A case of sebaceous adenoma of the eyelid showing excessively rapid growth

Abstract

BackgroundSebaceous adenomas are found mainly in elderly individuals and are usually tan, pink, or yellow nodules or papules, usually approximately 5 mm in the largest size.Case reportA 65-year-old man presented with a progressively enlarging exophytic lesion in the right eyelid for 3 months. External examination revealed a yellowish-pink growth measuring 18 × 13 × 14 mm. The lesion surface was covered by palpebral conjunctiva with fine papillary projections, vascularity, crusting, and ulceration. Two weeks later, the growth enlarged to 20 × 14 × 14 mm, and ulceration also expanded. An excisional biopsy with clear resection margins was performed. No malignancy was found in the stump. Histopathologically, the lesion was located principally within the cutaneous compartment and composed of multiple circumscribed sebaceous lobules, separated, and exhibiting no cytologic atypia. Cystic change was not evident, and no infiltrative growth pattern, pagetoid lesions, mitotic figures, and lymphovascular space invasion were observed. The Ki-67 nuclear antigen was detected in 10%–15% of cells located in the basal zone of the nodule. Fluorescence in situ hybridization showed low human epidermal growth factor receptor 2 amplification, suggesting no genetic changes. The clinical findings, lack of infiltrative border, low Ki-67 index, and low proliferative ability support a diagnosis of sebaceous adenoma.ConclusionSebaceous adenoma that shows excessively rapid growth due to hyperplasia may appear to be malignant. Histopathology, fluorescence in situ hybridization, and Ki-67 were useful to the diagnosis of the adenoma. Excisional biopsy with clear resection margins must be performed in rapidly growing tumors.

Sebaceous Adenoma: A Dermoscopic Case Perspective

“…In the eyelids, they can involve the glands of Zeiss or the meibomian glands. Sebaceous adenomas typically manifest around the age of 60 and usually measure approximately 5 mm in their greatest dimension [ 5 ]. Dermatoscopic features of sebaceous adenoma are still limited in the literature.…”

“…Typically located in the superficial dermis, sebaceous adenoma can raise suspicion for well-differentiated sebaceous carcinoma if it extends into the deep dermis, exhibits high mitotic activity, and mild cytologic atypia [ 5 ]. Differentiating well-differentiated sebaceous carcinoma from sebaceous adenoma can be challenging in rare cases.…”

“…Sebaceous adenomas also demonstrate variably expanded basaloid cells, exceeding the typical two-cell layers observed in sebaceous glands and sebaceous hyperplasia. The differential diagnosis of sebaceous adenoma involves distinguishing it from clear cell variants of eccrine, melanocytic, keratinocytic, or xanthomatous lesions, as well as renal cell carcinoma [5,[7][8][9].…”

Basaloid and lobulated: Sebaceous adenoma.

“…However, undifferentiated basaloid cells quantifiably exceed the differentiated, lipidrich sebaceous cells in lobular proliferations of sebaceous adenoma. Sebaceous carcinoma also demonstrates a proliferation of basaloid cells and sebaceous cells with a solid sheet like arrangement along with features of malignancy such as mitotic figures, nuclear hyperplasia and hyperchromasia, necrosis, cellular and nuclear pleomorphism and occasional pagetoid manner of tumour dissemination (Figures 1-12) [5,6].…”

“…Aforesaid immune stain is particularly efficacious in discerning poorly differentiated sebaceous carcinoma. Which is immune non-reactive for Epithelial membrane antigen (EMA) and associated epithelial markers with the requirement of exhibiting additional, specific or sebaceous immune biomarkers [5,6]. Sebaceous adenoma depicts minimal immune reaction with p53 and Ki67 (MIB-1).…”