1.
ACADEMIC REVIEW
Sebaceous carcinoma

2.
PATIENT DETAILS
Mr. Thulukanam
76 years / Female
MR/17/201855
Dept: GS -III
Biopsy No: 1288/17
Date of report: 01.06.2017
Nature of specimen: Excision biopsy - Squamous cell
carcinoma of left maxillary region

3.
Clinical findings:
-Ulceroproliferative growth over left maxillary region
-3x2 cm
-raised and everted margin
Clinical diagnosis:
Squamous cell carcinoma – left maxillary region

4.
Gross examination

5.
Scanner view

6.
Scanner view

7.
IMPRESSION
Differential diagnosis
• Sebaceous carcinoma
• Squamous cell carcinoma
Lateral surgical margin alone shows tumor
Superior, inferior, medial and deep resected margin are
free of tumor.
Advice:
IHC – Adipophilin, AR, EMA, P63

8.
Sebaceous carcinoma
• Rare
• Malignant neoplasm demonstrating exclusive
sebocytic differentiation
• Adults - 62yrs ( sixth or seventh decade)
• Female predominance (2:1)
• Tumours of eyelids seen in Asians

9.
Clinical features
• Periocular and extraocular presentations
• May follow radiation therapy
• Presents as painless mass
• Can be multifocal in the ocular adnexae
• Can be mistaken clinically for chalazion, blepharitis or
cicatricial pemphigoid
• Muir – Torre syndrome

10.
Sebaceous carcinoma

11.
Clinical features
• Extraocular – mistaken for basal cell carcinoma or
squamous cell carcinoma
• Skin of head and neck, trunk, genitals and
extremities
• Rare cases seen in mouth, salivary glands, lungs and
breasts

12.
Gross features
• Nodules that enlarge slowly, occasionally grows
rapidly
• Some become ulcerated

13.
Histopathology
• Well differentiated tumours show tumour cells in
well defined lobules with well circumscribed borders
• The cells appear basaloid and central part of tumour
lobule shows sebaceous differentiation –
multivesicular and vacuolated clear abundant
cytoplasm with oval vesicular nuclei and distinct
nucleoli
• Central portions of the tumor cell nests may be
necrotic –’comedo’ necrosis

14.
Histopathology
Moderately differentiated
Number of differentiated cells will be less
Poorly differentiated
• High N:C ratio, nuclear pleomorphism, prominent
nucleoli, brisk mitotic activity and amphobilic or
basophilic cytoplasm
• Infiltrative borders
• Intracellular vacuolations may not be seen

15.
Sebaceous carcinoma

16.
Grading of sebaceous carcinoma
Based on growth patterns
• Grade I: well demarcated, roughly equally sized
cellular lobules
• Grade II: Admixture of well- defined nests with
infiltrative profiles or confluent cell groups
• Grade III: Highly invasive growth or medullary sheet
–like pattern

17.
Variants
• Basaloid sebaceous carcinoma
Small cells with scant cytoplasm, nuclear palisading
Manifests as Grade III with sparse sebocytic elements
and difficult to identify
• Squamoid Sebaceous carcinoma
Shows prominent squamous metaplasia, often with
keratin pearl formation
• Sarcomatoid
Some may demonstrate spindle cell areas
• Pseudo – neuroendocrine organoid growth focally
resembling pattern of carcinoid tumors

18.
Differential diagnoses
• Basal cell carcinoma with sebaceous differentiation
• Clear cell variant of squamous cell carcinoma

19.
Immunoprofile
Positive for Pankeratin, EMA, AR
EMA – enhances cytoplasmic bubbliness
Negative for S-100 and CEA