Background

54-year-old male, with history of scleroderma on methotrexate, presented with right frontal scalp ulcerated lesion measuring 3 x 1 cm in size. Punch biopsy from lesion.

Microscopy

Fig.2a; H&E 2.5x

Fig.2b; H&E; 20x

Fig.2c; H&E; 20x

Images show ulcerated epidermis with a dermal tumor. The tumor has a lobulated appearance with pushing margins [Fig.2a]. The tumor cells are polygonal with bubbly or eosinophilic cytoplasm having oval vesicular nuclei exhibiting conspicuous nucleoli and brisk mitosis [Fig.2b]. Squamous metaplasia with keratin pearl formation is also seen [Fig.2c].

Final Impression: Sebaceous Carcinoma, Grade 1

POINTS TO REMEMBER

• Origin: Sebaceous glands of skin or ocular adnexa
• Types: Periocular or Extraocular
• Periocular tumors: more aggressive
• May follow radiation therapy
• Association with Muir Torre syndrome
• Necrosis is related to poor prognosis
• IHC:
  • Positive stains: CK, EMA, LeuM1, BEREP4, Androgen Receptor
  • Negative stains: CEA, s100
• Differential diagnosis:
  • Basal cell carcinoma with sebaceous differentiation
  • Squamous cell carcinoma with hydropic changes

Contributed by: Dr. Anila Sharma

Compiled by: Dr. Ankur Kumar & Dr. Himanshi Diwan

In case of queries, email us at: kumar.ankur@rgcirc.org

Head & Neck Sebaceous carcinoma Skin adnexal tumor

Last modified: 05/06/2021