Sebaceous Epithelioma

An 83-year-old woman had developed an asymptomatic, yellowish, dome-shaped skin tumor on her scalp which had enlarged for a period of 60 years to 10 times 10 times 10 mm in size. Histopathologically, the tumor consisted of undifferentiated basaloid cells, differentiated sebaceous cells and transitional cells. Although the basaloid cells resembled those of basal cell epithelioma (BCE), the tumor was distinct from BCE in the following points; existence of cystic spaces, no peripheral palisading, no proliferation of connective tissue stroma, and no tendency toward local invasion. Immunohistochemical studies using antikeratin monoclonal antibodies revealed that the tumor contained both the keratin types of BCE and of sebaceous glands. Electron microscopically, the tumor cells contained lipid droplets and keratohyaline granules in their cytoplasm. It is suggested that “sebaceous epithelioma” is a benign skin tumor which may be distinguished cytologically from BCE.     

Enzymatic studies on adnexal tumors of the skin. Histochemical and biochemical studies on tumors of sebaceous origin.

Sebaceous gland carcinoma (SGC), basal cell epithelioma with sebaceous cell differentiation (BCE+S) and basal cell epithelioma (BCE) were examined enzymatically, in order to elucidate the enzymatic characteristics of these tumors and the tumor cell origin of BCE+S. SGC demonstrated significantly higher enzyme activity of glucose-6-phosphate dehydrogenase (G-6-PDH), isocitrate dehydrogenase (ICDH) and α-glycerophosphate dehydrogenase (Gly-PDH) than did BCE. BCE+S had an enzymatic pattern similar to BCE, except for Gly-PDH which resembled SGC. The results obtained in this study indicated that BCE+S derived not from sebaceous gland cells but from primitive basal cells or epidermal cells which transformed into BCE and then partially differentiated toward sebaceous gland cells.     

A tumor with sebaceous differentiation showing intraepidermal epithelioma

A sixty-year-old woman had a small papule within a plaque on the left arm. Histologically, the papule was similar to irritated seborrheic keratosis or inverted follicular keratosis and the plaque was intraepidermal epithelioma. However, both lesions included mature sebaceous cells showing sebaceous differentiation. This tumor may be closely related to the pilo-sebaceous unit or sebaceous gland. To our knowledge, no similar tumor has been reported in the literature.     

A case of multiple sebaceous epithelioma: analysis of microsatellite instability

Sebaceous gland tumor is a rare disease that is a sign of Muir-Torre syndrome, an autosomal, dominantly inherited genodermatosis characterized by the presence of at least one sebaceous gland tumor and a minimum of one internal malignancy. Recent studies have indicated that defective DNA mismatch repair occurs in Muir-Torre syndrome. Cutaneous lesions may occur before diagnosis of the internal cancer. We describe a 64-year-old male patient with multiple sebaceous epitheliomas with no evident internal malignancy. Microsatellite instability, determined by examining dinucleotide CA repeats at the microsatellite loci, was observed in DNA from one sebaceous epithelioma but not from the other two sebaceous epitheliomas or from one basal cell epithelioma with sebaceous differentiation, suggesting that this condition is unlikely to be due to germ-line mutation of mismatch repair genes.     

A Case of Superficial Epithelioma with Sebaceous Differentiation

Superficial epithelioma with sebaceous differentiation developed on the left cheek of a 58-year-old man over a three-year period. Biopsy of the lesion demonstrated plate-like lobules of basophilic basaloid cells with broad attachments to the overlying epidermis. Clusters of or solitary sebaceous cells were present within the lobules. Three tumor types were considered; a subtype of sebaceoma growing in the epidermis, an acanthotic seborrheic keratosis subtype with sebaceous differentiation, or a tumor of the follicular infundibulum with sebaceous differentiation.     

Superficial epithelioma with sebaceous differentiation

Five cases of superficial epithelioma with sebaceous differentiation (SESD) are reported. They occurred as solitary papules on the face of 5 patients, aged 57 to 72. The tumor is characterized by a superficial platelike proliferation of basaloid to squamoid cells with broad attachments to the overlying epidermis. Clusters of mature sebaceous cells are present within the tumors. None of the tumors have recurred or spread following simple excision. SESD is a non-aggressive tumor of uncertain histogenesis with a tendency toward sebaceous differentiation.     

PNA-binding sites in sebaceous tumors

The presence and distribution of peanut agglutinin (PNA)-binding sites was studied in normal sebaceous glands, nevus sebaceous, senile sebaceous hyperplasia, sebaceous adenoma, sebaceous epithelioma, and sebaceous carcinoma. Cell surface staining and sponge-like cytoplasmic staining was observed in sebaceous glands, nevus sebaceus and sebaceous hyperplasia. In sebaceous adenoma, sebaceous epithelioma, and sebaceous carcinoma, diffuse cytoplasmic staining was observed in addition to cell surface staining.     

