RESUMEN
The purpose of this study was to evaluate the clinical features and prognosis of eyelid sebaceous gland carcinoma (SGC) based on the T category of the American Joint Committee on Cancer (AJCC) classification (7th edition). This is a retrospective interventional case series study. Based on the T category of the AJCC classification, 191 patients with eyelid sebaceous gland carcinoma were classified as T1 (n = 1, 1 %), T2 (n = 111, 58 %), T3 (n = 76, 40 %), and T4 (n = 3, 2 %). Based on multivariate analysis, the factors predictive of regional lymph node metastasis included duration of symptoms >6 months (p = 0.04) and orbital tumor extension (p < 0.001). The factors predictive of systemic metastasis included orbital tumor extension (p < 0.001) and perivascular invasion (p = 0.007). The factor predictive of death due to systemic metastasis included orbital tumor extension (p < 0.001). Kaplan-Meier estimates of regional lymph node metastasis at 5 and 10 years, respectively, were 0 and 0 % for T1, 11 and 11 % for T2, 44 and 59 % for T3, and 100 and 100 % for T4 (p < 0.001). Kaplan-Meier estimates of systemic metastasis at 5 and 10 years, respectively, were 0 and 0 % for T1, 6 and 6 % for T2, 35 and 35 % for T3, and 100 and 100 % for T4 (p < 0.001). Kaplan-Meier estimates of death due to metastasis at 5 and 10 years, respectively, were 0 and 0 % for T1, 3 and 3 % for T2, 30 and 50 % for T3, and 100 and 100 % for T4 (p < 0.001). Primary tumor (T) category of the AJCC classification predicts the prognosis of patients with eyelid SGC. The risk of systemic metastasis and death increases with increasing tumor category.
Asunto(s)
Adenocarcinoma Sebáceo/diagnóstico , Neoplasias de los Párpados/diagnóstico , Neoplasias de las Glándulas Sebáceas/diagnóstico , Adenocarcinoma Sebáceo/clasificación , Adenocarcinoma Sebáceo/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de los Párpados/clasificación , Neoplasias de los Párpados/mortalidad , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Neoplasias de las Glándulas Sebáceas/clasificación , Neoplasias de las Glándulas Sebáceas/mortalidad , Tasa de Supervivencia , Adulto JovenRESUMEN
PURPOSE: To investigate whether the clinical and pathologic T category classification, as defined by the American Joint Committee on Cancer (AJCC), is associated with lymph nodes (LN) or distant metastasis in patients with eyelid sebaceous carcinoma. METHODS: Forty patients treated for eyelid sebaceous carcinoma at Seoul National University Hospital between March 1999 and December 2011 were retrospectively staged according to the AJCC 7th edition criteria. Three different primary tumor classifications-(1) clinical tumor size at presentation; (2) clinical AJCC T stage (cT) at presentation based not only on size, but also on the extent of involvement and (3) pathologic AJCC T stage (pT) based on histopathological examination-were compared and evaluated with regard to their association with LN or distant metastasis. RESULTS: In univariate analysis, the AJCC cT (p = 0.005) and pT (p = 0.029) categories were significantly associated with metastasis, but clinical tumor size alone did not correlate with metastasis (p = 0.093). Clinical and pathologic AJCC stage T2b or higher tumors were significantly associated with metastasis compared to stage T1 or T2a tumors [odds ratio cT, 8.00 (p = 0.025); pT, 6.91 (p = 0.028)]. CONCLUSIONS: The clinical and pathologic AJCC T category has predictive value for LN or distant metastasis in eyelid sebaceous carcinoma. However, the clinically assessed largest tumor dimension alone is not an effective predictive factor. Clinicians should be aware of the increased risk of metastasis in patients with tumors of stage T2b or higher at initial presentation.
