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| CLINICAL CHALLENGE |
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| Year : 2011 | Volume
: 3
| Issue : 2 | Page : 123-124 |
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Elevated yellow nodule over the scalp in a middle-aged man
Mani Anand, Sanjay D Deshmukh, Harveen K Gulati
Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra, India
| Date of Web Publication | 14-Dec-2011 |
Correspondence Address:
Mani Anand
Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Off Pune-Mumbai Bypass, Pune - 411 041, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-7753.90838
How to cite this article:
Anand M, Deshmukh SD, Gulati HK. Elevated yellow nodule over the scalp in a middle-aged man. Int J Trichol 2011;3:123-4 |
 Introduction | |  |
A 36-year-old man presented to the surgical OPD with a gradually increasing painless swelling over the scalp for past two years. On local examination, a 2.5×1 cm yellow elevated nodule with a circumscribed margin [Figure 1] was seen on the frontal region of the scalp. The nodule was non-motile and non-tender. The lesion was excised and sent for histopathological examination. Microscopic examination revealed a tumor comprised of incompletely differentiated sebaceous lobules of varying shapes and sizes. Two cell types were identified within the lobules-central mature sebaceous cells and peripheral undifferentiated basaloid cells. There was no evidence of atypia or invasion [Figure 2],[Figure 3],[Figure 4],[Figure 5]. | Figure 1: External (a) and cut surface (b) of the nodule showing an elevated yellow circumscribed lesion
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 | Figure 2: (a) Photomicrograph revealing a tumor comprised of incompletely differentiated sebaceous lobules of varying shapes and sizes (H and E, ×100) (b) Higher magnification revealing the lobules comprised of two cells-central mature sebaceous cells and peripheral undifferentiated basaloid cells (H and E, ×400)
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| What is your Diagnosis ? | | |
- Sebaceous carcinoma (SC)
- Sebaceous epithelioma (SE)
- Sebaceous adenoma (SA)
- Sebaceous hyperplasia (SH)
Answer: (c), Sebaceous adenoma
Sebaceous neoplasms are rare adnexal tumors that present a complex challenge to the clinician. Their nature and the wide spectrum of lesions lead to confusion regarding many facets including their nomenclature and treatment. [1]
SA is a rare epithelial neoplasm with a predilection for the forehead and scalp. Occasional cases have been reported at rare sites like oral cavity. [2] It usually presents as a raised yellow circumscribed nodule or papule. [3] In terms of differentiation, SA stands between SH, in which sebaceous lobules appear fully mature and SE which is comprised of less than 50% mature sebaceous cells. SA and SE lack nuclear atypia and invasive, asymmetric growth patterns, which are hallmarks of SC. [3] SC shows increased expression of proliferation markers like p53 and Ki-67, whereas SA shows increased bcl-2 expression. [4] SA is the most distinctive cutaneous marker of Muir-Torre Syndrome, which is characterized by the combined occurrence of at least one sebaceous skin tumor and one internal malignancy (colon/genitourinary tract/breast) in the same patient. [3] Hence, patients with SA should be evaluated for internal malignancy. Surgical excision forms the treatment of choice; however, topical photodynamic therapy is being tried currently. [5]
| References | | |
| 1. | Prioleau PG, Santa Cruz DJ. Sebaceous gland neoplasia. J Cutan Pathol 1984;11:396-414. 
[PUBMED] |
| 2. | Kaminagakura E, Andrade CR, Rangel AL, Coletta RD, Graner E, Almeida OP, et al. Sebaceous adenoma of oral cavity: Report of case and comparative proliferation study with sebaceous gland hyperplasia and Fordyce's granules. Oral Dis 2003;9:323-7.
[PUBMED] [FULLTEXT] |
| 3. | Klein W, Chan E, Seykora JT. Tumors of the epidermal appendages. In: Elder DE, Elenitsas, Johnson BL, Murphy GF editors. Lever's histopathology of the skin. 9 th ed. Philadelphia; Lippincot Williams and Wilkins; 2005. p. 867-926.
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| 4. | Cabral ES, Auerbach A, Killian JK, Barrett TL, Cassarino DS. Distinction of benign sebaceous proliferations from sebaceous carcinomas by immunohistochemistry. Am J Dermatopathol 2006;28:465-71.
[PUBMED] [FULLTEXT] |
| 5. | Kim SK, Lee JY, Kim YC. Treatment of sebaceous adenoma with topical photodynamic therapy. Arch Dermatol. 2010;146:1186-8.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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