title: Aggressive Extraocular Sebaceous Carcinoma of the Scalp Involving the Brain in a Patient With Muir-Torre Syndrome.
abstract: This article reports an unusual case of aggressive extraocular sebaceous carcinoma located on the scalp with subsequent usurpation of the bone and penetrating through the bone and meninges to the brain in a 56-year-old man affected by Muir-Torre syndrome. Microscopically, the sebaceous neoplasm was located in the middle to deep dermis without any connection to the epidermis and showed a multinodular growth with neoplastic nodules with a central comedo-type necrosis separated from each other by fibrovascular stroma. The nodules were composed of varying proportions of mature sebaceous cells and atypical basaloid cells with high degree of atypia, including high nuclear/cytoplasmic ratio, nuclear pleomorphism, macronucleoli, atypical mitoses, and necrosis. The neoplasm was totally removed. Histopathological examinations of the recurrent lesion showed identical morphological features and, in addition, signs of the tumors growing through the periosteum were noted. In the final excision specimen, both the dura mater and the brain tissue were infiltrated by the sebaceous carcinoma. The diagnosis of Muir-Torre syndrome was confirmed by molecular genetic investigation that revealed an identical germline mutation in MSH2 gene in several family members, some of whom had colorectal tumors.
authors.affiliation: *Sikl's Department of Pathology, Charles University in Prague, Medical Faculty in Pilsen, Pilsen, Czech Republic; †Bioptical Laboratory, Pilsen, Czech Republic; ‡Department of Radiology, University of Ostrava, Medical Faculty Hospital, Ostrava, Czech Republic; and §Department of Oncology and Radiotherapy, Charles University in Prague, Medical Faculty in Pilsen, Pilsen, Czech Republic.
authors.forename: Ladislav
authors.initials: L
authors.lastname: Hadravsky
authors.forename: Dmitry V
authors.initials: DV
authors.lastname: Kazakov
authors.forename: Jan
authors.initials: J
authors.lastname: Stehlik
authors.forename: Michal
authors.initials: M
authors.lastname: Michal
authors.forename: Romuald
authors.initials: R
authors.lastname: Curik
authors.forename: Petr
authors.initials: P
authors.lastname: Krupa
authors.forename: Alena
authors.initials: A
authors.lastname: Skalova
authors.forename: Denisa
authors.initials: D
authors.lastname: Kacerovska
mesh_terms: D000328:Adult; D001706:Biopsy; D001921:Brain / Q000473:pathology*; D002277:Carcinoma / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D004252:DNA Mutational Analysis; D018450:Disease Progression; D017809:Fatal Outcome; D020022:Genetic Predisposition to Disease; D018095:Germ-Line Mutation; D006258:Head and Neck Neoplasms / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055653:Muir-Torre Syndrome / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D051718:MutS Homolog 2 Protein / Q000235:genetics; D009361:Neoplasm Invasiveness; D010375:Pedigree; D010641:Phenotype; D012535:Scalp / Q000473:pathology* / Q000601:surgery; D012626:Sebaceous Gland Neoplasms / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: C497172:MSH2 protein, human; D051718:MutS Homolog 2 Protein