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zhongshihua 离线
liziqiang88 离线
I cannot exclude sebaceous carcinoma: 1) tumor nodules with central necrosis (pic 1) is the typical architecture for sebaceous carcinoma; 2) some cells show foamy cytoplasma; 3) nowhere i see any clear squamous differentiation (non-seratinizing SCC usually still show focal squamous differention). High power photos don't show appreciable intercellular bridges either; 4) female eyelid is the typical site for sebaceous carcinoma. Please not it is common to see some squamous cell differetiation in sebaceous ca.
Of course SCC is also in the differential.
I suppose you don't have any fresh tissue for Oil red O?
Any SCC in situ in attached skin? Please note sebaceous carcinoma usually has pagetoid extension into skin adnexa or epidermis, but true SCC in situ shound be absent.
If the tumor grossly is really in the lacrimal gland, not attached to the skin, that would be a supportive evidence for sebaceous Ca.
These are my thoughts. Not a clear cut case, especially with photos only. Sorry i cannot think of any immunostains to help. I clearly remember a sebaceous carcinoma case i presented in tumor board. The tumor was on the back (unusual location for sebaceous ca). The surgeon gave me a very hard time for the diagnosis. He wanted to call it SCC. Back then i was a surgical pathology fellow, my attending defended me well.