Tumor of the follicular infundibulum with sebaceous differentiation

BACKGROUND: Tumor of the follicular infundibulum (TFI) is a relatively rare tumor which clinically presents as a solitary keratotic papule usually on the head and neck which on microscopic examination typically reveals a plate-like fenestrated epithelial tumor composed of pale staining cells. METHODS: We describe a new variant of TFI. An 80-year-old male with a history of multiple basal cell carcinomas and a squamous cell carcinoma presented with a 2-year history of a red, scaly, slightly elevated plaque on the lateral aspect of his right buttock. RESULTS: Histopathological examination revealed plate-like reticulate epithelial outgrowths of large and pale cells with foci of sebaceous differentiation and numerous colloid bodies. Differential diagnosis included superficial basal cell carcinoma with sebaceous and ductal differentiation, tumor of the follicular infundibulum, an unusual fibroepithelioma of Pinkus or an eccrine fibroadenoma with sebaceous differentiation. CONCLUSION: This case illustrates a hybrid adnexal tumor with histologic features common to both tumor of the follicular infundibulum and superficial epithelioma with sebaceous differentiation.     

Complex adnexal tumor of the primary epithelial germ with distinct patterns of superficial epithelioma with sebaceous differentiation, immature trichoepithelioma, and apocrine adenocarcinoma.

A 60-year-old man came for treatment of a sharply outlined erythematous plaque on the gluteal area (45 x 20 mm) of 20 years' duration. Eccentrically located on the plaque was a nodule, 20 mm in diameter. Histological study of the plaque showed a superficial platelike tumor with basaloid bland cytology and sebaceous gland differentiation. Histologic study of the nodule found an undifferentiated adenocarcinoma whose ductlike glandular structures opened to the skin surface and infiltrated the whole depth of the dermis. Study of other areas of the lesion detected two more neoplasms. A nodule of squamous cell carcinoma was found within the superficial band of the benign sebaceous tumor. The fourth neoplastic pattern consisted of epithelial islands composed of basaloid cells within a fibroblastic stroma. There was prominent palisading of epithelial cell nuclei at the periphery of the islands, which usually were surrounded by a sheath of mesenchymal cells. In this complex adnexal tumor of the primary epithelial germ, sebaceous and follicular differentiation both simulate neoplastic patterns recently described as separate entities: superficial epithelioma with sebaceous differentiation and immature trichoepithelioma. The undifferentiated adenocarcinoma may represent differentiation toward the third component of the germ, that is, the apocrine gland.     

Immunohistochemical staining for androgen receptors: a sensitive marker of sebaceous differentiation.

Androgen receptors (AR) are present in normal skin being localized to the basal and differentiating cells of the sebaceous gland, and as such, sebaceous glands are androgen sensitive tissue. Androgen receptor expression was examined in 43 sebaceous neoplasms including 8 sebaceous carcinomas, 22 sebaceous adenomas, 12 specimens showing sebaceous hyperplasia, and 1 sebaceous epithelioma, as well as in 14 squamous cell carcinomas, 2 clear cell acanthomas, and 35 basal cell carcinomas. Epithelial membrane antigen (EMA) expression was also examined in all of the sebaceous neoplasms. All specimens were fixed in formalin and embedded in paraffin. Diffuse positive nuclear androgen receptor antibody immunohistochemical staining was observed in all samples of sebaceous neoplasms, whereas approximately 60% of basal cell carcinomas showed only focal positivity for nuclear androgen receptor immunoreactivity. Clear cell acanthomas and squamous cell carcinomas were uniformly negative. Whereas all sebaceous neoplasms exhibited immunoreactivity for androgen receptors, the staining pattern was more marked in the nuclei of seboblasts and differentiating sebocytes in the adenomatous, hyperplastic, and epitheliomatous lesions than in the nuclei of the less differentiated sebaceous carcinoma cells. All the sebaceous neoplasms except for sebaceous carcinomas exhibited immunoreactivity for EMA. In the sebaceous carcinomas, EMA staining was absent in the most poorly differentiated specimen, but with increasing differentiation, the carcinomas became immunoreactive to EMA. We have shown that the nuclei of sebaceous neoplasms, including sebaceous gland carcinomas, show immunoreactivity for androgen receptors (AR), that immunohistochemical staining for the presence of AR may be a reliable marker of sebaceous differentiation, and that the AR may be a better marker of sebaceous differentiation than EMA, particularly in poorly differentiated sebaceous carcinomas.     

