Abstract
Importantly, sebaceous carcinoma represents an uncommon and aggressive malignant cutaneous tumor. Typically, this condition affects the elderly population. Notably, this neoplasm develops from sebaceous glands in the skin. Therefore, it may originate anywhere in the body. Usually, the periocular region contains rich concentrations of these glands. Consequently, this region serves as a common site of origin. However, we found this case in the left axillary region.
The objective of this presentation was to present a rare case of sebaceous carcinoma in the axillary region. In this case, a 37-year-old female presented with a lump in the left axillary region with ulceration for 2 months. Subsequently, a wide excision biopsy from the ulcerated growth revealed sebaceous carcinoma, papillary variant on routine histopathological examination. Therefore, we advised immunohistochemistry. Importantly, early recognition that sebaceous carcinoma can occur in young patients with no evidence of hereditary cancer risk or radiation therapy presents challenges.
Keywords
Axillary lump, sebaceous carcinoma, Immunohistochemistry
Introduction
Understanding Sebaceous Carcinoma
Initially, sebaceous carcinoma presents as an uncommon and aggressive malignant cutaneous tumor. Researchers believe this neoplasm arises from sebaceous glands in the skin. Therefore, it may originate anywhere in the body where these glands exist. Since the periocular region contains abundant concentrations of this gland type, this region becomes a common site of origin. However, we discovered this case in the left axillary region
Demographics and Associations
Generally, clinicians consider sebaceous carcinoma to be a tumor of older patients. Interestingly, sebaceous carcinoma appears more prevalent in the ocular adenexa than elsewhere in the body for unknown reasons⁴. Furthermore, researchers have associated it with Asians and Muir-Torre syndrome².
Case Report
Patient Presentation
Initially, we diagnosed a 37-year-old female with sebaceous carcinoma of papillary variant in the left axillary region.
Clinical History
The patient presented with a lump in the left axillary region for 2 months to the surgical outpatient department of Shree Krishna Hospital, Karamsad. Notably, she had no complaints of pain or fever. Recently, the lump had undergone ulceration. Subsequently, the clinician rendered a presumptive diagnosis of axillary lymphadenopathy. Therefore, the medical team performed a wide excision of the ulcerated growth over the left axillary region. Finally, the team sent the specimen to the Histopathology section of Central Diagnostic Laboratory, Shree Krishna Hospital, Karamsad, Anand, Gujarat.
Gross Examination Findings:
Upon examination, we received a skin-covered, grayish white fibro fatty mass measuring 4.5 x 3.0 x 2.0 cm. Additionally, the overlying skin measured 3.8 x 3.0 cm. Furthermore, the ulcerated nodule measured 1.8 x 1.5 cm. On sectioning, the cut surface showed a friable, granular, whitish soft tissue mass, measuring 2.0 x 1.5 cm. Subsequently, we obtained relevant sections from the mass, surgical margins, and base of resection. Then, we gave formalin fixation and prepared paraffin-embedded blocks from them.
Microscopic Analysis:
On examination, H and E-stained sections showed a tumor located in the dermis, invaginating from the epidermis. Structurally, the tumor consisted of numerous lobules and papillae having fibrovascular cores. Specifically, the lobules had cells with sebaceous differentiation in the center. Meanwhile, the papillae were lined by cells having pleomorphism and numerous mitotic figures. Characteristically, the cells with sebaceous differentiation had foamy vacuolated cytoplasm.
In terms of margins, the closest margin was 0.6 cm, the farthest margin was 1.1 cm, and the base was 0.1 cm away from the tumor, respectively.
Immunohistochemistry
The analysis revealed that tumor cells expressed p63. Conversely, they were immunonegative for CEA and GCDFP15. Additionally, the Mib-1 labeling index is approximately 10%.
Discussion
Diagnostic Challenges
Often, early recognition of sebaceous carcinoma presents challenges. Therefore, it requires close collaboration between the clinician and the pathologist. Initially, the early stages of the disease can consist of only Pagetoid extension without tumefaction⁵.
Epidemiological Patterns
Statistically, sebaceous carcinoma occurs more commonly in women. Furthermore, it rarely appears before the age of 40 years. Usually, the disease spreads by direct extension. However, metastasis to lymph nodes, lung, liver, brain, and skull is also possible.
Prognostic Factors
Clinicians associate several features with poor prognosis. These include origin from meibomian glands or upper eyelid, duration of symptoms longer than 6 months, size greater than 10 mm, an infiltrative growth pattern, poor sebaceous differentiation, pagetoid invasion, and lymphatic, vascular, or orbital invasion⁶.
Clinical Significance
This case demonstrates the importance of recognizing that sebaceous carcinoma can occur in younger patients. Notably, these patients may have no evidence of hereditary cancer risk or radiation therapy. Therefore, the present case underlines that a younger age should not exclude consideration of sebaceous carcinoma⁴.
Genetic Associations
Researchers know that Muir-Torre syndrome results from inactivation of MSH2 or MLH1. Consequently, this condition predisposes patients to sebaceous tumors and other neoplasms⁷. Furthermore, genomic instability may provide a mechanism for the occurrence of sebaceous carcinoma with Muir-Torre syndrome⁸.
Conclusion
It is very rare to see sebaceous carcinoma at a younger age without any specific history. Therefore, the correlation between suspected clinical features and histopathological findings helps with early diagnosis. Subsequently, this correlation assists in the patient’s further treatment and management.
This case emphasizes the need for heightened awareness among clinicians. Specifically, they should consider sebaceous carcinoma in younger patients presenting with unusual axillary lesions. Furthermore, early diagnosis and appropriate treatment planning remain crucial for optimal patient outcomes.
References
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