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Sebaceous Gland Carcinoma: Workup

Author: Michael L Glassman, MD, Ophthalmic Plastic, Orbital and Reconstructive Surgery, Department of Ophthalmology, Oculoplastic and Orbital Surgery, New York Eye and Ear Infirmary, Manhattan Eye Ear and Throat Hospital
Coauthor(s): Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD; Mirelle Benchimol, MD, Consulting Staff, Benchimol Eye Clinic
Contributor Information and Disclosures

Updated: Dec 15, 2008

Workup

Diagnostic Procedures

  • Obtain a biopsy specimen of the lesion to establish the diagnosis.
    • Numerous sebaceous elements with mitotic figures are observed; the cells may stain positively for fat with oil red O stain.
    • The tumor can be multicentric, and it may grow into nests with central necrosis mimicking comedocarcinoma of the breast.
    • Individual tumor cells may be present in the epithelium in a pattern of intraepithelial spread reminiscent of Paget disease. Therefore, it is recommended to perform multiple conjunctival map biopsies at the time of the initial lesion biopsy to stage the local disease. 
  • It is good clinical practice to obtain a biopsy specimen of any recurrent chalazion or unilateral blepharitis that is resistant to usual treatment. It is also advisable to alert the pathologist to the possible diagnosis and ask for the preferred method of tissue handling. Formalin fixation is fine if the laboratory staff know to avoid alcohol and xylene histoprocessing methods.
  • Evaluate lymph nodes to rule out distant spread.

Histologic Findings

The histopathology of sebaceous gland cell carcinoma is dominated by large anaplastic cells with open vesicular nuclei and prominent nuclei set in foamy or frothy cytoplasm. The appearance of the cytoplasm is a result of the presence of lipid vacuoles. A useful histopathologic feature is large nuclear forms, including multinucleated tumor cells and bizarre monstrous cell forms. The spread of the tumor in the form of infiltrating lobules, nests, and cords, as well as superficially within the epithelium, is highly characteristic.

More on Sebaceous Gland Carcinoma

Overview: Sebaceous Gland Carcinoma
Workup: Sebaceous Gland Carcinoma
Treatment: Sebaceous Gland Carcinoma
Follow-up: Sebaceous Gland Carcinoma
Multimedia: Sebaceous Gland Carcinoma
References
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References

  1. Song A, Carter KD, Syed NA, et al. Sebaceous cell carcinoma of the ocular adnexa: clinical presentations, histopathology, and outcomes. Ophthal Plast Reconstr Surg. May-Jun 2008;24(3):194-200. [Medline].

  2. Awan KJ. Sebaceous carcinoma of the eyelid. Ann Ophthalmol. May 1977;9(5):608-10. [Medline].

  3. Brauninger GE, Hood CI, Worthen DM. Sebaceous carcinoma of lid margin masquerading as cutaneous horn. Arch Ophthalmol. Nov 1973;90(5):380-1. [Medline].

  4. Chao AN, Shields CL, Krema H, et al. Outcome of patients with periocular sebaceous gland carcinoma with and without conjunctival intraepithelial invasion. Ophthalmology. Oct 2001;108(10):1877-83. [Medline].

  5. Kass LG, Hornblass A. Sebaceous carcinoma of the ocular adnexa. Surv Ophthalmol. May-Jun 1989;33(6):477-90. [Medline].

  6. Khan JA, Doane JF, Grove AS Jr. Sebaceous and meibomian carcinomas of the eyelid. Recognition, diagnosis, and management. Ophthal Plast Reconstr Surg. 1991;7(1):61-6. [Medline].

  7. Lai TF, Huilgol SC, Selva D, et al. Eyelid sebaceous carcinoma masquerading as in situ squamous cell carcinoma. Dermatol Surg. Feb 2004;30(2 Pt 1):222-5. [Medline].

  8. Margo CE, Lessner A, Stern GA. Intraepithelial sebaceous carcinoma of the conjunctiva and skin of the eyelid. Ophthalmology. Feb 1992;99(2):227-31. [Medline].

  9. Nijhawan N, Ross MI, Diba R, et al. Experience with sentinel lymph node biopsy for eyelid and conjunctival malignancies at a cancer center. Ophthal Plast Reconstr Surg. Jul 2004;20(4):291-5. [Medline].

  10. Shields JA, Shields CL. Sebaceous carcinoma of the glands of Zeis. Ophthal Plast Reconstr Surg. 1988;4(1):11-4. [Medline].

  11. von Below H, Rose GE, McCartney AC, et al. Multicentric sebaceous gland carcinoma of the lid?. Br J Ophthalmol. Dec 1993;77(12):819-20. [Medline].

  12. Wagoner MD, Beyer CK, Gonder JR, et al. Common presentations of sebaceous gland carcinoma of the eyelid. Ann Ophthalmol. Feb 1982;14(2):159-63. [Medline].

  13. Yeatts RP, Waller RR. Sebaceous carcinoma of the eyelid: pitfalls in diagnosis. Ophthal Plast Reconstr Surg. 1985;1(1):35-42. [Medline].

  14. Zurcher M, Hintschich CR, Garner A, et al. Sebaceous carcinoma of the eyelid: a clinicopathological study. Br J Ophthalmol. Sep 1998;82(9):1049-55. [Medline].

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Further Reading

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Keywords

sebaceous gland carcinoma, meibomian gland carcinoma, sebaceous carcinoma, sebaceous cell carcinoma, carcinoma of meibomian and Zeis glands, sebaceous hyperplasia, sebaceous gland adenomas, eyelid malignancy

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Contributor Information and Disclosures

Author

Michael L Glassman, MD, Ophthalmic Plastic, Orbital and Reconstructive Surgery, Department of Ophthalmology, Oculoplastic and Orbital Surgery, New York Eye and Ear Infirmary, Manhattan Eye Ear and Throat Hospital
Michael L Glassman, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Mirelle Benchimol, MD, Consulting Staff, Benchimol Eye Clinic
Disclosure: Nothing to disclose.

Medical Editor

Jorge G Camara, MD, Professor of Ophthalmology, Department of Surgery and Director of Fellowship Training Program in Ophthalmic Plastic and Reconstructive Surgery for Countries Served by the Aloha Medical Mission, University of Hawaii John A Burns School of Medicine
Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Ophthalmic Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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