Diffuse intraepithelial sebaceous carcinoma of the conjunctiva

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Abstract
A 70-year-old woman presented with a 10 month history of left sided, unilateral redness, tearing, and swelling of the lids. Examination showed marked conjunctival injection and thickening along the superior temporal and inferotemporal limbus, with moderate lid thickening, and pale corneal changes (Fig 1). There was mild foreshortening and scarring of the inferior fornix. A presumptive diagnosis of carcinoma in situ was considered with a secondary diagnosis of sebaceous gland carcinoma with intraepithelial spread. Biopsies of several sites of limbal, bulbar, and palpebral conjunctiva (Fig 2) revealed a diffuse intra-epithelial malignancy with pagetoid and bowenoid growth and moderate chronic non-granulomatous inflammation in the underlying substantia propria but no evidence of stromal invasion. The tumour cells were markedly polymorphic and often exhibited multiple nucleoli. Mitotic figures were frequent (Fig 2B). Occasional dyskeratosis was noted but in many tumour cells the cytoplasm appeared foamy. Stains for mucin, mucopolysaccharides, and melanin within tumour cells were inconclusive, nor could lipid be demonstrated in either frozen or paraffin sections. Staining with OM1 antibody (kindly provided by Dr H Grossniklaus, Emory University, Atlanta, GA, USA) against sebaceous gland antigen, however, revealed positive labelling of tumour cells.

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