title: Perforin expression in eyelid sebaceous carcinomas: a useful and specific immunomarker for the differential diagnosis of eyelid carcinomas.
abstract: OBJECTIVE
  Eyelid sebaceous carcinoma (SC) remains a common diagnostic pitfall for both the clinician and histopathologist. The aim of this study was to describe perforin as a new marker in the immunohistochemistry panel for SC.
  
  
  METHODS
  A total of 29 cases were retrieved from the Pathology archives, including 11 sebaceous neoplasms (nine SC; two sebaceomas), 10 squamous cell carcinomas (SCC) and eight basal cell carcinomas (BCC). These were stained using the monoclonal antibody for perforin, epithelial membrane antigen (EMA), Ber-EP4 and adipophilin (ADP). Sensitivity and specificity of perforin as an immunohistologic marker for sebaceous tumours were compared to EMA, ADP and Ber-EP4.
  
  
  RESULTS
  Perforin stained strongly 9/11 (81%) of the sebaceous neoplasms (SN), 7/9 SC and 2/2 of sebaceomas (2/2), similar to ADP. Epithelial membrane antigen (EMA) stained 8/9 SC and was negative (1/2) or only very weakly expressed (1/2) in sebaceomas. The specificity of perforin in identifying SN versus SCC and BCC was 100% (95% CI 69-100), while EMA specificity in identifying SN varied according the comparison group (SCC: 50%, 95% CI 18-81, 100% (95% CI 63-100). Perforin better highlighted the intraepithelial spread of SC than EMA. Ber-EP4 was strongly expressed in six of nine SC, but was consistently negative in sebaceomas.
  
  
  CONCLUSIONS
  The expression pattern of perforin in sebaceous neoplasms enables us to recommend the use of perforin as a new immunohistochemical marker for sebaceous neoplasms.
authors: Dalmia Ophthalmic Pathology Services, L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India.
authors: Ruchi
authors: R
authors: Mittal
authors: Department of Pathology and Forensic Medicine, Federal University of Bahia, Bahia, Brazil.
authors: Iguaracyra
authors: I
authors: Araujo
authors: Department of Biostatistics, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.|Department of Eye and Vision Science, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
authors: Gabriela
authors: G
authors: Czanner
authors: NHS Department of Cellular Pathology, Royal Liverpool University Hospital, Liverpool, UK.|Liverpool Ocular Oncology Research Group, Department of Clinical and Molecular Cancer Medicine, University of Liverpool, Liverpool, UK.
authors: Sarah E
authors: SE
authors: Coupland
mesh_terms: D018266:Adenocarcinoma, Sebaceous / Q000175:diagnosis* / Q000378:metabolism; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000378:metabolism; D003937:Diagnosis, Differential; D005142:Eyelid Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D018396:Mucin-1 / Q000378:metabolism; D054353:Perforin / Q000378:metabolism*; D000070780:Perilipin-2 / Q000378:metabolism; D012626:Sebaceous Gland Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D012680:Sensitivity and Specificity; D000951:Antigens, Neoplasm
chemical_list: D014408:Biomarkers, Tumor; D018396:Mucin-1; D054353:Perforin; D000070780:Perilipin-2; C000602982:PLIN2 protein, human; C115012:human epithelial antigen-125; D000951:Antigens, Neoplasm
keywords: immunohistochemistry; perforin expression; sebaceous carcinoma