Primary sebaceous carcinoma of lacrimal gland: A case report and review of literature

Abstract

BACKGROUNDPrimary sebaceous carcinoma of lacrimal gland (SCLG) is extremely rare. Due to its clinical characteristics, it is often misdiagnosed. It is known to be aggressive so delay in diagnosis can increase the chance of local recurrence and metastasis. We report a case of primary SCLG.CASE SUMMARYA 75-year-old man was referred with a painful swelling in the right eyelid. Computed tomography scan demonstrates a 2.6 cm mass in upper outer quadrant of right orbit. After the incisional biopsy of the mass, he was diagnosed with squamous cell carcinoma of lacrimal gland. A right orbital exenteration, cervical lymph node dissection was performed. There was no involvement of the overlying periorbital skin, eyelid, or conjunctiva. Histological examination of the exenteration specimen showed tumor arising from the lacrimal gland, which had been entirely replaced by sebaceous carcinoma with sarcomatous and squamous differentiation. Neoplastic cells which were large and contained prominent nucleoli. Focal tumor remained in the posterior resection margin. Patient underwent adjuvant radiotherapy, total dose of 56 Gy with dose-per-fraction 2 Gy to primary lesion. There has been no sign of recurrence until 2-years follow-up.CONCLUSIONWe report a rare case of sebaceous carcinoma arising from the lacrimal gland. Accurate diagnosis of SCLG is important for appropriate treatment and prognosis prediction.

Sebaceous carcinoma of lacrimal gland with endophthalmitis

“…14 Park et al also found malignant cells mixed with sarcomatous, adenocarcinomatous, and pleomorphic sarcomatoid components in their patient's histopathology. 3 Our patient's histopathology showed identical results: the tumor was composed of nests of cuboidal and columnar cells with proliferation round core cells, pleomorphic, hyperchromatic, vacuole cytoplasm, and prominent nuclei.…”

“…SC occurs commonly 80% within the head and neck, and 40% within the ocular region, commonly in the upper lid due to more sebaceous glands there and frequently considered as either ocular or extraocular. 3,4 Although sex reports have varied, most authors found that SC is more frequent in older women. 6,7 SC commonly arises in patients over the age of 40 or presents within the elderly (average of 70 years of age), and the peak incidence arises in the seventh and eighth decades of life.…”

“…However, it has been reported in Asian populations sebaceous carcinoma is the second most common malignant eyelid tumor and about 22%-28% of all orbital space-occupying lesions, moreover 20-50% of these tumors are malignant. [3][4][5] Sebaceous carcinoma usually emerges from the periorbital area, which commonly affects in the eyelid. Sebaceous carcinoma of the orbit is commonly caused by orbital invasion of the periorbital carcinoma or by metastasis of tumors from other body parts.…”

“…Therefore, early diagnosis and accurate examination of the eyelids is essential to confirm a diagnosis and to prevent the metastasis. 3…”