Case for Diagnosis
Slow-Growing Keratotic Tumor on the Eyelid
Tumor queratósico palpebral de largo tiempo de evolución
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Navarro-Triviño, J. Aneiros-Fernández, A.M. Almodóvar-Real" "autores" => array:3 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "Navarro-Triviño" "email" => array:1 [ 0 => "fntmed@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Aneiros-Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A.M." 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B, C, and D, Hematoxylin-eosin, original magnification x20.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 47-year-old man with a past history of hepatitis C and negative human immunodeficiency virus (HIV) serology presented with an asymptomatic lesion on the left upper eyelid that had first appeared more than 5 years earlier. The lesion began as a “pimple” and grew progressively. The patient reported no exposure to toxic chemical products or to radiotherapy. He had received a diagnosis of chalazion from the ophthalmology department.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a single, well-defined, brownish-yellow tumor on the left upper eyelid that was keratotic with an erythematous base, which made contact with the edge of the eyelid (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient had no palpable locoregional lymph nodes.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">A panoramic image (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) revealed a neoformation with a polypoid pattern that ulcerated the entire epidermis. This infiltrating tumor formed confluent nests that included some necrotic areas in the central zone. Higher magnification revealed the presence of cells with moderate atypia and prominent nucleoli in the tumor nests. Clear cell differentiation with a clear and finely vacuolated cytoplasm was also observed, and staining was positive for carcinoembryonic antigen, epithelial membrane antigen, and adipophilin.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">A full ophthalmologic examination revealed no pathological findings. Blood tests and chest radiograph were normal.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Sebaceous carcinoma.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The lesion was removed by wedge excision with a surgical margin of 4<span class="elsevierStyleHsp" style=""></span>mm. Margins were tumor-free in the histologic study. A computed tomography scan of the head, neck, and chest revealed no evidence of locoregional or distant metastases. No signs of tumor recurrence have been found during periodic follow-up over the past 2 years.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Sebaceous carcinoma (SC) is a rare, aggressive neoplasm of adnexal origin. SC accounts for 0.7% of all skin neoplasms.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The most common site is the upper eyelid (75% of cases reported), although it can be found on any body part where sebaceous glands are present.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> SC usually presents as painful yellowish-pink nodules that may clinically resemble chalazions.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> In rare cases, it presents as a pedunculated mass resembling a cutaneous horn, as in our patient. Histology can show changes ranging from a well-differentiated sebaceous neoplasm with a lobular proliferation of neoplastic cells with abundant foamy cytoplasm—similar to mature sebocytes—to an undifferentiated tumor with an infiltrative growth pattern formed by neoplastic cells with marked nuclear pleomorphism, a high mitotic index, and a small amount of intracytoplasmic lipids. Stains such as adipophilin and perilipin have shown high sensitivity and specificity for this type of neoplasm.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Metastases most frequently affect the local lymph nodes (preauricular, parotid, submandibular, and cervical). SC can spread through distant metastasis to organs such as the lungs, liver, bone, and brain.</p><p id="par0045" class="elsevierStylePara elsevierViewall">SC can appear spontaneously or in the context of Muir-Torre syndrome. This syndrome has an autosomal dominant inheritance pattern and is associated with 1 or more sebaceous skin tumors (benign or malignant, as in the case of SC), the possible presence of keratoacanthomas, and 1 or more visceral malignancies, most frequently hereditary nonpolyposis colorectal cancer, followed by genitourinary tumors. Twenty-three percent of patients with Muir-Torre syndrome have SC, so it is important to rule out this association.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Surgery is the first-line treatment for SC. Because the eyelid is the most common site, the first-line technique is Mohs surgery,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a> which is associated with a lower tumor recurrence rate (11%) than that of conventional surgery with 5 to 6<span class="elsevierStyleHsp" style=""></span>mm safety margins (30%). Radiotherapy has been shown to be a good alternative to surgery.