ALL Metrics
-
Views
-
Downloads
Get PDF
Get XML
Cite
Export
Track
Case Report
Revised

Case Report: Sebaceous carcinoma of the eyelid

[version 2; peer review: 1 approved with reservations, 1 not approved]
PUBLISHED 12 Jun 2024
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS

This article is included in the Oncology gateway.

This article is included in the Datta Meghe Institute of Higher Education and Research collection.

Abstract

Sebaceous carcinoma is an extremely rare malignant disease and it is more aggressive when it occurs in the eyelids and orbit. It can mimic several benign lesions, resulting in diagnostic delay. We present a case of sebaceous carcinoma in a 50-year-old male who presented with complaints of swelling of the upper eyelid, which was followed by appearance of an ulcerative growth over the eyelid. Magnetic resonance imaging (MRI) reports showed an ulcerated mass in the left periorbital and orbital region appearing heterogeneously hyperintense. Fine needle aspiration cytology (FNAC) showed malignant epithelial differentiation which was followed by exenteration of the eyeball. Histopathology showed the rare diagnosis of sebaceous carcinoma. The disease has a poor prognosis as the entity is associated with increased morbidity and if not detected early it can metastasize to other organs which may be fatal sometimes.

Keywords

Sebaceous carcinoma, Muir- Torre syndrome, eyelid cancer

Revised Amendments from Version 1

We have added certain details suggested by the reviewer for better understanding of the disease.

See the authors' detailed response to the review by Jianmin Ma

Introduction

Sebaceous carcinoma originates from cutaneous sebaceous glands, gland of Zeis or the Meibomian glands.1 It is more commonly found in the Asian population.2 It has a syndromic association with Muir-Torre syndrome, with hereditary nonpolyposis colorectal cancer syndrome.3 It can occur secondary to radiation therapy for retinoblastoma.4 It clinically mimics some benign conditions such as blepharitis, chalazion and sometimes basal cell carcinoma or squamous cell carcinoma which causes difficulty in diagnosing the disease.5 It is very essential to diagnose this fatal disease due to its potential of metastasis and local invasion. Early diagnosis can prevent patient’s vision and may increase survival. Here, we report a case of sebaceous carcinoma of the upper eyelid on histopathology of orbital exenteration specimen.

Patient information

A 50-year-old male, farmer by occupation, presented with an 8-month history of an ulcerated growth over the left eye. The patient stated that the lesion started as a pea sized cystic swelling which gradually increased in size. He also gave a history of pain and maggot infestation in the same eye for which he took symptomatic treatment. Condition of patient deteriorated further, so he came to the tertiary care centre for further management.

Clinical findings

Routine investigations were performed, on ocular examination no light perception was present. Slit lamp examination of the left showed a mass of 6.3 × 3 × 1.5 cm with ulcerated appearance. Eyelashes were spared. The eyeball appeared as degenerated and distorted. On general examination no lymphadenopathy and organomegaly was noted.

Diagnostic assessment

MRI (Magnetic resonance imaging) reports showed an ulcerated mass in the left periorbital and orbital region appearing heterogeneously hyperintense on T2 and hypointense on T1 which was involving the left orbital group, adjacent intraorbital optic nerve and extraocular muscles.

Fine needle aspiration cytology (FNAC) was performed which showed polymorphs, lymphocytes and islands of tumor cells. These tumor cells appeared large in size, oval in shape and were arranged in groups. These cells had hyperchromatic nuclei. Cells also showed malignant epithelial differentiation.

Therapeutic interventions

One day prior to surgery general physical examination and orbital examination was done. Patient was considered fit for the intervention. A surgical intervention named intraoperative frozen section was performed from the lesion and diagnosis suggestive of carcinoma either from sebaceous or squamous origin was made. After that, left eye exenteration was done.

The follow up and outcomes

The resected orbital exenteration specimen [Figure 1] was sent to histopathology. Specimen measured 6.2 × 6 × 3.5 cm. A tumor mass involving the upper eyelid extending from the medial margin measuring 5 × 2 × 1.5 cm was identified.

cd0f2d02-4505-4527-9ad9-b1680901318e_figure1.gif

Figure 1. The resected orbital exenteration specimen.

Microscopy showed pigmented lining epithelium. A scanner view of the section [Figure 2] also showed tumor cells arranged in lobules and sheets at places. High power view i.e. 40× showed sebaceous differentiation [Figure 3], individual tumor cells, which were polygonal in shape with scant, multivacuolated cytoplasm, it also showed round to oval, enlarged pleomorphic nuclei with 1–2 prominent nucleoli [Figure 4]. Deeper tissues showed fibro collagenous tissue, necrotic hemorrhagic tissue and infiltration by malignant cells.

cd0f2d02-4505-4527-9ad9-b1680901318e_figure2.gif

Figure 2. 10× magnification showing tumor cells arranged in lobules and sheets.

cd0f2d02-4505-4527-9ad9-b1680901318e_figure3.gif

Figure 3. 40× magnification showing sebaceous differentiation.

cd0f2d02-4505-4527-9ad9-b1680901318e_figure4.gif

Figure 4. 40× magnification showing individual tumor cells, polygonal in shape with scant, multivacuolated cytoplasm.

