Objective: The diagnosis of metastasis to the lymph node, especially with an inconspicuous primary lesion, poses a challenge to clinicians as well as to pathologists. We report the cytologic findings of sebaceous gland carcinoma (SGC) of the eyelid metastatic to the lymph node with confirmation by oil red O stain whenever required. Study Design: We reviewed cases and slides with cytologic diagnosis of metastatic SGC in lymph nodes. Results: Fifteen patients presented with metastasis to the preauricular (n = 15), submandibular (n = 6) and anterior cervical nodes (n = 3). The mean age was 56.4 years and the male:female ratio was 2:3. The upper lid was involved in 53.3% of cases. Fine needle aspiration cytology performed on the lymph nodes showed large polygonal cells with abundant vacuolated cytoplasm, numerous histiocytes and fat globules in the background. Oil red O staining was performed on air-dried smears in 7/15 cases and showed bright orange positivity in intracytoplasmic vacuoles and extracytoplasmic globules, confirming metastasis from SGC. Tissue was obtained from eyelid lesions for histopathologic diagnosis in 12 out of 15 cases. Out of 12 patients, 7 showed pagetoid spread at the primary site, with the tumor showing moderate differentiation in 6 cases. Conclusion: Cytologic diagnosis of metastatic SGC is straightforward in most cases; however, use of oil red O stain supports the diagnosis, especially in cases with a silent primary tumor site.

Keywords:
Fine needle aspiration cytology, Cytology, Sebaceous gland carcinoma, Oil red O stain
1.
Rosner M: Sebaceous gland carcinoma; in Singh AD, Damato BE, Pe’ee J, Murphree AL, Perry JD (eds): Clinical Ophthalmic Oncology. China, Saunders Elsevier, 2007, pp 85–89.
2.
Kass LG, Hornblass A: Sebaceous carcinoma of the ocular adnexa. Surv Ophthalmol 1989;33:477–490.
3.
Jakobiac FA, To K: Sebaceous tumors of the ocular adnexa; in Albert DM, Jakobiac FA (eds): Principles and Practice of Ophthalmology, ed 2. Philadelphia, Saunders, 2000, pp 3382–3405.
4.
Shields JA, Demirci H, Marr BP, Eagle RC Jr, Shields CL: Sebaceous carcinoma of the ocular region: a review. Surv Ophthalmol 2005;50:103–122.
5.
Shields JA, Shields CL: Sebaceous adenocarcinoma of the eyelid. Int Ophthalmol Clin 2009;49:45–61.
6.
Rao NA, McLean IW, Zimmerman LE: Sebaceous cell carcinoma of eyelids and caruncle: correlation of clinicopathological features with prognosis; in Jakobiec FA (ed): Ocular and Adnexal Tumors. Birmingham, Aesculapius Publishing, 1978, pp 461–476.
7.
Malhotra P, Arora VK, Singh N, Bhatia A: Metastatic extraocular sebaceous carcinoma with an occult primary. Diagn Cytopathol 2004;31:326–329.
8.
Jain P, Nanda A, Handa U, Bal A, Mohan H, Gupta SK: FNA diagnosis of recurrent sebaceous carcinoma. Diagn Cytopathol 2006;34:124–126.
9.
Shields JA, Demirci H, Marr BP, Eagle RC, Shields CL: Sebaceous carcinoma of the eyelids. Ophthalmology 2004;111:2151–2157.
10.
Song A, Carter K, Syed NA, Song J, Nerad JA: Sebaceous cell carcinoma of the ocular adnexa: clinical presentations, histopathology, and outcomes. Ophthal Plast Reconstr Surg 2008;24:194–220.
11.
Khan JA, Grove AS, Goodman M: Sebaceous carcinoma: diuretic use, lacrimal system spread, and surgical margins. Ophthal Plast Reconstr Surg 1989;5:227–234.
12.
Chao AN, Shields CL, Krema H, Shields JA: Outcome of patients with periocular sebaceous gland carcinoma with and without conjunctival intraepithelial invasion. Ophthalmology 2001;108:1877–1883.
13.
Doxanas MT, Green WR: Sebaceous gland carcinoma. Arch Ophthalmol 1984;102:245–249.
14.
Das DK, Das J, Natarajan R, Chachra KL, Bhambhani S: Meibomian gland carcinoma initially identified by cytology. Diagn Cytopathol 1986;2:154–156.
15.
Vemuganti GK, Rai NN: Neoplastic lesions of eyelids, eyeball and orbit. Symposium Ophthalmic Cytol 2007;24:30–36.
16.
Young JA: Diagnostic problems in fine needle aspiration cytopathology of the salivary glands. J Clin Pathol 1994;47:193–198.
17.
Arora R, Rewari R, Betheria SM: Fine needle aspiration cytology of eyelid tumors. Acta Cytol 1990;34:227–232.
18.
Maheshwari R, Maheshwari S, Shekde S: Role of fine needle aspiration cytology in diagnosis of eyelid sebaceous carcinoma. Indian J Ophthalmol 2007;55:217–219.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.