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The prognosis is very unfavorable, with a mortality rate of 50% in the first 5 years. Factors associated with poor prognosis include female sex, advanced age, time since onset of more than 6 months, tumor size >1<span class="elsevierStyleHsp" style=""></span>cm and, histologically, an infiltrative tumor, poor differentiation, vascular or perineural invasion, and pagetoid dissemination.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Navarro-Triviño FJ. Tumor queratósico palpebral de largo tiempo de evolución. Actas Dermosifiliogr. 2017;108:667–668.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 672 "Ancho" => 900 "Tamanyo" => 105908 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1200 "Ancho" => 1650 "Tamanyo" => 339846 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hematoxylin-eosin, original magnification x1. B, C, and D, Hematoxylin-eosin, original magnification x20.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumors of sebaceous glands" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Warren" 1 => "W.N. 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Suster" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0000000000000255" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2015" "volumen" => "37" "paginaInicial" => "809" "paginaFinal" => "821" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26485238" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sebaceous carcinoma of the eyelid treated with Mohs micrographic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.M. Spencer" 1 => "R. Nossa" 2 => "D.T. Tse" 3 => "M. Sequeira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2001.113692" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2001" "volumen" => "44" "paginaInicial" => "1004" "paginaFinal" => "1009" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11369914" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Micrographic surgery for the microscopically controlled excision of eyelid cancers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.E. Mohs" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Ophthalmol" "fecha" => "1986" "volumen" => "104" "paginaInicial" => "901" "paginaFinal" => "909" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3718316" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000007/v2_201708291348/S1578219017301919/v2_201708291348/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010800000007/v2_201708291348/S1578219017301919/v2_201708291348/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017301919?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 13 | 22 |
| 2024 October | 67 | 47 | 114 |
| 2024 September | 64 | 32 | 96 |
| 2024 August | 99 | 66 | 165 |
| 2024 July | 60 | 33 | 93 |
| 2024 June | 93 | 42 | 135 |
| 2024 May | 59 | 38 | 97 |
| 2024 April | 68 | 30 | 98 |
| 2024 March | 58 | 25 | 83 |
| 2024 February | 63 | 37 | 100 |
| 2024 January | 51 | 35 | 86 |
| 2023 December | 41 | 15 | 56 |
| 2023 November | 55 | 24 | 79 |
| 2023 October | 66 | 21 | 87 |
| 2023 September | 59 | 29 | 88 |
| 2023 August | 32 | 18 | 50 |
| 2023 July | 55 | 28 | 83 |
| 2023 June | 51 | 25 | 76 |
| 2023 May | 60 | 22 | 82 |
| 2023 April | 62 | 20 | 82 |
| 2023 March | 70 | 30 | 100 |
| 2023 February | 49 | 26 | 75 |
| 2023 January | 56 | 26 | 82 |
| 2022 December | 69 | 44 | 113 |
| 2022 November | 26 | 23 | 49 |
| 2022 October | 24 | 25 | 49 |
| 2022 September | 17 | 37 | 54 |
| 2022 August | 22 | 36 | 58 |
| 2022 July | 22 | 36 | 58 |
| 2022 June | 18 | 27 | 45 |
| 2022 May | 36 | 43 | 79 |
| 2022 April | 50 | 32 | 82 |
| 2022 March | 42 | 48 | 90 |
| 2022 February | 32 | 31 | 63 |
| 2022 January | 34 | 84 | 118 |
| 2021 December | 33 | 53 | 86 |
| 2021 November | 40 | 46 | 86 |
| 2021 October | 33 | 56 | 89 |
| 2021 September | 35 | 42 | 77 |
| 2021 August | 27 | 41 | 68 |
| 2021 July | 34 | 38 | 72 |
| 2021 June | 23 | 33 | 56 |
| 2021 May | 36 | 49 | 85 |
| 2021 April | 96 | 62 | 158 |
| 2021 March | 78 | 40 | 118 |
| 2021 February | 59 | 40 | 99 |
| 2021 January | 36 | 46 | 82 |
| 2020 December | 50 | 40 | 90 |
| 2020 November | 40 | 30 | 70 |
| 2020 October | 22 | 14 | 36 |
| 2020 September | 32 | 21 | 53 |
| 2020 August | 24 | 28 | 52 |
| 2020 July | 36 | 24 | 60 |
| 2020 June | 31 | 40 | 71 |
| 2020 May | 9 | 16 | 25 |
| 2020 April | 23 | 14 | 37 |
| 2020 March | 21 | 13 | 34 |
| 2020 February | 3 | 0 | 3 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 6 | 0 | 6 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 6 | 0 | 6 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 8 | 0 | 8 |
| 2019 April | 2 | 1 | 3 |
| 2019 February | 4 | 0 | 4 |
| 2018 December | 3 | 0 | 3 |
| 2018 November | 2 | 0 | 2 |
| 2018 September | 3 | 0 | 3 |
| 2018 February | 17 | 4 | 21 |
| 2018 January | 26 | 5 | 31 |
| 2017 December | 36 | 13 | 49 |
| 2017 November | 28 | 6 | 34 |
| 2017 October | 34 | 12 | 46 |
| 2017 September | 194 | 24 | 218 |
| 2017 August | 93 | 26 | 119 |
| 2017 July | 4 | 8 | 12 |
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