Asunto(s)
Adenocarcinoma Sebáceo/patología , Neoplasias de los Párpados/patología , Neoplasias de las Glándulas Sebáceas/patología , Adenocarcinoma Sebáceo/clasificación , Adenocarcinoma Sebáceo/secundario , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de los Párpados/clasificación , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Oncología Médica/organización & administración , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , República de Corea , Estudios Retrospectivos , Neoplasias de las Glándulas Sebáceas/clasificación , Biopsia del Ganglio Linfático Centinela , Estados UnidosRESUMEN
AIMS: Separation of sebaceous adenoma, sebaceoma and well differentiated sebaceous carcinoma is a clinically important distinction which relies on a number of subjective criteria. In routine practice we had noted significant interobserver variability in the classification of these lesions. This study sought to determine the degree of interobserver variability between general surgical pathologists and dermatopathologists in the diagnosis of well differentiated cutaneous sebaceous neoplasms. METHODS: We circulated 61 examples of well circumscribed cutaneous sebaceous neoplasms to nine pathologists, including dermatopathologists and general surgical pathologists who were asked to submit a diagnosis for each case. Fleiss' kappa statistic was used for assessment of interobserver agreement. RESULTS: We found that only seven cases (11%) had consensus agreement across all nine pathologists. Many cases had multiple diagnoses suggested, with three or more submitted diagnoses in 26 cases (43%), while 38 cases (62%) were diagnosed as sebaceous carcinoma by at least one pathologist. There was marked variability amongst the individual pathologists in the proportion of cases diagnosed as carcinoma, ranging from 5% to 57% of cases. Fleiss' kappa statistic for all pathologists across all diagnostic categories was 0.44, amounting to only fair to moderate agreement. CONCLUSIONS: These data indicate that there is substantial interobserver variability in the diagnosis of well circumscribed sebaceous neoplasms. This was seen in both the separation of benign and malignant lesions, as well as in the classification of the benign entities. This interobserver variability is likely to have significant clinical implications in terms of potential for over- or under-treatment, as well as in selection of cases for mismatch repair protein evaluation.
Asunto(s)
Adenocarcinoma Sebáceo/diagnóstico , Neoplasias Cutáneas/diagnóstico , Adenocarcinoma Sebáceo/clasificación , Anciano , Anciano de 80 o más Años , Dermatología/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Patología/normas , Neoplasias Cutáneas/clasificaciónRESUMEN
PURPOSE: To determine whether T category of the American Joint Committee on Cancer (AJCC) TNM staging system for eyelid carcinoma, 7th edition, correlates with lymph node metastasis, distant metastasis, and survival in patients with sebaceous carcinoma of the eyelid. DESIGN: Retrospective, cohort study. PARTICIPANTS: Fifty consecutive patients treated by 1 author (BE) for eyelid sebaceous carcinoma between May 1999 and August 2010. METHODS: Each tumor was staged according to the AJCC 7th edition TNM criteria. The Kaplan-Meier method was used to determine associations between disease-specific survival and (1) T category at presentation, (2) lymph node metastasis, and (3) distant metastasis. MAIN OUTCOME MEASURES: T category at presentation, nodal metastasis, survival. RESULTS: The study included 37 women and 13 men (median age, 68.5 years; range, 44-86 years). Forty-four patients were white, 5 were Hispanic, and 1 was Asian. TNM designations were TXN0M0, 7 patients; T1N0M0, 4 patients; T2aN0M0, 12 patients; T2bN0M0, 11 patients; T2bN1M0, 2 patients; T2bN1M1, 1 patient; T3aN0M0, 2 patients; T3aN1M0, 5 patients; T3bN0M0, 1 patient; T3bN1M0, 1 patient; T3bN0M1, 2 patients; T4N0M0, 1 patient; and T4N0M1, 1 patient. T category at presentation was significantly associated with lymph node metastasis (P = 0.0079). No tumors with T category better than T2b or smaller than 9 mm in greatest dimension were associated with nodal metastasis. Five patients (10%) died of disease during follow-up. Their TNM designations were T2bN1M1, 1 patient; T3bN0M1, 2 patients; T4N0M0, 1 patient; and T4N0M1, 1 patient. No tumors smaller than 12 mm in greatest dimension were associated with distant metastasis or death. T category was significantly associated with disease-specific survival (P = 0.0009). Disease-specific survival was poorer among patients with T category of T3a or worse (P = 0.035). CONCLUSIONS: T category in the 7th edition of the AJCC TNM staging system for eyelid carcinoma correlates with outcomes in patients with sebaceous carcinoma of eyelid. On the basis of the present findings, it seems reasonable to recommend sentinel lymph node biopsy or at least strict regional lymph node surveillance for patients with eyelid sebaceous carcinoma with tumors of T category T2b or worse or 10 mm or more in greatest dimension.
