Sebaceous Cell Carcinoma of the Eyelid: Histopathological Analysis of 44 Cases

Abstract

Abstract: : Purpose: Sebaceous carcinoma is a rare tumor of the skin adnexae and its diagnosis can be challenging for both the clinician and pathologist. Clinically, sebaceous carcinoma of the eyelid can mimic recurrent chalazion or inflammation. Histopathologically, this tumor can mimic squamous cell carcinoma or basal cell carcinoma. The purpose of this study is to analyze the histopathologic features of sebaceous carcinoma that can be used as criteria to achieve an accurate diagnosis. Methods: A total of 44 eyelid specimens diagnosed as sebaceous carcinoma were retrieved from The Henry C. Witelson Ocular Pathology Laboratory, McGill University, Canada and Hospital L. Bulnes, Mexico. Two independent pathologists reviewed the H&E microscopic slides. Results: Of the 44 cases retrieved, 31 were from Canada and 13 from Mexico. The mean size of the tumors retrieved from Canada and Mexico was 19.7 mm and 35.1 mm respectively. 37 (84%) of the cases were classified as poorly differentiated sebaceous carcinomas. Of these 44 cases, a solid growth pattern was observed in 12 cases (26%) of the cases and a lobular growth pattern was seen in another 12 cases (26%). Superficial spread such as Bowen disease was seen in 15 cases (33%) and pagetoid spread was observed in another 15 cases. Comedocarcinoma was present in 14 lesions (31.8%). Non–invasive sebaceous carcinoma (in situ) corresponded to 8 (25.8%) of the Canadian cases but none of the Mexican cases. Of the 37 poorly differentiated cases, cytoplasmic vacuoles were an important feature in 18 of them (48%). 28 (75%) of these cases had features resembling squamous cell carcinoma. Only 3 cases (7%) resembled basal cell carcinoma including dyskeratosis. Conclusions: Sebaceous carcinoma can be a diagnostic dilemma because it may histopatologically mimic other malignant neoplasms. Vacuolated cytoplasm, lobular growth pattern and pagetoid superficial spread were frequently observed, therefore may be used as a diagnostic criteria for sebaceous cell carcinoma. The early diagnosis of sebaceous cell carcinoma is critical for good prognosis. At McGill University all chalazions are histopathologically examined which could explain the difference in tumor size between Canadian and Mexican patients.

Keywords: pathology: human • eyelid