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Case 07

View the images and select the correct diagnosis from the list below.

Spine-tingling mystery . . .

An FNA was obtained under image guidance from a lytic region in the anterior aspect of the L2 vertebral body from a 53-year-old woman. She had a previous lacrimal gland mass:

 

 

 

 

 

Select the correct diagnosis:

You answered: Malignant melanoma
Sorry, that is INCORRECT

The correct diagnosis is: Metastatic sebaceous carcinoma with squamous differentiation

CYTOPATHOLOGY:

  • The aspirates are cellular containing predominantly dispersed, atypical polygonal cells with a mixture of finely vacuolated and dense (squamoid) blue cytoplasm.
  • The nuclei are centrally located, moderately atypical with occasional prominent nucleoli.
  • The findings are consistent with metastatic carcinoma of mixed squamous and sebaceous type.

DISCUSSION:

  • Histologic appearances of sebaceous carcinomas can be diverse.
  • This biopsy reveals a sebaceous tumour with infiltrating clusters, cords and single malignant cells with foamy, finely vacuolated cytoplasm and prominent nucleoli. There are numerous poorly-differentiated areas with monotonous sheets of cells with clear cytoplasm. Areas of squamous differentiation are also seen.
  • Sebaceous carcinoma most often arises in the eyelid, presenting as a painless, enlarging mass. The median age of the patients with this tumour is 64 years and there is a higher incidence in females.
  • These are rare but highly malignant neoplasms with frequent regional and distant metastasis.
  • Clinically, these tumours are often mistaken for basal cell carcinomas. On cytology, basal cell carcinomas typically have more tightly cohesive clusters of uniform, hyperchromatic basaloid cells without cytoplasmic vacuolization.
  • Sebaceous cells resemble mucinous cells of a mucoepidermoid carcinoma and in the presence of intermediate-type, or epidermoid cells, distinction between these two carcinomas can be difficult.
  • Oil-red-O stain for intracytoplasmic lipid can be a helpful marker of sebaceous differentiation.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Malhotra P, Arora VK, Singh N, Bhatia A. Metastatic Extraocular Sebaceous Carcinoma With an Occult Primary. Diagn Cytopathol. 2004 Nov;31(5):326-9.





Stern RC, Liu K, Dodd LG. Cytomorphologic features of sebaceous carcinoma on fine needle aspiration. Acta Cytol 2000;44:760-764.

You answered: Metastatic sebaceous carcinoma with squamous differentiation
That is CORRECT!!

CYTOPATHOLOGY:

  • The aspirates are cellular containing predominantly dispersed, atypical polygonal cells with a mixture of finely vacuolated and dense (squamoid) blue cytoplasm.
  • The nuclei are centrally located, moderately atypical with occasional prominent nucleoli.
  • The findings are consistent with metastatic carcinoma of mixed squamous and sebaceous type.

DISCUSSION:

  • Histologic appearances of sebaceous carcinomas can be diverse.
  • This biopsy reveals a sebaceous tumour with infiltrating clusters, cords and single malignant cells with foamy, finely vacuolated cytoplasm and prominent nucleoli. There are numerous poorly-differentiated areas with monotonous sheets of cells with clear cytoplasm. Areas of squamous differentiation are also seen.
  • Sebaceous carcinoma most often arises in the eyelid, presenting as a painless, enlarging mass. The median age of the patients with this tumour is 64 years and there is a higher incidence in females.
  • These are rare but highly malignant neoplasms with frequent regional and distant metastasis.
  • Clinically, these tumours are often mistaken for basal cell carcinomas. On cytology, basal cell carcinomas typically have more tightly cohesive clusters of uniform, hyperchromatic basaloid cells without cytoplasmic vacuolization.
  • Sebaceous cells resemble mucinous cells of a mucoepidermoid carcinoma and in the presence of intermediate-type, or epidermoid cells, distinction between these two carcinomas can be difficult.
  • Oil-red-O stain for intracytoplasmic lipid can be a helpful marker of sebaceous differentiation.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Malhotra P, Arora VK, Singh N, Bhatia A. Metastatic Extraocular Sebaceous Carcinoma With an Occult Primary. Diagn Cytopathol. 2004 Nov;31(5):326-9.





Stern RC, Liu K, Dodd LG. Cytomorphologic features of sebaceous carcinoma on fine needle aspiration. Acta Cytol 2000;44:760-764.

