Clinicopathological Analysis of Periocular Sebaceous Gland Carcinoma

Abstract

Background: We analyzed the clinicopathological features and prognosis in patients with periocular sebaceous gland carcinoma. Methods: Retrospectively, we studied the records of 24 cases of sebaceous gland carcinoma treated in our clinic between 1999 and 2004. The reviewed data included demographic information, initial clinical and histopathological diagnosis, anatomic tumor location, details of treatment, tumor involvement of resection margin, and outcomes such as local recurrence, distant metastasis and survival. Results: Local recurrence developed in 6 cases (25%) at a median of 20 months from initial diagnosis. Only 2 patients (8.3%) died of systemic metastasis to brain and bone from primary lacrimal gland carcinoma. The local recurrence rate in the complete excision group (5.9%) was significantly lower compared with the incomplete excision with irradiation group (71.4%; Fisher’s exact test, p = 0.003). We observed a shorter duration of symptom, a higher rate of eventual exenteration and local recurrence, and a shorter time interval to local recurrence from initial management in poorly differentiated tumors compared with moderately differentiated tumors. Conclusion: It is critical to achieve a negative tumor margin in both frozen and permanent section to prevent local recurrence. Early aggressive management is required in sebaceous gland carcinoma of the lacrimal gland, as its mortality is much higher than that of eyelid origin.

Sebaceous carcinoma in Japanese patients: clinical presentation, staging and outcomes

“…In contrast, 94% of our patients presented with a solitary mass or nodule, and 29% of our cases were misdiagnosed as a chalazion, compared with just 5% as blepharoconjunctivitis. This difference in presentation between Caucasian and Asian patients is also reflected in the literature, with chalazion being the most commonly reported misdiagnosis of sebaceous carcinoma from Japanese and Korean studies 12 14. This possible difference in clinical presentation may also be a factor in the lower rate of clinical misdiagnosis in Asian populations as compared with Caucasian ones.…”

“…However, we found much lower rates, with just 21% of our cases demonstrating pagetoid spread histologically. Yoon et al 14 reported even fewer cases of pagetoid spread within their Korean series, which occurred in only 8.3% of patients. Chao et al also demonstrated differing clinical features of sebaceous carcinoma depending on the presence of intraepithelial spread, with 72% of patients with pagetoid spread presenting with diffuse eyelid thickening and 43% of patients without pagetoid spread presenting with a distinct mass 16.…”

“…Frozen section monitoring has previously been associated with false negative rates in 25% of cases, and for this reason, many centres advocate the use of fast-tracked permanent paraffin-embedded sections and delayed closure 13 17. However, in centres where pathologists are experienced with the use of frozen section for margin control, the rate of false negatives is low, and recurrence rates appear to be comparable with permanent section 1 14. Frozen section was the preferred form of margin control at our institution, which may be reasonably effective in the short-term, as we had a recurrence rate of 8% (4/51) during a median follow-up of 4.2 years.…”

Increased gene copy number of HER2 and concordant protein overexpression found in a subset of eyelid sebaceous gland carcinoma indicate HER2 as a potential therapeutic target

“…Although the mortality rate of this carcinoma is relatively low, local invasion and metastasis to regional lymph nodes or distant organs occasionally occur in aggressive cases (Shields et al 2005;Song et al 2008). The recurrence rate of SbGC has been reported to be up to 10-25 % (Shields et al 2004;Song et al 2008;Yoon et al 2007). The standard frontline treatment of eyelid SbGC is either wide excision or Mohs micrographic surgery; however, the tendency for multicentricity or pagetoid spread remains the main obstacle preventing its complete removal.…”

Sebaceous carcinoma of eyelid

“…Radiotherapy may be given to those patients who refuse surgery. Features of poor prognosis include orbital invasion, poor differentiation, tumour diameter of more than 10 mm and lacrimal gland involvement 22 23. Tumours of the lower eye lid have been associated with better prognosis than those affecting the lower lid 24…”