Discussion

Sebaceous carcinoma is a great masquerader.6 Although sebaceous carcinoma has great tendency to arise in the ocular region, especially in the eyelids, it does occur in extraocular regions such as parotid. It accounts for 1 to 3% of malignant orbital tumors.7 Among the reported malignancies of eyelid tumors it is the third most common malignancy.8 It has a female predominance.9 The upper eyelid is affected more than the lower lid due to the abundance of meibomian glands.10 Periocular sebaceous carcinoma can clinically mimic a range of conditions and are misdiagnosed as basal cell carcinoma or squamous cell carcinoma.11

The most common presentation of sebaceous carcinoma in the eyelid is as round highly cellular nests of poorly differentiated tumor cells. Sometimes better differentiated cells with vacuolated cytoplasm are identified.12

Many studies have shown that sebaceous carcinoma of the eyelid has a poor prognosis and if there is an orbital or vascular invasion present prognosis further worsens.13

The treatment of choice for sebaceous carcinoma is surgery, with complete excision verified by negative margins.14

Conclusions

Sebaceous carcinoma of the eyelid is a rare entity, but might be difficult to diagnose because of its ability to masquerade as the periocular lesions. However, accurate and prompt diagnosis is crucial for planning further management of the disease and prevention of any complications such as loss of vision, metastasis to other organs etc, therefore tissue diagnosis is the gold standard method and it can be aided by a panel of immunohistochemistry stains.

Case report consent

Written informed consent for publication of their clinical details and clinical images was obtained from the patients.

Author’s contributions

Jayashree Bhawani: drafting the case report and overview of patient management. Dr. Samarth Shukla: Reporting of the excised specimen sent for histopathological investigation and giving the suitable diagnosis. All the authors read and approved the final version of this manuscript.

Comments on this article Comments (0)

Version 2
VERSION 2 PUBLISHED 06 Dec 2023
Comment
Author details Author details
Competing interests
Grant information
Copyright
Download
 
Export To
metrics
Views Downloads
F1000Research - -
PubMed Central
Data from PMC are received and updated monthly.
- -
Citations
CITE
how to cite this article
Bhawani J, Shukla S, Acharya S et al. Case Report: Sebaceous carcinoma of the eyelid [version 2; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2024, 12:1563 (https://doi.org/10.12688/f1000research.138780.2)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
track
receive updates on this article
Track an article to receive email alerts on any updates to this article.

Open Peer Review

Current Reviewer Status: ?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 2
VERSION 2
PUBLISHED 12 Jun 2024
Revised
Views
2
Cite
Reviewer Report 12 Sep 2024
Vijitha S Vempuluru, LV Prasad Eye Institute, Hyderabad, Telangana, India 
Not Approved
VIEWS 2
The authors report a case of eyelid sebaceous carcinoma with orbital extension which was managed with orbital exenteration.
The pathology images are good. There are no external photographs or MRI images. There is no mention of systemic metastatic workup ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Vempuluru VS. Reviewer Report For: Case Report: Sebaceous carcinoma of the eyelid [version 2; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2024, 12:1563 (https://doi.org/10.5256/f1000research.167808.r320812)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Version 1
VERSION 1
PUBLISHED 06 Dec 2023
Views
9
Cite
Reviewer Report 30 May 2024
Jianmin Ma, Capital Medical University, Beijing, China 
Approved with Reservations
VIEWS 9
Overall Assessment
The case report on sebaceous carcinoma is comprehensive and detailed, providing valuable insights into the presentation, diagnostic process, therapeutic interventions, and outcomes of this rare condition. However, several areas require attention to improve clarity, accuracy, and readability. ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Ma J. Reviewer Report For: Case Report: Sebaceous carcinoma of the eyelid [version 2; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2024, 12:1563 (https://doi.org/10.5256/f1000research.152008.r263242)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 11 Jun 2024
    Jayashree Bhawani, Department of Pathology, Jawaharlal Nehru Medical College, Sawangi(Meghe), Wardha, 442001, India
    11 Jun 2024
    Author Response
    Thank you for the suggestions Sir/Maam
    I am including your suggestions in the new version of the case report.
    Competing Interests: No competing interest
COMMENTS ON THIS REPORT
  • Author Response 11 Jun 2024
    Jayashree Bhawani, Department of Pathology, Jawaharlal Nehru Medical College, Sawangi(Meghe), Wardha, 442001, India
    11 Jun 2024
    Author Response
    Thank you for the suggestions Sir/Maam
    I am including your suggestions in the new version of the case report.
    Competing Interests: No competing interest

Comments on this article Comments (0)

Version 2
VERSION 2 PUBLISHED 06 Dec 2023
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
Sign In
If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password.

The email address should be the one you originally registered with F1000.

Email address not valid, please try again

You registered with F1000 via Google, so we cannot reset your password.

To sign in, please click here.

If you still need help with your Google account password, please click here.

You registered with F1000 via Facebook, so we cannot reset your password.

To sign in, please click here.

If you still need help with your Facebook account password, please click here.

Code not correct, please try again
Email us for further assistance.
Server error, please try again.