Case Number : 121 Posted By: Guest

Richard Carr - Warwick (UK) Wrote:

This was a case I sent to Phillip and in fact it was quite stunning because this degree of palisading is uncommon in sebaceoma and on this field alone a very difficult case. However immunostains are completely definitive in the differential of sebaceoma (BerEP4 and EMA negative basaloid epithelioma; EMA limited to mature sebocytes) and BCC with sebaceous differentiation (BerEP4 strong diffuse in the basaloid epithelium and EMA limited to the mature sebocytes). This case showed the typical pattern for sebaceoma. Interestingly there is evidence to suggest that EMA may be helpful in distinguishing sebaceoma with mitotic activity (as here) and sebaceous carcinoma as EMA tends to stain the basaloid epithelium (i.e. not limited to mature sebocytes) in sebaceous carcinoma. So dual BerEP4/EMA staining supports sebaceous carcinoma in this setting (naturally first principles with respect to malignancy apply i.e. margins, pleomorphism etc. There is quite a bit of subjectivity in the diagnosis of sebaceous adenomas v's sebaceous carcinoma (as is well illustrated in the literature). Saleem is right true BCC with sebaceous differentiation is exceedingly rare in the literature (we have managed to collect 3 cases from different centres) and the immuno above, for BCC, holds up. You must always mention the possibility of Muir Torre syndrome when making a diagnosis of sebaceous neoplasms particularly for extra-ocular and extra-facial lesions in the young. We can do pseudo-genetic testing for the mis-match repair genes (absent in MTS) but we usually ask for patient consent in this setting. Regards to all. Richard.

Submitted on 26/11/2010 09:58
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Iskander Chaudhry - Manchester Royal Infirmary (Manchester) Wrote:

The final diagnosis is Sebaceoma . Well done to all who worked it out. The tumour displayed multiple nodules with fibrous septa, showing a lack of pleomorphism, and spotty distribution of mature sebocytes and the duct formation. There is a distinct lack of retraction artefact and mucin which excludes BCC with sebaceous differentiation which in any event is exceptionally rare. Phillip is back tomorrow after Thanksgiving.

Submitted on 25/11/2010 23:01
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Marcela Saeb Lima - Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (Mexico City) Wrote:

I also favor sebaceoma

Submitted on 25/11/2010 20:45
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

The intervening stroma reminds me of perifollicular mesenchyme, so I'm going to stick my neck out and suggest a diagnosis of trichoblastoma with sebaceous differentiation.

Submitted on 25/11/2010 17:29
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Phillip McKee - Overseas consultations (Sedona, Arizona, USA) Wrote:

I will be away for the rest of the day and so Iskander has kindly offered to look after today's case Dear Mona, I have made a comment to your question on yesterdays page

Submitted on 25/11/2010 15:47
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Phillip McKee - Overseas consultations (Sedona, Arizona, USA) Wrote:

Please see my final comment of yesterdays case

Submitted on 25/11/2010 15:45
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María Antonia Pastor - Hospital de Guadalajara (Spain) () Wrote:

Sebaceous carcinoma

Submitted on 25/11/2010 15:37
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Rodrigo Restrepo - UPB/CES (Colombia) Wrote:

I favor sebaceoma

Submitted on 25/11/2010 14:34
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Good morning..Islands of basaloid cells, nest of sebaceous cells, a sebaceous duct.... Sebaceoma

Submitted on 25/11/2010 13:35
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Richard A Carr - Warwick (UK) Wrote:

Nice image!! - Looks very like a recent case we saw in Warwick!!

Submitted on 25/11/2010 09:16
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Saleem Taibjee - Warwick () Wrote:

I think the differential lies between sebaceoma (uncommon) and BCC with sebaceous differentiation (rare). The peripheral pallisading is striking here, but can't see mucin in retraction spaces in this field to 100% plump for BCC (although slightly favour that diagnosis).

Submitted on 25/11/2010 09:06
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Marwa Fawzi - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Trichoblastoma

Submitted on 25/11/2010 07:52
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Because of the dense stroma, abcsence of peritumoral clefting, I favor trichoblastic carcinoma (although still BCC is a logic DD).

Submitted on 25/11/2010 05:36
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Dear Sir, I have posted a question in yesterday's case. I will be glad if you gave us your valuable comment.

Submitted on 25/11/2010 05:18
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Basaloid cell islands showing peripheral palisading. Within the islands there are clusters of sebocytes and duct like structures. I will consider this BCC with sebaceous differentiation. I think the presence of peripheral palisading excludes sebaceoma.

Submitted on 25/11/2010 05:15
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