Lowered Cu, Zn-superoxide dismutase activity in human malignant skin tumors

We examined Cu, Zn-superoxide dismutase (SOD) activities of fifteen malignant skin tumors (four malignant melanomas, three squamous cell carcinomas, four Bowen's diseases, two basal cell epitheliomas, one sebaceous epithelioma, and one extramammary Paget's disease) and compared them with those in adjacent normal tissues of the same patients. Though there were some individual differences, all the SOD activities in tumor tissues were significantly lower than those in adjacent normal tissues of the same subjects. The average SOD activity in tumor tissues was 12.01 +/- 2.17 unit/mg protein, while that of normal tissues was 17.62 +/- 2.85. These findings agree with previous reports from various other organ tumors.     

Intralesional Alpha 2b Recombinant Interferon for Basal Cell Carcinomas

Basal cell carcinoma (BCC) is a rather common skin neoplasm, particularly in white patients. It grows slowly, has a locally malignant behavior, and metas-tases occur only exceptionally. It is considered to be derived from pluripotential epithelial cells that can partially differentiate towards adnexal structures and sebaceous, apocrine, and sometimes eccrine glands. Prolonged exposure to the sun, a fair and freckled complexion, x-rays, burn scars, and arsenic by mouth are all predisposing factors for basal cell epithelioma. The face and the trunk are the parts most often affected. Some patients, especially those with a fair complexion, may have dozens of BCCs at one time.     

Basal cell carcinoma with sebaceous differentiation

Some authors have used sebaceous epithelioma as a synonym for basal cell carcinoma (BCC) with sebaceous differentiation. However, our review of the literature revealed that definite cases of BCC with sebaceous differentiation that provide adequate clinical and histopathologic information are scarce. We present the case of a 72-year-old woman with a pigmented nodular lesion on her right ala nasi region, clinically diagnosed as pigmented BCC. Histopathologically, this nodular lesion, which was completely excised, showed typical features of BCC. It was noteworthy that within one aggregation of the presented BCC, tiny and small duct-like structures lined by cornified layers with a crenulated inner surface were seen. Vacuolated cells were scattered within a few aggregations, and they had foamy, bubbly cytoplasm and starry nuclei. The vacuolated cells were immunohistochemically positive for epithelial membrane antigen (EMA). These histopathologic findings demonstrated unquestionable sebaceous differentiation in this BCC, namely BCC with sebaceous differentiation, which should be distinguishable from both sebaceoma and sebaceous carcinoma. The small duct-like structures lined by eosinophilic cuticle, indicating apocrine differentiation, were also observed in this BCC.     

The spectrum of organoid nevi

Two patients in whom tumors developed in organoid nevi are reported. The first patient, a 50-year-old man, had a trichilemmoma arising from an organoid nevus on the scalp. The second patient, a 68-year-old woman, had a basal cell epithelioma, sebaceous epithelioma, syringocystadenoma papilliferum, and a trichilemmoma arising from an organoid nevus on the face.     

Immunolabeling pattern of cytokeratin 19 expression may distinguish sebaceous tumors from basal cell carcinomas

Background:  Distinction between sebaceous tumors and basal cell carcinomas can often pose diagnostic problems. Recent work with the antibody to cytokeratin 19 (CK 19) has shown that this marker has high specificity for undifferentiated basaloid cells. Our aim was to evaluate the use of CK 19 staining patterns in differentiating between sebaceous tumors and basal cell carcinomas. The sebaceous tumors that were examined in this study included sebaceous adenomas, sebaceous epitheliomas (sebaceomas) and sebaceous carcinomas.
Methods:  Thirty-seven cases including 5 sebaceous adenomas, 16 sebaceous epitheliomas, 6 sebaceous carcinomas and 14 basal cell carcinomas (7 being of the morpheaform type and 7 nodular basal cell carcinomas) were tested with a monoclonal mouse antibody to human CK 19.
Results:  CK 19 was focally positive in 1/5 (20%) sebaceous adenomas, 8/16 (50%) of sebaceous epitheliomas and 1/6 (17%) of sebaceous carcinomas. Strongly positive expression of CK 19 was not seen in any of the sebaceous adenoma, sebaceous epithelioma or sebaceous carcinoma specimens. CK 19 was found to be strongly positive in 9/14 (64%) and focally positive in 2/14 (14%) of basal cell carcinomas.
Conclusion:  CK 19 expression can be helpful in differentiating sebaceous tumors (including sebaceous adenomas, sebaceous epitheliomas and sebaceous carcinomas) from basal cell carcinomas and may be a useful adjunct when these entities are included in the differential diagnosis.     

