinoma (PSC) is a rare but aggressive neoplasm that tends to clinically and histopathologically mimic other conditions. PSC can be challenging to diagnose using histomorphology alone given its overlap with 2 more common tumors that occur in this area (basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]). Use of immunohistochemistry can help resolve this differential diagnosis. METHODS A review of the literature was performed, focusing on the epidemiology, morphology, and immunohistochemical features of PSC. RESULTS The most useful immunostains in the differential diagnosis of PSC are epithelial membrane antigen, Ber-Ep4, androgen receptor (AR), and adipophilin. To discern PSC from BCC, one should use EMA, Ber-Ep4, AR, and adipophilin, whereas discerning PSC from SCC can be achieved by evaluating AR and adipophilin. In addition, p53 and ERBB2 (formally known as HER2/neu) are other potentially useful immunohistochemical markers for the differential diagnosis of PSC. CONCLUSIONS Use of new immunohistochemical techniques, as well as the elucidation of molecular alterations, such as the presence of ERBB2 amplification, will advance our understanding of PSC.
Collapse
Affiliation(s)
- Carlos Prieto-Granada
- Department of Dermatology & Cutaneous Surgery, University of South Florida, Tampa, FL 33612, USA.
| | | |
Collapse
|
40
|
Ansai SI. Topics in histopathology of sweat gland and sebaceous neoplasms. J Dermatol 2017; 44:315-326. [PMID: 28256768 DOI: 10.1111/1346-8138.13555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 07/13/2016] [Indexed: 12/14/2022]
Abstract
This article reviews several topics regarding sweat gland and sebaceous neoplasms. First, the clinicopathological characteristics of poroid neoplasms are summarized. It was recently reported that one-fourth of poroid neoplasms are composite tumors and one-fourth are apocrine type lesions. Recent progress in the immunohistochemical diagnosis of sweat gland neoplasms is also reviewed. CD117 can help to distinguish sweat gland or sebaceous tumors from other non-Merkel cell epithelial tumors of the skin. For immunohistochemical differential diagnosis between sweat gland carcinoma (SGC) other than primary cutanesous apocrine carcinoma and skin metastasis of breast carcinoma (SMBC), a panel of antibodies may be useful, including p63 (SGC+ , SMBC- ), CK5/6 (SGC+ , SMBC- ), podoplanin (SGC+ , SMBC- ) and mammaglobin (SGC- , SMBC+ ). Comparison of antibodies used for immunohistochemical diagnosis of sebaceous carcinoma (SC) suggests that adipophilin has the highest sensitivity and specificity. Some authors have found that immunostaining for survivin, androgen receptor and ZEB2/SIP1 has prognostic value for ocular SC, but not extraocular SC. In situ SC is rare, especially extraocular SC, but there have been several recent reports that actinic keratosis and Bowen's disease are the source of invasive SC. Finally, based on recent reports, classification of sebaceous neoplasms into three categories is proposed, which are sebaceoma (a benign neoplasm with well-defined architecture and no atypia), borderline sebaceous neoplasm (low-grade SC; an intermediate tumor with well-defined architecture and nuclear atypia) and SC (a malignant tumor with invasive growth and evident nuclear atypia).
Collapse
Affiliation(s)
- Shin-Ichi Ansai
- Division of Dermatology and Dermatopathology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki City, Japan
| |
Collapse
|
41
|
Ho J, Bhawan J. Folliculosebaceous neoplasms: A review of clinical and histological features. J Dermatol 2017; 44:259-278. [PMID: 28256760 DOI: 10.1111/1346-8138.13773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 12/21/2016] [Indexed: 01/10/2023]
Abstract
Numerous benign and occasionally malignant tumors arise from the folliculosebaceous apparatus. Confusing terminology, rarity of malignant variants and overlapping histological features can lead to diagnostic uncertainty. This review highlights the clinical and histopathological features that help to classify these entities, as well as the various syndromes associated with certain members of this large family of tumors.
