Sebaceous adenoma of the conjunctiva and caruncle: a clinicopathological report of three cases and literature review

Sebaceous tumors of the conjunctiva and caruncle are rare conditions, accounting for 1% of caruncle lesions and even lower among conjunctival lesions. Almost 50% of cases are associated with Muir-Torre syndrome, a rare autosomal-dominant condition characterized by at least one sebaceous skin tumor and one visceral malignancy. We report 3 cases of sebaceous adenoma with different presentations that were submitted to excisional biopsy and immunohistochemical study. Diagnosis of these tumors should increase the level of suspicion and lead to clinical investigation to rule out neoplasms, particularly because in up to 41% of cases, these can be the first sign of the disease.

Keywords:
Sebaceous gland neoplasm; Adenocarcinoma; Conjunctival neoplasms; Muir-Torre syndrome; Immunohistochemistry; Biopsy; Human; Case report

Authorship

Mariana Borges Barcellos Dias Corresponding author: Mariana Borges Barcellos Dias. E-mail: marianabbd@gmail.com

Ocular Oncology Service, Universidade Federal de São Paulo, São Paulo, SP, Brazil.Universidade Federal de São PauloBrazilSão Paulo, SP, BrazilOcular Oncology Service, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

http://orcid.org/0000-0002-5141-5869

Melina Correia Morales

Arthur Gustavo Fernandes

Moacyr Rigueiro

Department of Ophthalmic Pathology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.Universidade Federal de São PauloBrazilSão Paulo, SP, BrazilDepartment of Ophthalmic Pathology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Alexandre Nakao Odashiro

Department of Ophthalmology and Pathology, Henry C. Witelson Ocular Pathology Laboratory & McGill University Health Centre, Montreal, QC, Canada.Henry C. Witelson Ocular Pathology Laboratory & McGill University Health CentreCanadaMontreal, QC, CanadaDepartment of Ophthalmology and Pathology, Henry C. Witelson Ocular Pathology Laboratory & McGill University Health Centre, Montreal, QC, Canada.

Rubens Mattos Belfort Neto

http://orcid.org/0000-0003-1775-7328

Corresponding author: Mariana Borges Barcellos Dias. E-mail: marianabbd@gmail.com

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

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Figures

Figures (4)

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Figure 1.
(A) Biomicroscopic examination image showing a yellowish conjunctival lesion, with a papillomatous aspect on plica semilunaris topography. (B) Higher magnification.

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Figure 2.
(A and B) Histopathological examination results showing a nodular and lobulated tumor (hematoxylin-eosin [H&E], staining, original magnifications ×40 and ×100). (C) At the center, the tumor is composed of mature sebocytes with a clear cytoplasm containing lipid vacuoles without atypia. The periphery of the lobules consisted of small darker cells represented by basaloid germinative cells (H&E, original magnification ×200). (D) Immunohistochemistry with Ki67, a cell proliferation marker, is mainly negative in well-differentiated sebaceous cells and positive at the periphery of the lobules in germinative cells. This is consistent with the diagnosis of sebaceous adenoma (SA).

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Figure 3.
Immunohistochemistry of the mismatch repair proteins MSH6, PMS2, MHL1, and MSH2 showing nuclear positivity in the cells with all four markers.

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Figure 4.
(A) Clinical appearance of a papillomatous caruncle nodule. (B) Low-power view showing a lobulated tumor composed of clear cells on the center and darker cells at the periphery of the lobules (hematoxylin-eosin staining [H&E], original magnification ×40). (C) The tumor is composed of mature sebocytes with clear cytoplasms without pleomorphism or brisk mitotic activity. At a higher magnification, the cells present round-to- -oval nuclei with well-distributed chromatin, conspicuous nucleoli, and a vacuolated clear cytoplasm (H&E, original magnification ×400). (D) Yellowish subepithelial mass suggestive of sebaceous adenoma. (E) Histopathological examination result showing a well-delimitated and lobulated tumor, with features identical to those of cases 1 and 2 (H&E, original magnification ×40). (F) The clear cytoplasm represents empty spaces filled by the lipid vacuoles that were artefactually dissolved during specimen processing (H&E, original magnification ×400).

Figure 1. (A) Biomicroscopic examination image showing a yellowish conjunctival lesion, with a papillomatous aspect on plica semilunaris topography. (B) Higher magnification.

Figure 2. (A and B) Histopathological examination results showing a nodular and lobulated tumor (hematoxylin-eosin [H&E], staining, original magnifications ×40 and ×100). (C) At the center, the tumor is composed of mature sebocytes with a clear cytoplasm containing lipid vacuoles without atypia. The periphery of the lobules consisted of small darker cells represented by basaloid germinative cells (H&E, original magnification ×200). (D) Immunohistochemistry with Ki67, a cell proliferation marker, is mainly negative in well-differentiated sebaceous cells and positive at the periphery of the lobules in germinative cells. This is consistent with the diagnosis of sebaceous adenoma (SA).

Figure 3. Immunohistochemistry of the mismatch repair proteins MSH6, PMS2, MHL1, and MSH2 showing nuclear positivity in the cells with all four markers.

Figure 4. (A) Clinical appearance of a papillomatous caruncle nodule. (B) Low-power view showing a lobulated tumor composed of clear cells on the center and darker cells at the periphery of the lobules (hematoxylin-eosin staining [H&E], original magnification ×40). (C) The tumor is composed of mature sebocytes with clear cytoplasms without pleomorphism or brisk mitotic activity. At a higher magnification, the cells present round-to- -oval nuclei with well-distributed chromatin, conspicuous nucleoli, and a vacuolated clear cytoplasm (H&E, original magnification ×400). (D) Yellowish subepithelial mass suggestive of sebaceous adenoma. (E) Histopathological examination result showing a well-delimitated and lobulated tumor, with features identical to those of cases 1 and 2 (H&E, original magnification ×40). (F) The clear cytoplasm represents empty spaces filled by the lipid vacuoles that were artefactually dissolved during specimen processing (H&E, original magnification ×400).

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Sebaceous adenoma of the conjunctiva and caruncle: a clinicopathological report of three cases and literature review

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[1] Corresponding author: Mariana Borges Barcellos Dias. E-mail: marianabbd@gmail.com