PMC3161692_01
Original leasion.
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One year later he presented with a friable nodule measuring 1 cm x 0.75 cm in the scaphoid fossa of the right ear and incisional biopsy showed histological features of sebaceoma (Figs. 1, 2).
(A, B). A) Low power, B) High power Slide showed masses of basaloid cells. Some of the masses are attached to the undersurface of the epithelium. These masses show sebaceous differentiation. The lobules of sebaceous glands show Irregular growth pattern. Germinative epitheloid cells predominate and haphazardly arranged. There are multiple keratinous microcysts and few mitotic figures.
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One year later he presented with a friable nodule measuring 1 cm x 0.75 cm in the scaphoid fossa of the right ear and incisional biopsy showed histological features of sebaceoma (Figs. 1, 2).
Recurrence of lesion after Moh's surgery.
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Incisional biopsy was consistent with sebaceous carcinoma (Figs. 3, 4).
(A, B). A) Low power, B) High power The biopsy specimen showed marked proliferation of irregular sebaceous lobules of different sizes and shapes in the dermis. The cells of the lobules are mostly undifferentiated and demonstrated marked cylologic atypia with considerable nuclear pleomorphism and few mitotic activities. Some of the sebaceous lobules showed areas composed of atypical keratinizing cells. The overlying epidermis is normal with marked dermal fibrosis. Immunoperoxidase staining showed positive reaction for cytokeratin (CK), focal positive for epithelial membrane antigen (EMA) and negative reaction for carcino-embryonic antigen (CEA).
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Incisional biopsy was consistent with sebaceous carcinoma (Figs. 3, 4).
MRI study showed a 3.25 x 2.25 x 4.5 cm mass extending to the Masseter muscle and petrous bone medially, the cartilaginous part of the external auditory meatus posteriorly and the upper border of the right parotid gland inferiorly.
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One prominent ipsilateral lower cervical lymph node was felt, but fine needle examination showed no malignant metastasis (Fig. 5).
(A, B). A) Large defect created after wide local excision, B) reconstructed by a cervico-fascial flap extending down to the supra-clavicular area.
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Local cervicofascial rotational flap area (Fig. 6) was used to reconstruct the resulted defect.