Collapse
Affiliation(s)
- Jonathan Ho
- Department of Dermatology and Section of Dermatopathology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jag Bhawan
- Department of Dermatology and Section of Dermatopathology, Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
42
|
Ramezani M, Mohamadzaheri E, Khazaei S, Najafi F, Vaisi-Raygani A, Rahbar M, Sadeghi M. Comparison of EMA,CEA, CD10 and Bcl-2 Biomarkers by Immunohistochemistry in Squamous Cell Carcinoma and Basal Cell Carcinoma of the Skin. Asian Pac J Cancer Prev 2017; 17:1379-83. [PMID: 27039776 DOI: 10.7314/apjcp.2016.17.3.1379] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Basal and squamous cell carcinoma (BCC and SCC) are the most common skin cancers worldwide and distinction between the two may sometimes be very difficult in routine histopathology. The present study was aimed to evaluate a reliable diagnostic method for these cancers based on immunohistochemistry (IHC). MATERIALS AND METHODS IHC was used with antibodies to Bcl-2, CD10, CEA, and EMA biomarkers, which despite non-specificity are easily available for detection of various types of tumors in pathology sections and can be used as a panel for differentiation. In this descriptive and analytic study, paraffin- embedded blocks of 29 SCC patients and 29 BCC patients were collected and sectioned for IHC staining. The results were analyzed by the STATA (version 8) statistical package using the Chi-square test. RESULTS BCC patients were 100%, 75.8%, 0% and 0% positive for Bcl-2, CD10, CEA and EMA markers, respectively, and for SCC patients were 3.5%, 0%, 34.5% and 82.7% positive, respectively. Using simultaneously Bcl-2 and CD10 as positive markers, detection of BCC with 88% accuracy and 100% specificity was possible, while application of CEA and EMA positivity could detect SCC with 67% accuracy and 100% specificity. CONCLUSIONS SCC and BCC have different immunostaining profiles; therefore, Bcl-2, CD10, CEA and EMA markers can be helpful to distinguish between them.
Collapse
Affiliation(s)
- Mazaher Ramezani
- Molecular Pathology Research Center, Emam Reza University Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran E-mail :
| | | | | | | | | | | | | |
Collapse
|
43
|
Cutaneous PEComas Express CD10: Implications for the Classification of PEComas and the Differential Diagnosis With Metastatic Renal Cell Carcinoma. Am J Dermatopathol 2016; 38:645-52. [DOI: 10.1097/dad.0000000000000475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
44
|
Mittal R, Araujo I, Czanner G, Coupland SE. Perforin expression in eyelid sebaceous carcinomas: a useful and specific immunomarker for the differential diagnosis of eyelid carcinomas. Acta Ophthalmol 2016; 94:e325-30. [PMID: 26843360 DOI: 10.1111/aos.12972] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/29/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Eyelid sebaceous carcinoma (SC) remains a common diagnostic pitfall for both the clinician and histopathologist. The aim of this study was to describe perforin as a new marker in the immunohistochemistry panel for SC. METHODS A total of 29 cases were retrieved from the Pathology archives, including 11 sebaceous neoplasms (nine SC; two sebaceomas), 10 squamous cell carcinomas (SCC) and eight basal cell carcinomas (BCC). These were stained using the monoclonal antibody for perforin, epithelial membrane antigen (EMA), Ber-EP4 and adipophilin (ADP). Sensitivity and specificity of perforin as an immunohistologic marker for sebaceous tumours were compared to EMA, ADP and Ber-EP4. RESULTS Perforin stained strongly 9/11 (81%) of the sebaceous neoplasms (SN), 7/9 SC and 2/2 of sebaceomas (2/2), similar to ADP. Epithelial membrane antigen (EMA) stained 8/9 SC and was negative (1/2) or only very weakly expressed (1/2) in sebaceomas. The specificity of perforin in identifying SN versus SCC and BCC was 100% (95% CI 69-100), while EMA specificity in identifying SN varied according the comparison group (SCC: 50%, 95% CI 18-81, 100% (95% CI 63-100). Perforin better highlighted the intraepithelial spread of SC than EMA. Ber-EP4 was strongly expressed in six of nine SC, but was consistently negative in sebaceomas. CONCLUSIONS The expression pattern of perforin in sebaceous neoplasms enables us to recommend the use of perforin as a new immunohistochemical marker for sebaceous neoplasms.
