Sebaceous adenoma in the region of the medial canthus causing proptosis.AK Bhattacharya, SR Nayak, MV Kirtane, MV Ingle
Dept of Otolaryngology and Head and Neck Surgery, Seth GS Medical College, Parel, Mumbai.
Correspondence Address: Source of Support: None, Conflict of Interest: None PMID: 0010707724
Source of Support: None, Conflict of Interest: None
A case of sebaceous adenoma in the region of the medial canthus causing proptosis is presented along with a review of the medical literature. The clinicopathological aspects of the tumour are discussed. The mode of treatment was surgical excision. A six month follow-up showed a reduction in the proptosis with no recurrence.
Keywords: Adenoma, Sweat Gland, complications,diagnosis,surgery,Adult, Blepharoplasty, methods,Case Report, Exophthalmos, etiology,Eyelid Neoplasms, complications,diagnosis,surgery,Follow-Up Studies, Human, Male, Tomography, X-Ray Computed, Treatment Outcome,
Sebaceous adenoma, a rare, organoid tumour consists of circumscribed proliferation of incompletely differentiated glandular structures. Many tumours described in literature as sebaceous adenoma are in reality sebaceous naevi. The term ‘Sebaceous adenoma’ was first used by Baizer and Menetier in 1885.
The solitary sebaceous adenoma occurs as a smooth elevated, often slightly pedunculated tumour. In most of the reported cases, the lesion was solitary, was located in the face or scalp and measured less than one centimeter in diameter. None of the reported cases had proptosis although recurrence was common.
P T, a 23 year old male presented with a swelling in the region above the right medial can thus and proptosis of the right orbit. The swelling noticed three years before had been slowly increasing in size with a corresponding increase in the right orbital proptosis. An attempt at surgical excision had been made two years earlier at another hospital, The Histo-pathological diagnosis then was that of a dermoid cyst. The swelling however recurred soon after surgery and grew to its present size. The patient was blind in the right eye since birth.
Examination revealed a non-pulsatile swelling 1.5 cm x 2.5 cm in size over the right medial can thus which displaced the orbit laterally and downwards. The swelling was firm in consistency, free from skin. There was no evidence of bone erosion. The superomedial margin could not be palpated as it dipped beneath the orbital wall. Ophthalmological examination revealed aphakia and no perception of light in the right eye. Vision was normal in the left eye.
Computerised axial tomography revealed a mass showing the density of fat, located superomedially in the right orbit. The medial wall of the orbit was thinned and bulged inwards being displaced by the swelling. The medial rectus muscle was involved. The scan findings were consistent with a benign soft tissue tumour. [Figure - 1]
The swelling was approached by a Lynch incision. The medial palpebral ligament was cut. The tumour was reached after excising the adhesions and fibrotic tissue around it. It was dissected free from the medial rectus muscle. Grossly the tumour appeared to be a thick walled cyst 2.5 cm x 1.5 cm in size with a smooth mass occupying its superior and lateral wall. The mass was removed and sent for Histo-pathological examination.
The section showed multiple sebaceous glands, which were markedly hyper-plastic. The ducts were dilated. There was minimal inflammation and no adenocarcinomatous changes were seen. The findings were consistent with a sebaceous adenoma [Figure - 2]
Epidermal appendage tumours can be divided into tour categories, depending on differentiation towards sebaceous, hair, apocrine or eccrine glands. Tumours within these groups can be further subdivided on the basis of their degree of differentiation into hamartomas and hyperplasias, adenoma. epitheliomas and carcinomas.
Sebaceous adenoma a rare tumour of the dermal appendages is commonly seen in the scalp or face. Recently the association of multiple sebaceous neoplasms of the skin with visceral carcinomas especially of the colon has been described.
Microscopically this lobular tumour is composed of two cell types. The first is represented by masses of uniform, mature sebaceous elements similar in appearance to those seen in sebaceous hyperplasia. The second consists of layers of peripherally placed, uniform basaloid cells, which represent undifferentiated germinative elements. The distribution varies and in a given lobule the two cellular elements may not be present in equal proportions.
Previous recurrence of this tumour has been perhaps due to inadequate removal. Moreover the previous histopathology report as a dermoid suggests that the sebaceous adenoma arose from the wall of the dermoid cyst. The ideal treatment is complete surgical removal.
The sebaceous lesions of the skin are largely sebaceous adenoma but some have the histopathological appearance of a sebaceous epithelioma or a sebaceous carcinoma. Even the tumours classified as sebaceous on the basis of cellular atypicality do not metastasise.
[Figure - 1], [Figure - 2]