Asunto(s)
Adenocarcinoma Sebáceo/secundario , Neoplasias de los Párpados/patología , Neoplasias de las Glándulas Sebáceas/patología , Adenocarcinoma Sebáceo/clasificación , Adenocarcinoma Sebáceo/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de los Párpados/clasificación , Neoplasias de los Párpados/mortalidad , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Oncología Médica/organización & administración , Oncología Médica/normas , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Neoplasias de las Glándulas Sebáceas/clasificación , Neoplasias de las Glándulas Sebáceas/mortalidad , Biopsia del Ganglio Linfático Centinela , Tasa de Supervivencia , Estados UnidosRESUMEN
El leiomiosarcoma cutáneo primario es una neoplasia maligna originada de músculo liso, es infrecuente y de forma esporádica se ha encontrado asociado a trauma o exposición a radiación. Por factores pronósticos se subdividen en dérmicos y subcutáneos, el tipo dérmico tiende a crecer lentamente y tiene un mejor pronóstico que el tipo subcutáneo. Se presenta el caso de un paciente masculino de 87 años de edad con antecedente de quemadura con agua caliente en el 1/3 distal de pierna izquierda hace 20 años. Sobre la misma se desarrolló tumor de 3 años de evolución, con ulceración en los últimos meses, no dolorosa. Por sospecha clínica de carcinoma de células escamosas se realizó biopsia en la que se observó tumor dérmico con extensión a tejido celular subcutáneo que correspondióa leiomiosarcoma cutáneo, el cual se confirmó con estudio de inmunohistoquímica...
Asunto(s)
Masculino , Anciano de 80 o más Años , Leiomiosarcoma/diagnóstico , Neoplasias Cutáneas/complicaciones , Sarcoma de Parte Blanda Alveolar/complicaciones , Adenocarcinoma Sebáceo/clasificación , Músculo Liso Vascular , SarcomaRESUMEN
El leiomiosarcoma cutáneo primario es una neoplasia maligna originada de músculo liso, es infrecuente y de forma esporádica se ha encontrado asociado a trauma o exposición a radiación. Por factores pronósticos se subdividen en dérmicos y subcutáneos, el tipo dérmico tiende a crecer lentamente y tiene un mejor pronóstico que el tipo subcutáneo. Se presenta el caso de un paciente masculino de 87 años de edad con antecedente de quemadura con agua caliente en el 1/3 distal de pierna izquierda hace 20 años. Sobre la misma se desarrolló tumor de 3 años de evolución, con ulceración en los últimos meses, no dolorosa. Por sospecha clínica de carcinoma de células escamosas se realizó biopsia en la que se observó tumor dérmico con extensión a tejido celular subcutáneo que correspondióa leiomiosarcoma cutáneo, el cual se confirmó con estudio de inmunohistoquímica...(AU)
Asunto(s)
Masculino , Anciano de 80 o más Años , Leiomiosarcoma/diagnóstico , Sarcoma de Parte Blanda Alveolar/complicaciones , Neoplasias Cutáneas/complicaciones , Sarcoma , Adenocarcinoma Sebáceo/clasificación , Músculo Liso VascularRESUMEN
Sebaceous carcinoma is a rare, aggressive, malignant tumor derived from the adnexal epithelium of sebaceous glands. It may arise in ocular or extraocular sites and exhibits such a variety of histologic growth patterns and diverse clinical presentations that the diagnosis is often delayed for months to years. We discuss incidence as well as clinical, histologic, diagnostic, prognostic, and management issues of this aggressive neoplasm.