Collapse
Affiliation(s)
- Ruchi Mittal
- Dalmia Ophthalmic Pathology Services; L.V. Prasad Eye Institute; Bhubaneswar Odisha India
| | - Iguaracyra Araujo
- Department of Pathology and Forensic Medicine; Federal University of Bahia; Bahia Brazil
| | - Gabriela Czanner
- Department of Biostatistics; Faculty of Health and Life Sciences; University of Liverpool; Liverpool UK
- Department of Eye and Vision Science; Faculty of Health and Life Sciences; University of Liverpool; Liverpool UK
| | - Sarah E. Coupland
- NHS Department of Cellular Pathology; Royal Liverpool University Hospital; Liverpool UK
- Liverpool Ocular Oncology Research Group; Department of Clinical and Molecular Cancer Medicine; University of Liverpool; Liverpool UK
| |
Collapse
|
45
|
Ribero S, Baduel ES, Brizio M, Picciotto F, Dika E, Fierro MT, Macripò G, Quaglino P. Metastatic sebaceous cell carcinoma, review of the literature and use of electrochemotherapy as possible new treatment modality. Radiol Oncol 2016; 50:308-12. [PMID: 27679547 PMCID: PMC5024664 DOI: 10.1515/raon-2016-0039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/14/2016] [Indexed: 11/24/2022] Open
Abstract
Background Metastatic extraorbital sebaceous carcinoma is a rare event that could involve the head and neck. The treatment of choice for the initial stage of the disease is surgery and/or radiotherapy. The treatment of recurrent or advanced disease is still controversial. Material and methods Extensive literature search was done, and the treatment options are discussed. Results Results. The literature search found several treatment modalities in use for the treatment of metastatic extraorbital sebaceous carcinoma. Electrochemotherapy was not included in the reported treatments. We used this technique for a man of 85 years old with a recurrent and locally metastatic extraorbital sebaceous carcinoma of the scalp. During the period of 8 months, two sessions of electrochemotherapy were employed, which resulted in an objective response of the tumour and good quality of life. Conclusions Electrochemotherapy has shown to be a interesting tools for treatment of metastatic extraorbital sebaceous carcinoma when other radical options are not available or convenient.
Collapse
Affiliation(s)
- Simone Ribero
- University of Turin, Department of Medical Sciences, Section of Dermatology, Turin, Italy
- Città della Salute e della Scienza di Torino University Hospital, Department of Oncology, Section of Dermatologic Surgery, Turin, Italy
| | - Eugenio Sportoletti Baduel
- University of Turin, Department of Medical Sciences, Section of Dermatology, Turin, Italy
- Città della Salute e della Scienza di Torino University Hospital, Department of Oncology, Section of Dermatologic Surgery, Turin, Italy
| | - Matteo Brizio
- University of Turin, Department of Medical Sciences, Section of Dermatology, Turin, Italy
| | - Franco Picciotto
- Città della Salute e della Scienza di Torino University Hospital, Department of Oncology, Section of Dermatologic Surgery, Turin, Italy
| | - Emi Dika
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Maria Teresa Fierro
- University of Turin, Department of Medical Sciences, Section of Dermatology, Turin, Italy
| | - Giuseppe Macripò
- Città della Salute e della Scienza di Torino University Hospital, Department of Oncology, Section of Dermatologic Surgery, Turin, Italy
| | - Pietro Quaglino
- University of Turin, Department of Medical Sciences, Section of Dermatology, Turin, Italy
| |
Collapse
|
46
|
Clark LN, Elwood HR, Uhlenhake EE, Smoller BR, Shalin SC, Gardner JM. Nuclear factor XIIIa staining (clone AC-1A1 mouse monoclonal) is a highly sensitive marker of sebaceous differentiation in normal and neoplastic sebocytes. J Cutan Pathol 2016; 43:657-62. [DOI: 10.1111/cup.12727] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/11/2016] [Accepted: 05/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Lindsey N. Clark
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Dermatology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Hillary R. Elwood
- Department of Pathology; University of New Mexico School of Medicine; Albuquerque NM USA
| | - Elizabeth E. Uhlenhake
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Dermatology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Bruce R. Smoller
- Department of Pathology; University of Rochester; Rochester NY USA
| | - Sara C. Shalin
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Dermatology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - Jerad M. Gardner
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
- Department of Dermatology; University of Arkansas for Medical Sciences; Little Rock AR USA
| |
Collapse
|
47
|
