Sebaceous Carcinoma - Analysis of Our 20-Year Clinical Experience in Taipei Veterans General Hospital

皮脂腺癌分析──台北榮民醫院總20年之經驗分享

Shao-Chen Wang(王劭丞) ； Tien-Hsiang Wang(王天祥) ； Yu-Jen Chiu(邱宇任)

《臺灣整形外科醫學會雜誌》 32卷1期 (2023/03) Pp. 14-26

摘要

Background: Sebaceous carcinoma (SC) is a rare skin malignancy derived from the skin appendage (sebaceous gland) that has high local recurrence and spreading rates and probably fatal tumors. Clinically, SC has a variable presentation and can be easily misdiagnosed as a benign lesion, leading to a delay in diagnosis and appropriate treatment. Aims and Objectives: This study aimed to determine the characteristics and outcomes of sebaceous carcinoma from clinical experience. The clinical features and pathological findings of this disease were reviewed. Materials and Methods: Twenty-nine cases with a primary diagnosis of SC were enrolled retrospectively. Patient characteristics, underlying disease, past cancer history, and duration of follow-up were collected. The tumor size, location, treatment methods, and pathological features were collected. We analyzed local recurrence, metastasis, and cancer-related death. Results: The study included 16 female and 13 male patients, with 20 patients in the ocular group and 9 patients in the extraocular group. In total 29 patients, six patients had intraepithelial invasion, 1 had perineural invasion, and 1 had lymphovascular invasion. The mean follow-up duration was 18.1 months. Five patients demonstrated local tumor recurrence, and 2 patients died. Conclusion: This study demonstrated the clinicopathological features of SC through our experience. SC is a rare skin malignancy that can be easily ignored, especially in extraocular cases, which possibly delays diagnosis and treatment and cause a poor clinical outcome. Clinicians and pathologists should be aware of the disease to obtain a suitable treatment for patients.

關鍵字

sebaceous cell carcinoma ； sebaceous gland carcinoma ； periocular ； ocular ； extraocular ； eyelid tumor

並列摘要

背景：皮脂腺癌是一種罕見的皮膚惡性腫瘤，源自皮膚附屬構造（皮脂腺）。臨床上皮脂腺癌具有各式各樣臨床表徵，以致容易被忽略以及誤診，皮脂腺癌具有高度局部復發、遠端轉移及可能致死的特性；目前治療仍以手術切除為主，若手術無法完全切除或已發生轉移，全身性的化學性治療也是後續治療的方式之一。目的及目標：本研究分析台北榮總20年間皮脂腺癌病例特徵，結合過去文獻分析，探討皮脂腺癌之診斷及治療。材料及方法：藉由病歷回顧2000年1月至2020年5月間，於台北榮總醫院診斷皮脂腺癌且接受治療之病人；針對病患特色、腫瘤分期、病理特色、治療方式及預後探討分析。結果：本研究收錄29位患者，其中20位皮脂腺癌侵犯眼睛及眼周部位、9位侵犯眼周外部位（16位女性與13位男性，皆台灣人），病患全部都接受外科手術切除腫瘤；病理發現6位有表皮侵犯、1位神經侵犯、1位淋巴血管侵犯，但是與局部復發無關聯。在皮脂腺癌侵犯眼睛及眼周部位的族群與侵犯眼睛以外部位的族群比較生存分析上亦無統計意義。有1位病患合併有大腸癌，且家族中有多位大腸癌病史，病理特殊染色分析，高度懷疑Muir-Torre syndrome。結論：皮脂腺癌因有許多表徵，易誤診成良性皮膚病兆而被忽略、延誤診斷及治療。過去文獻指出皮脂腺癌好發亞洲族群、老年人、女性，手術完全切除腫瘤仍是目前治療目標；當病患合併消化道或泌尿道腫瘤時，Muir-Torre syndrome則需要進一步檢查。本研究侷限是單一醫學中心、病患數量小且族群皆亞洲人，雖可藉本研究之臨床經驗表現區域皮脂腺癌病患特性，但未來仍需要更多皮脂腺癌研究，健全皮脂腺癌之診斷和治療。