F1000ResearchF1000Research2046-1402F1000 Research LimitedLondon, UK10.12688/f1000research.138780.2Case ReportArticlesCase Report: Sebaceous carcinoma of the eyelid
[version 2; peer review: 1 approved with reservations, 1 not approved]
BhawaniJayashreeConceptualizationData CurationFormal AnalysisFunding AcquisitionInvestigationMethodologyResourcesVisualizationWriting – Original Draft PreparationWriting – Review & Editinghttps://orcid.org/0000-0001-8552-0678a1ShuklaSamarthConceptualizationData CurationFormal AnalysisInvestigationMethodologyResourcesSupervisionValidationVisualizationWriting – Original Draft PreparationWriting – Review & Editing1AcharyaSouryaMethodologyResourcesSupervisionValidationVisualizationWriting – Review & Editing2VaghaSunitaConceptualizationInvestigationMethodologyResourcesSupervisionValidationVisualizationWriting – Original Draft PreparationWriting – Review & Editing1JagtapMiheerInvestigationMethodologyResourcesSupervisionWriting – Original Draft PreparationWriting – Review & Editing1
Department of Pathology, Jawaharlal Nehru Medical College, Sawangi(Meghe), Wardha, Maharashtra, 442001, India
Department of General Medicine, Jawaharlal Nehru Medical College, Sawangi(Meghe), Wardha, Maharashtra, 442001, Indiajayashree1993rey@gmail.com
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.
Sebaceous carcinomaMuir- Torre syndromeeyelid cancerThe author(s) declared that no grants were involved in supporting this work.Amendments from Version 1
We have added certain details suggested by the reviewer for better understanding of the disease.
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.
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.
10× magnification showing tumor cells arranged in lobules and sheets.
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.
Data availability
All data underlying the results are available as part of the article and no additional source data are required.
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10.1097/PRS.0b013e3181ea450d10.5256/f1000research.167808.r320812Reviewer response for version 2VempuluruVijitha S1Refereehttps://orcid.org/0000-0002-1859-6629
LV Prasad Eye Institute, Hyderabad, Telangana, India
Competing interests: No competing interests were disclosed.
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 or further follow-up.
Overall this is not a rare diagnosis or a rare presentation of a common disease.
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?
No
Is the case presented with sufficient detail to be useful for other practitioners?
No
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?
Partly
Is the background of the case’s history and progression described in sufficient detail?
Yes
Reviewer Expertise:
Ocular oncology
I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.
References:
Eyelid/Periocular Sebaceous Gland Carcinoma in 500 Eyes: Analysis based on 8th Edition American Joint Cancer Committee Classification.Am J Ophthalmol.2024;
10.1016/j.ajo.2024.07.0363910313710.1016/j.ajo.2024.07.03610.5256/f1000research.152008.r263242Reviewer response for version 1MaJianmin1Referee
Capital Medical University, Beijing, China
Competing interests: No competing interests were disclosed.
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. The following are my detailed comments and suggestions:
Abstract
Content and Clarity: The abstract is clear and summarizes the case effectively. Consider adding a sentence about the prognosis or significance of prompt diagnosis to underscore the clinical importance.
Keywords: The keywords are appropriate but could include "orbital exenteration" and "histopathology" for better indexing.
Introduction
Background Information: The introduction provides a good overview. Consider expanding on the clinical significance of sebaceous carcinoma and its diagnostic challenges.
Patient Information
Patient History: The patient history is well-detailed. Consider specifying the duration between the onset of symptoms and seeking medical advice to highlight any potential delays in diagnosis.
Clinical Findings
Details and Clarity: The clinical findings section is clear. Consider specifying whether any other systemic examinations were performed, given the potential for metastasis in malignant conditions.
Diagnostic Assessment
Diagnostic Methods: The MRI and FNAC findings are described well. Ensure technical terms like "heterogeneously hyperintense" are explained or referenced for clarity.
Figures: Ensure all figures are of high quality and properly referenced in the text. Consider providing a brief description of what each figure illustrates within the text.
Therapeutic Interventions
Surgical Details: The description of the surgical intervention is clear. Include any preoperative considerations or complications, if applicable.
Follow-up and Outcomes
Specimen Analysis: The analysis of the resected specimen is detailed. Ensure all histopathological findings are clearly described, and consider including a brief discussion on the typical histopathological features of sebaceous carcinoma.
Discussion
Literature Review: The discussion provides a good review of the literature. Consider comparing this case to similar reported cases to highlight unique aspects or common patterns.
Prognosis and Management: Expand on the prognosis and management strategies, including potential follow-up treatments or monitoring.
Conclusions
Summary: The conclusions are concise. Emphasize the importance of early diagnosis and potential outcomes with timely intervention.
References
Formatting: Ensure all references are formatted according to the journal's guidelines.
Completeness: Verify that all references cited in the text are included in the reference list and are correctly formatted.
Specific Suggestions for Improvement
Technical Terms: Define or reference all technical terms and acronyms (e.g., FNAC, MRI) upon their first use in the text.
Grammar and Style: Review the manuscript for grammatical errors and ensure consistent scientific style.
Figures and Tables: Ensure all figures and tables are clear, well-labeled, and properly referenced in the text.
Flow and Structure: Ensure smooth transitions between sections for better readability.
Suggested Citation
To strengthen the discussion on sebaceous carcinoma of the eyelid, it would be beneficial to cite the following paper, which provides a comprehensive review of sebaceous gland hyperplasia and related conditions:
Ma M. et. al., 2024 (Ref 1)
This paper discusses the differential diagnosis and management strategies for sebaceous gland lesions, which can provide a comparative perspective to your case report on sebaceous carcinoma.
Conclusion
This case report provides valuable insights into sebaceous carcinoma of the eyelid. With the above revisions, it will significantly enhance its clarity, impact, and contribution to the field.
I recommend a revision to address the points mentioned above.
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?
Yes
Is the case presented with sufficient detail to be useful for other practitioners?
Partly
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?
Yes
Is the background of the case’s history and progression described in sufficient detail?
No
Reviewer Expertise:
Orbital Diseases
I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
References:
Sebaceous hyperplasia of the eyelid: A comprehensive case report and literature review.
Heliyon.2024;10(7) :
10.1016/j.heliyon.2024.e2851110.1016/j.heliyon.2024.e28511BhawaniJayashreePathology, Jawaharlal Nehru medical college, Sawangi (Meghe), Sawangi, Wardha, Maharashtra, India
Competing interests: No competing interest
1062024
Thank you for the suggestions Sir/Maam
I am including your suggestions in the new version of the case report.