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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 1646 - 17 October Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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The patient is an 80-year-old man with a shave biopsy of a lesion on the left neck. Information provided by the referring dermatopathologist: "Clinically, it was basal cell carcinoma. This sebaceous neoplasm has features I suppose could be seen in the spectrum of sebaceoma. There is some increase in mitotic figures and some cellular atypia. Would this reach the threshold for sebaceous carcinoma to you?"

Case Posted by Dr Mark Hurt


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Admin_Dermpath

Posted

Get your week off to a great start with this interesting Spot Diagnosis Case

Cheers, Geoff

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vincenzo polizzi

Posted

Difficult case. The more than mild sebaceous differentiation with poor germinative component fits better to adenoma... but too much atypia and mitosis and a bowenoid shoulder. So I favor low grade sebaceous carcinoma

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Dr. Mona Abdel-Halim

Posted

It is difficult!!! I am inclined more to call it sebaceous adenoma but if my case will double check with an expert first !!!!  I think the overall sebaceous component is more than the basaloid germinative component. About more than half of the each lobule is mature sebocytes. Very well circumscribed. Not that pleomorphic. Not infiltrative. Giant sebaceous adenomas can be mitotically active. Can mimic BCC clinically also. It is difficult though !! Muir Torre syndrome should be verified.

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Raul Perret

Posted (edited)

I thought there was a minimal predominance of immature cells but this is subjective i guess. Atypia is low as well as mitotic index. Tumor is quite lobular but has a marked horizontal extension, picture number 4 shows compromise of epidermis. From my perspective this is sebaceous carcinoma rather low grade. 

Edited by Raul Perret

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Arash Daryakar

Posted

This is an ulcerated multilobulated neoplasm focally attached to overlying epidermis with a sharp and pushing boundary to surrounding dermis . there are foci of mitoses but no obvious atypia.normal looking mitoses and ulceration can also be found in sebaceous adenoma.IHC study for ki67,p53 , Bcl-2 and p21 may help to make distinction from low grade sebaceous carcinoma.some intra and peritumoral lymphocytes may point to MTS(?).

overall i lean more toward to sebaceous adenoma.

waiting for Mark's precious idea!

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Nitin Khirwadkar

Posted

I would favour a low grade sebaceous carcinoma. Don't like the atypia. A Ki67 and p53 will be hopefully helpful. To rule out MTS.  Waiting to hear from Dr Hurt.

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Mark A. Hurt MD

Posted (edited)

-- SEBACEOUS CARCINOMA

COMMENT:  There is a loss of MSH-2 and MSH-6 in this lesion, suggesting that screening might be of some value for family members, but that question should be put to the clinician for followup. 

 

 

 

In general, I have the opinion that sebaceous carcinomas resemble native sebaceous lobules, but their maturation sequence is abnormal.  As a rule, they have some features of carcinomas in general, namely nuclear overlapping, some degree of nuclear pleomorphism, and mitotic figures that are found without much difficulty.  In contrast, lesions of sebaceoma, in my opinion, usually do not resemble the native sebaceous lobules, and they are similar to cylindromas and spiradenomas in their basic structure.  Their composition is that of germinative sebocytes, and usually they are monomorphous ones studded with mature sebocytes throughout.

 

 

 

Thus, the pattern of this particular lesion, in my opinion, is that of sebaceous carcinoma.

Edited by Mark A. Hurt MD
typo

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Dr. Richard Carr

Posted

If this is a sebaceous carcinoma it is clearly in situ (lobulated pushing only borders). Analagous to our concept in follicular SCC in situ. I found image quality sub-optimal to assess the cytology with confidence but I suspect I would have let it go as an adenoma myself based on the architecture.  We should be aware of a difference in individual's approach in this somewhat contentious / challenging area but a mutant / null p53 would certainly pitch the scales.

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