Muir-Torre syndrome: a case of this uncommon entity

A 69-year-old Hispanic woman presented for the evaluation of nodules on the head and back. In the past, she had been treated for basal cell carcinoma (BCC) of the face; the referring physician was concerned that the new lesions might also be BCC. The patient had an extensive past medical history. In addition to BCC, she had been treated for breast cancer, colon cancer, and cervical cancer prior to emigrating to the USA. Her colonic malignancy had been localized proximal to the splenic flexure. She also had a history of colonic polyps and distal colonic villous adenoma. She denied ever being treated with radiation. Further details of her medical history and cancer staging were not available. Her family history was significant for a sister with colon cancer and transitional cell carcinoma of the urinary bladder. In addition, she had a great aunt with oral cancer and a great uncle with lung cancer. Neither the patient or her relatives had any history of tobacco use. On physical examination, in addition to scars from a radical mastectomy and midline abdominal laparotomy, four skin lesions were noted: two on the scalp, one on the tragus, and one on the mid-back. The first lesion on the vertex of the scalp was a yellow-brown waxy papule measuring 0.6 x 0.5 cm. This lesion was similar to that on the mid-back, except in size. The lesion on the back measured 1.2 x 1.0 cm. The second lesion on the frontal scalp measured 0.8 x 0.6 cm and was red-brown with a pearly appearance and some central hyperkeratosis. The tragus lesion was similar in appearance to that on the frontal scalp. Shave biopsies of all lesions were obtained. The lesions on the scalp and mid-back revealed lobules of sebaceous cells in the dermis with a minority of surrounding basaloid cells, consistent with a diagnosis of sebaceous adenoma (Fig. 1). Although the lesion on the frontal scalp also showed sebaceous differentiation, there were a greater number of basaloid cells, some with hyperchromatic nuclei and mitotic figures; this was consistent with a diagnosis of sebaceous epithelioma (Fig. 2). The final lesion (tragus) was histologically consistent with a keratotic BCC. No further treatment was required for these benign sebaceous tumors, but their presence defined our patient's condition as Muir-Torre syndrome. Mohs' micrographic surgery was performed on the tragus BCC and the margins were tumor free in one stage. The patient returned 1 year later with a lesion anterior to the left axilla which was biopsied to rule out BCC (Fig. 3). Histologically, this lesion was also consistent with sebaceous epithelioma.     

Anti-keratin monoclonal antibody against basal cell epithelioma keratin: BKN-1

A BALB/c mouse was immunized with fibrous proteins (FP) extracted from basal cell epithelioma (BCE) and anti-keratin monoclonal antibodies were produced by a hybridoma technique with a mouse myeloma cell line. One monoclonal antibody was designated as BKN-1. Immunohistochemically, in 17 cases of BCE, the cytoplasm of all the tumor cells was always stained by BKN-1. In the normal human skin tissue, BKN-1 specifically reacted with the basal cells in the epidermis and in the infundibular epithelium of the hair follicle, the entire follicular cells below the isthmus portion in the anagen hair follicle, the peripheral cells of sebaceous glands, and sweat gland cells. The reaction of BKN-1 was immunoelectron microscopically located on the tonofilaments in the cytoplasm. By immunoblot analysis, BKN-1 stained either a band of 56–56.5K in FP from BCE or several bands in normal epidermal FP. These results suggest that the keratin expression of BCE may resemble that of the follicular epithelium below the isthmus portion.     

Transfollicular Extrusion of Sebaceous Glands: Natural Phenomenon or Artifact? A Case Report

A sebaceous gland tumor on the back of a 28-year-old man underwent periodic exudation of yellowish material in association with local irritation. Pathological examination revealed entire sebaceous gland lobes lying subcorneally in the orifices of sebaceous follicles. This case appears to represent transfollicular extrusion of sebaceous gland lobes as a natural phenomenon rather than as an artifact.     

Melanosomes of pigmented basal cell epithelioma

Electron microscopic examination of a pigmented basal cell epithelioma of scrotal skin revealed many tumor cells and melanocytes which were laden with large packages of melanosomes. In tumor cells these packages were delimited by either single- or double-limiting membranes or were not membrane bound. The matrix of these large complexes was less electron dense and homogeneous than normal, containing electrontranslucent droplets besides melanosomes. No remnants of intracellular organelles such as nucleus, mitochondria or ribosomes could be found. The basal cell epithelioma cells in this case appear to have differentiated toward fetal basal cells and have developed the ability to phagocytize large packages of melanosomes.