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SEBACEOUS CARCINOMA- CLINICOPATHOLOGICAL STUDY OF AN AGGRESSIVE PRESENTATION (FP524)

SEBACEOUS CARCINOMA- CLINICOPATHOLOGICAL STUDY OF AN AGGRESSIVE PRESENTATION (FP524). Dr Richa Gupta ( AIOS No: G11962) Dr M Manjunath Kamath Dr Rajesh Nayak , Dr Susan D’ Souza DEPT. OF OPHTHALMOLOGY, KASTURBA MEDICAL COLLEGE, MANGALORE. INTRODUCTION.

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SEBACEOUS CARCINOMA- CLINICOPATHOLOGICAL STUDY OF AN AGGRESSIVE PRESENTATION (FP524)

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  1. SEBACEOUS CARCINOMA- CLINICOPATHOLOGICAL STUDY OF AN AGGRESSIVE PRESENTATION(FP524) Dr Richa Gupta ( AIOS No: G11962) Dr M ManjunathKamath Dr Rajesh Nayak, Dr Susan D’ Souza DEPT. OF OPHTHALMOLOGY, KASTURBA MEDICAL COLLEGE, MANGALORE

  2. INTRODUCTION • Sebaceous gland carcinoma of the eyelid is relatively rare (accounting for less than 1% of all eyelid tumors),1 and arises from periocularMeibomian gland, Zeiss gland or sebaceous gland. • Its recognition is often delayed because of its ability to masquerade as other periocularlesions like chronic chalazion, blepharoconjunctivitis, superior limbic keratitisor chronic conjunctivitis.2,3 1. Shields JA, Shields CL, eds. Atlas of Eyelid and Conjunctiva Tumors. Philadelphia: Lipincott Williams and Wilkins, 1999;40–9. 2. Yeatts RP, Waller RR. Sebaceous carcinoma of the eyelid: pitfalls in diagnosis. OphthalPlastReconstrSurg 1985;1:35–42. 3. Boniuk M, Zimmerman LE. Sebaceous carcinoma of the eyelid, eyebrow, caruncle, and orbit. IntOphthalmolClin 1972;12:225–57.

  3. CASE REPORT: History... • A 60 year old female presented with a fleshy, painless mass in the lower lid RE of 4 months duration, progressively increasing in size, associated with occasional bleeding and purulent discharge. • There was history of excision biopsy (report suggestive of squamous cell carcinoma) and use of Mitomicin C eye drops one year back. RE: right eye LE: left eye

  4. On examination... • Local examination revealed a 10 X 15mm irregular mass, with areas of necrosis and ulceration, arising from the conjunctival surface of the lower lid, involving both upper and lower lid margins • (with thickening and loss of lashes). • Visual acuity: No perception of light (RE) and best corrected visual acuity (LE) 6/6, N6. Fig 1: Pre-operative clinical photograph

  5. On examination... • The globe was pushed upwards and backwards. Cornea was clear, anterior chamber was shallow with a non reactive pupil. Status of the lens could not be made out. • Left eye was pseudophakic with normal features, with normal fundus findings. • No lymph nodes were palpable.

  6. Investigations… • Ultrasonography of the abdomen and X-ray chest ruled out systemic metastases. • All routine blood investigations including renal and liver function tests were normal. Fig 2: CT scan (axial view) showing the mass, with no bony erosion.

  7. Treatment…

  8. Histopathological findings… Histopathology report: moderately differentiated sebaceous cell carcinoma (mixed type)

  9. The Final Picture… Fig 7: 2 weeks post- op photograph, showing granulation tissue

  10. DISCUSSION • Sebaceous cell carcinoma affects mainly elderly females, average age being 72.4 It is much more prevalent in countries such as India and China,5 often producing potentially fatal consequences.Almost 50% of sebaceous cell carcinomas are misdiagnosed as squamous cell carcinoma. • Poor prognostic factors include upper lid origin, size of more than 10 mm, Meibomian gland origin, symptoms for more than 6 months, infiltrative growth pattern, poor differentiation, pagetoid infiltration, orbital, lymphatic or vascular invasion.6 4. Shields JA, Demirci H, Marr BP, Eagle RC Jr, Stefanyszyn M, Shields CL. Sebaceous carcinoma of the eyelids: personal experience with 60 cases. Ophthalmology 2004; 111: 2151-2157. 5. Ni C, Searl S, Kuo PK. Sebaceous cell carcinomas of the ocular adnexa. IntOphthalmolClin 1982; 22: 23-61. 6. Rao NA, Hidayat AA, Mc Lean IW, Zimmerman LE: Sebaceous gland carcinoma of the ocular adnexa: a clinicopathologic study of 104 cases with five year follow up data. Hum Pathol 1982;13:113-122.

  11. Classifications A) B)

  12. Management 7. Shields JA, Demirci H, Marr BP, Eagle RC, Stefanyszyn M, Shields CL. Conjunctivalephithelial involvement by eyelid sebaceous carcinoma. The 2003 J. Howards Stokes Lecture. Opthalmic Plastic and Recostructive Surgery 2005; 21: 92-96. 8. Shields CL, Naseripour M, Shields JA, Eagle RC Jr. Topical mitomycin-C for pagetoid invasion of the conjunctiva by eyelid sebaceous gland carcinoma. Ophthalmology 2002; 109: 2129-2133.

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