Uhlenhake EE, Clark LN, Smoller BR, Shalin SC, Gardner JM. Nuclear factor XIIIa staining (clone AC-1A1 mouse monoclonal) is a sensitive and specific marker to discriminate sebaceous proliferations from other cutaneous clear cell neoplasms. J Cutan Pathol 2016; 43:649-56. [PMID: 27153339 DOI: 10.1111/cup.12726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/11/2016] [Accepted: 05/03/2016] [Indexed: 11/28/2022]
Abstract
Sebaceous carcinoma is a rare but serious malignancy that may be difficult to diagnose when poorly differentiated. Other epithelial tumors with clear cell change may mimic sebaceous carcinoma. Few useful or specific immunohistochemical markers for sebaceous differentiation are available. Nuclear staining with factor XIIIa (clone AC-1A1) was recently found to be a highly sensitive marker of sebaceous differentiation. We evaluated nuclear factor XIIIa (AC-1A1) staining in sebaceous neoplasms vs. other cutaneous clear cell tumors. We stained 27 sebaceous proliferations: sebaceous hyperplasia (7), sebaceous adenoma (8), sebaceoma (5), sebaceous carcinoma (7). We also stained 67 tumors with clear cell change: basal cell carcinoma (8), squamous cell carcinoma (8), hidradenoma (7), desmoplastic trichilemmoma (2), trichilemmoma (10), trichilemmal carcinoma (3), clear cell acanthoma (9), atypical fibroxanthoma (1), syringoma (8), trichoepithelioma (1), metastatic renal cell carcinoma (2), and nevi with balloon cell change (8). Nuclear factor XIIIa (AC-1A1) staining was present in 100% of sebaceous proliferations; 96% displayed strong staining. Non-sebaceous clear cell tumors were negative or only weakly positive with factor XIIIa (AC-1A1) in 95.5%; only 4.5% showed strong staining. This suggests that strong nuclear factor XIIIa (AC-1A1) staining is a sensitive and specific marker of sebaceous neoplasms vs. other clear cell tumors.
Collapse
Affiliation(s)
- Elizabeth E Uhlenhake
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lindsey N Clark
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bruce R Smoller
- Department of Pathology, University of Rochester, Rochester, NY, USA
| | - Sara C Shalin
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jerad M Gardner
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
48
|
Moon TC, Cassler NM, Lackey JN. Sebaceous carcinoma on the abdomen in an African-American male patient. Indian Dermatol Online J 2016; 6:S27-9. [PMID: 26904445 PMCID: PMC4738511 DOI: 10.4103/2229-5178.171044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sebaceous carcinoma is a rare, aggressive cutaneous tumor most commonly involving the head and neck, especially the periorbital area. It has been associated with Muir–Torre syndrome, human papillomavirus infection, and radiotherapy. This case report describes an unusual clinical presentation of a large sebaceous carcinoma on the abdomen of an African-American male patient who was successfully treated with Mohs micrographic surgery. The case is reported due to the unusual location of the lesion on the abdomen and the rare occurrence of this tumor type in an African-American male.
Collapse
Affiliation(s)
- Talitha C Moon
- Department of Medicine, College of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Nicole M Cassler
- Department of Dermatology, Walter Reed National Military Medical Center, Maryland, USA
| | - Jeffrey N Lackey
- Department of Dermatology, Walter Reed National Military Medical Center, Maryland, USA
| |
Collapse
|
49
|
Danialan R, Mutyambizi K, Aung PP, Prieto VG, Ivan D. Challenges in the diagnosis of cutaneous adnexal tumours. J Clin Pathol 2015; 68:992-1002. [DOI: 10.1136/jclinpath-2015-203228] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The diagnosis of cutaneous adnexal neoplasms, a heterogeneous group of entities, is often perceived by practising pathologists as challenging. A systematic approach to diagnosis is necessary for classification of these lesions, which establishes the tumour differentiation (follicular, sebaceous, sweat gland or apocrine) and evaluates histological features differentiating between benign and malignant entities. Consideration of clinical history is a necessary adjunct in evaluation of the adnexal neoplasm, as characteristic anatomical sites are described for many adnexal lesions. In some instances, immunohistochemical studies may also be employed to aid the diagnosis. The differential diagnosis between primary cutaneous adnexal neoplasms and cutaneous metastases from visceral tumours may also be difficult. Clinical, radiological, histological and immunohistochemical characteristics will be further discussed, considering that the correct diagnosis has a significant impact on the patient's management and prognosis.
Collapse
|
50
|
|