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E-IJD® - CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 2  |  Page : 209
Sebaceoma in a patient with a history of kidney transplantation


From the Department of Dermatology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Date of Web Publication13-Jul-2022

Correspondence Address:
Nader Pazyar
From the Department of Dermatology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_760_21

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How to cite this article:
Yaghoobi R, Pazyar N. Sebaceoma in a patient with a history of kidney transplantation. Indian J Dermatol 2022;67:209

How to cite this URL:
Yaghoobi R, Pazyar N. Sebaceoma in a patient with a history of kidney transplantation. Indian J Dermatol [serial online] 2022 [cited 2022 Aug 9];67:209. Available from: https://www.e-ijd.org/text.asp?2022/67/2/209/350846




Sir,

Immunosuppressed individuals are susceptible to various skin cancers, but a causal relationship between immunosuppression and sebaceous tumors has not yet been described. Available data suggest that immunosuppression can be an underlying risk factor of developing sebaceous neoplasms.[1]

A 48-year-old man presented to evaluate a mass on the midline of his chest that appeared after 4 years of kidney transplantation. After transplantation, he took some medication, including prednisolone, mycophenolate mofetil, tacrolimus, and mycophenolic acid.

Physical examination showed a circumscribed, exophytic, firm, and yellowish mass measuring 3 cm × 3 cm × 0.5 cm on the middle of his chest [Figure 1]. The surface of the mass was papilliferous. No lymphadenopathy was detected in the neck and armpits. A biopsy was taken from the lesion. The histology report revealed irregular cell masses composed of more than half of the cells of basaloid type, with some aggregates of sebaceous and transitional cells. The surrounding stroma was hemorrhagic with scattered inflammatory cells [Figure 2] and [Figure 3]. The histopathologic study was compatible with sebaceous epithelioma. Immunohistochemical (IHC) analysis was positive for cytokeratin (CK) with a diffuse pattern and positive for epithelial membrane antigen (EMA) with a patchy shape. These findings were consistent with the staining of sebaceous glands [Figure 4] and [Figure 5]. The staining for epithelial antigen (Ber-EP4) was negative [Figure 6]. The Ki-67 index was positive (30%–35%) [Figure 7]. Based on the histopathology study and IHC analysis, we diagnosed the chest mass of the patient as a sebaceoma.
Figure 1: A yellowish exophytic mass on the midline of the chest

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Figure 2: Low-power magnification shows multiple lobules of the sebaceous architecture (Hematoxylin- Eosin magnification ×40)

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Figure 3: Multiple nests of basaloid cells less than 50% mature sebocytes (Hematoxylin- Eosin magnification ×100)

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Figure 4: Immunohistochemical staining with cytokeratin (CK) is positive with a diffuse pattern ×100

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Figure 5: Immunohistochemical staining with epithelial membrane antigen (EMA) is positive with a patchy pattern ×100

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Figure 6: Immunohistochemical staining with Ber-EP4 is negative ×100

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Figure 7: Immunohistochemical staining with Ki-67 is positive in 30%–35% of epithelial cells ×100

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The patient was referred to the surgery department for the treatment of chest mass in 2020. No recurrent occurred after a 1-year follow-up.

Sebaceoma is a rare benign sebaceous neoplasm that has been named sebatrixoma or sebaceous epithelioma.[2] The term “epithelioma” suggests the risk of malignancy. Sebaceous carcinoma arising from sebaceoma has been reported, and differentiation of sebaceoma from the basal cell carcinoma (BCC) is necessary.[2],[3] Sebaceoma is an adnexal epithelioma with differentiation of sebaceous glands.[3] Clinically, sebaceoma appears as rounded, elevated, and yellowish papulonodules. The tumor size is typically approximately 1 cm, but larger lesions have been reported.[3]

Histologically, sebaceoma is a dermal tumor with a connection or no connection to the epidermis. The histologic appearance of the tumor is benign and includes multiple nests of basaloid cells with less than 50% mature sebocytes. The absence of peripheral palisading and clefts between the nests and the stroma distinguish it from BCC with sebaceous differentiation.[2] The main difference between sebaceoma and sebaceous adenoma is that the sebaceoma randomly scatters sebaceous cells without nuclear atypia, but sebaceous adenoma shows more highly organized, irregularly shaped lobules of sebaceous cells with an outer rim of more than a single layer of small germinal cells.[3] The IHC of our patient showed that CK was diffusely positive in epithelial cells, and EMA was positive with a patchy pattern. These positive staining highlighted the differentiated sebaceous cells. The IHC also revealed negative Ber-EP4. Ki-67 showed a proliferation index of 30%–35% in the basaloid cells. The results of negative Ber-EP4 and positive EMA are a reliable means for differentiation of sebaceoma (EMA+/Ber-EP4-) from BCC (Ber-EP4+/EMA-).[4]

The patient was referred to the surgery department for complete excision and prophylaxis of arising sebaceous carcinoma from the sebaceoma in the future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Reinhart J, James WD. Sebaceous adenoma in the setting of immunosuppression for kidney transplantation. J Am Acad Dermatol 2019;5:818-20.  Back to cited text no. 1
    
2.
Poggi BC, Fernandes Melo D, Marques da Costa J, Auxiliadora Jeunon Sousa M. Sebaceoma on the scalp simulating a malignant pigmented neoplasia. An Bras Dermatol 2019;94:590-3.  Back to cited text no. 2
    
3.
Lee DW, Kwak SH, Kim JH, Byeon JY, LeeHJ, Choi HJ. Sebaceous carcinoma arising from sebaceoma. Arch Craniofac Surg 2021;22:126-30.  Back to cited text no. 3
    
4.
Takahashi M, Arima M, Iwata Y, Suzuki K, Mizoguchi Y, Kuroda M, et al. A patient with giant rippled-pattern sebaceoma in the occipital Region. Case Rep Dermatol 2016;8;107-11.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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