Case for Diagnosis
Slow-Growing Keratotic Tumor on the Eyelid
Tumor queratósico palpebral de largo tiempo de evolución
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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. 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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" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 13 | 21 |
| 2024 Octubre | 67 | 47 | 114 |
| 2024 Septiembre | 64 | 32 | 96 |
| 2024 Agosto | 99 | 66 | 165 |
| 2024 Julio | 60 | 33 | 93 |
| 2024 Junio | 93 | 42 | 135 |
| 2024 Mayo | 59 | 38 | 97 |
| 2024 Abril | 68 | 30 | 98 |
| 2024 Marzo | 58 | 25 | 83 |
| 2024 Febrero | 63 | 37 | 100 |
| 2024 Enero | 51 | 35 | 86 |
| 2023 Diciembre | 41 | 15 | 56 |
| 2023 Noviembre | 55 | 24 | 79 |
| 2023 Octubre | 66 | 21 | 87 |
| 2023 Septiembre | 59 | 29 | 88 |
| 2023 Agosto | 32 | 18 | 50 |
| 2023 Julio | 55 | 28 | 83 |
| 2023 Junio | 51 | 25 | 76 |
| 2023 Mayo | 60 | 22 | 82 |
| 2023 Abril | 62 | 20 | 82 |
| 2023 Marzo | 70 | 30 | 100 |
| 2023 Febrero | 49 | 26 | 75 |
| 2023 Enero | 56 | 26 | 82 |
| 2022 Diciembre | 69 | 44 | 113 |
| 2022 Noviembre | 26 | 23 | 49 |
| 2022 Octubre | 24 | 25 | 49 |
| 2022 Septiembre | 17 | 37 | 54 |
| 2022 Agosto | 22 | 36 | 58 |
| 2022 Julio | 22 | 36 | 58 |
| 2022 Junio | 18 | 27 | 45 |
| 2022 Mayo | 36 | 43 | 79 |
| 2022 Abril | 50 | 32 | 82 |
| 2022 Marzo | 42 | 48 | 90 |
| 2022 Febrero | 32 | 31 | 63 |
| 2022 Enero | 34 | 84 | 118 |
| 2021 Diciembre | 33 | 53 | 86 |
| 2021 Noviembre | 40 | 46 | 86 |
| 2021 Octubre | 33 | 56 | 89 |
| 2021 Septiembre | 35 | 42 | 77 |
| 2021 Agosto | 27 | 41 | 68 |
| 2021 Julio | 34 | 38 | 72 |
| 2021 Junio | 23 | 33 | 56 |
| 2021 Mayo | 36 | 49 | 85 |
| 2021 Abril | 96 | 62 | 158 |
| 2021 Marzo | 78 | 40 | 118 |
| 2021 Febrero | 59 | 40 | 99 |
| 2021 Enero | 36 | 46 | 82 |
| 2020 Diciembre | 50 | 40 | 90 |
| 2020 Noviembre | 40 | 30 | 70 |
| 2020 Octubre | 22 | 14 | 36 |
| 2020 Septiembre | 32 | 21 | 53 |
| 2020 Agosto | 24 | 28 | 52 |
| 2020 Julio | 36 | 24 | 60 |
| 2020 Junio | 31 | 40 | 71 |
| 2020 Mayo | 9 | 16 | 25 |
| 2020 Abril | 23 | 14 | 37 |
| 2020 Marzo | 21 | 13 | 34 |
| 2020 Febrero | 3 | 0 | 3 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 6 | 0 | 6 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 6 | 0 | 6 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 8 | 0 | 8 |
| 2019 Abril | 2 | 1 | 3 |
| 2019 Febrero | 4 | 0 | 4 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Febrero | 17 | 4 | 21 |
| 2018 Enero | 26 | 5 | 31 |
| 2017 Diciembre | 36 | 13 | 49 |
| 2017 Noviembre | 28 | 6 | 34 |
| 2017 Octubre | 34 | 12 | 46 |
| 2017 Septiembre | 194 | 24 | 218 |
| 2017 Agosto | 93 | 26 | 119 |
| 2017 Julio | 4 | 8 | 12 |
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