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Andre Nihad Ali-Ridha, Seymour Brownstein, Kailun Jiang, Tatyana Milman, Bruce Burns, Paula Blanco, James Farmer; Immunohistochemical Analysis of Sebaceous Cell Carcinoma in Comparison to Both Basal Cell Carcinoma and Squamous Cell Carcinoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5432.
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Basal cell carcinoma is the most common malignancy of the eyelid followed by sebaceous cell and squamous cell carcinoma. The mortality rate of sebaceous cell carcinoma has been reported as 9 to 30% and both it and squamous cell carcinoma can develop metastatic disease. Clinically, sebaceous cell carcinoma frequently mimics inflammatory conditions and other neoplasms of the eyelid, including both squamous cell and basal cell carcinoma. Our study compares the immunostaining profile of sebaceous cell carcinoma to that of basal cell and squamous cell carcinoma.
Retrospective and prospective case series. Eight specimens each of sebaceous cell, basal cell and squamous cell carcinoma of the eyelid were obtained from the Ottawa Ocular Pathology Laboratory from 2007 to 2013. We compared the immunohistochemical profile of these specimens by staining each of them with EMA, BER-EP4, adipophilin, androgen receptor (AR), P16, BCL-2, CK7, Ki67, BRST1, BRST2, p53, and CK20. We compared the extent of staining to that of normal surface and glandular epithelial tissue on each slide as normal internal controls. The immunoreactivity data was then analyzed using a 2-tailed Kruskal-Wallis test (p<0.05 is significant) with a post-hoc analysis using Mann-Whitney tests.
Our test results were statistically significant (p<0.05) for positive staining of EMA, adipophilin, P16 and AR in sebaceous cell carcinoma. This group also showed a higher percentage of positivity for Ki67. The basal cell tumours exhibited positive staining for CK7, BCL2, and BER-EP4, while squamous cell carcinoma showed substantial positivity only for EMA. Adipophilin stained positive in sebaceous cell carcinoma with intracytoplasmic lipid vesicles in 94% of the cells in our series as compared to the nonspecific or minimal staining of granules in basal and squamous carcinoma cells respectively.
Our study helps clarify much of the controversy in the literature concerning immunostains which overlap in reactivity for sebaceous cell carcinoma. We have found that the most informative panel of immunostains, from our original 12 stains, for differentiating sebaceous cell carcinoma from other related tumors consists of P16, adipophilin, EMA, AR, CK7 and Ki67. This diagnostically optimal panel of immunostains may allow for earlier diagnosis and treatment of sebaceous cell carcinoma of the eyelid.
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