You answered: Metastatic mucoepidermoid carcinoma
Sorry, that is INCORRECT

The correct diagnosis is: Metastatic sebaceous carcinoma with squamous differentiation

CYTOPATHOLOGY:

  • The aspirates are cellular containing predominantly dispersed, atypical polygonal cells with a mixture of finely vacuolated and dense (squamoid) blue cytoplasm.
  • The nuclei are centrally located, moderately atypical with occasional prominent nucleoli.
  • The findings are consistent with metastatic carcinoma of mixed squamous and sebaceous type.

DISCUSSION:

  • Histologic appearances of sebaceous carcinomas can be diverse.
  • This biopsy reveals a sebaceous tumour with infiltrating clusters, cords and single malignant cells with foamy, finely vacuolated cytoplasm and prominent nucleoli. There are numerous poorly-differentiated areas with monotonous sheets of cells with clear cytoplasm. Areas of squamous differentiation are also seen.
  • Sebaceous carcinoma most often arises in the eyelid, presenting as a painless, enlarging mass. The median age of the patients with this tumour is 64 years and there is a higher incidence in females.
  • These are rare but highly malignant neoplasms with frequent regional and distant metastasis.
  • Clinically, these tumours are often mistaken for basal cell carcinomas. On cytology, basal cell carcinomas typically have more tightly cohesive clusters of uniform, hyperchromatic basaloid cells without cytoplasmic vacuolization.
  • Sebaceous cells resemble mucinous cells of a mucoepidermoid carcinoma and in the presence of intermediate-type, or epidermoid cells, distinction between these two carcinomas can be difficult.
  • Oil-red-O stain for intracytoplasmic lipid can be a helpful marker of sebaceous differentiation.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Malhotra P, Arora VK, Singh N, Bhatia A. Metastatic Extraocular Sebaceous Carcinoma With an Occult Primary. Diagn Cytopathol. 2004 Nov;31(5):326-9.





Stern RC, Liu K, Dodd LG. Cytomorphologic features of sebaceous carcinoma on fine needle aspiration. Acta Cytol 2000;44:760-764.

You answered: Metastatic renal cell carcinoma
Sorry, that is INCORRECT

The correct diagnosis is: Metastatic sebaceous carcinoma with squamous differentiation

CYTOPATHOLOGY:

  • The aspirates are cellular containing predominantly dispersed, atypical polygonal cells with a mixture of finely vacuolated and dense (squamoid) blue cytoplasm.
  • The nuclei are centrally located, moderately atypical with occasional prominent nucleoli.
  • The findings are consistent with metastatic carcinoma of mixed squamous and sebaceous type.

DISCUSSION:

  • Histologic appearances of sebaceous carcinomas can be diverse.
  • This biopsy reveals a sebaceous tumour with infiltrating clusters, cords and single malignant cells with foamy, finely vacuolated cytoplasm and prominent nucleoli. There are numerous poorly-differentiated areas with monotonous sheets of cells with clear cytoplasm. Areas of squamous differentiation are also seen.
  • Sebaceous carcinoma most often arises in the eyelid, presenting as a painless, enlarging mass. The median age of the patients with this tumour is 64 years and there is a higher incidence in females.
  • These are rare but highly malignant neoplasms with frequent regional and distant metastasis.
  • Clinically, these tumours are often mistaken for basal cell carcinomas. On cytology, basal cell carcinomas typically have more tightly cohesive clusters of uniform, hyperchromatic basaloid cells without cytoplasmic vacuolization.
  • Sebaceous cells resemble mucinous cells of a mucoepidermoid carcinoma and in the presence of intermediate-type, or epidermoid cells, distinction between these two carcinomas can be difficult.
  • Oil-red-O stain for intracytoplasmic lipid can be a helpful marker of sebaceous differentiation.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Malhotra P, Arora VK, Singh N, Bhatia A. Metastatic Extraocular Sebaceous Carcinoma With an Occult Primary. Diagn Cytopathol. 2004 Nov;31(5):326-9.





Stern RC, Liu K, Dodd LG. Cytomorphologic features of sebaceous carcinoma on fine needle aspiration. Acta Cytol 2000;44:760-764.

From the Cytopathology files of BC Cancer
Submitted by: Brenda Smith, BSc and Tom Thomson, MD

SOURCE: Case 07 ( )
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