Sebaceous carcinoma of the breast
A breast sebaceous carcinoma is essentially a skin cancer which happens to be growing in the skin of the breast, and is not normally related to the conventional ductal carcinomas characteristic of breast cancer. However, it is also possible for women to have an invasive ductal carcinoma which has many features or a certain percentage of the tumor which has commonalities with sebaceous gland carcinomas of the skin. Sebaceous breast carcinoma is exceedingly rare.
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It is a distinctive type of breast cancer which is characterized by unequivocal morphologic differentiation towards sebaceous epithelium or sebocytes. (Sebocytes are epithelial cells that originate from a basal cell layer at the periphery of the gland).
Sebaceous breast cancer cells resemble skin sebaceous glands
Sebaceous breast carcinomas will often contain many lobules and nests of clear cells which closely resemble the skin sebaceous glands. This type of breast carcinoma can also sometimes develop within an intraductal breast papilloma.
Sebaceous breast cancers tend to be of a low grade
Sebaceous breast carcinomas tend to be considered a ‘low grade‘ tumor, and they are actually most commonly develop in and around the eyelids. If a sebaceous breast carcinoma shows multicentricity, poor differentiation, infiltrative growth, then the tumor may have a worse prognosis. Most patients who develop sebaceous breast carcinoma do so in their 60’s or 70’s, though it sometimes develops a little earlier.
Clinical presentation of sebaceous carcinoma of the breast
A sebaceous breast carcinoma will usually present as a small mass, but the danger is that the lesion will be dismissed as something benign, like a common skin lesion. Sebaceous breast carcinomas are not always easy to see on a screening mammogram either. The size of a sebaceous breast tumor will often range from 1 to 4 cm when it is first diagnosed. A mammogram of a breast sebaceous carcinoma will usually reveal pleomorphic calcifications, and these lesions are often well circumscribed.
Histological features common with breast sebaceous carcinomas
Breast sebaceous carcinomas are usually composed of well-defined solid sheets or lobules of atypical epithelial cells, which also frequently include many large pale or clear cells, often with ‘scalloped‘ nuclei. The cytoplasm is often coarsely vacuolated , and abundant lipid droplets can often be identified in the cytoplasm with oil-red-O staining.
Important differentiation from squamous and basal cell breast carcinomas
The clear cells of sebaceous breast carcinomas tend to be negative with alcian blue and periodic acid-Schiff and staining. The atypical epithelial tumor cells tend to test positive for the epithelial membrane antigen, human milk fat globules subclass 1, human milk fat globules subclass 2 and Leu M1.
Breast sebaceous tumor cells tend not to express carcinoembryonic antigen, breast carcinoma associated antigen, S-100 protein, gross cystic disease fluid protein-15 or Dako M1. Sebaceous breast carcinomas are also frequently reactive for Cam 5.2, and also BRST-1. This can be an important means of differentiated sebaceous gland breast carcinomas from squamous cell breast carcinomas and breast basal cell carcinomas.
Sebaceous carcinomas of the breast are quite often positive for cytokeratin, but not for vementin and carcinoembryonic antigen. Most of the tumor cell nuclei in sebaceous breast carcinomas will be reactive for antibodies to progesterone and estrogen receptors, but not for the HER2/neu protein.
Outlook and treatment for breast sebaceous carcinoma
Not a great deal is known about sebaceous carcinomas of the breast, as they are so rare. However, if the example of a skin sebaceous carcinoma is considered informative, then clearly, sebaceous breast carcinoma should be considered an aggressive cancer. Sebaceous cell breast tumors will likely exhibit an aggressive clinical course, with a significant tendency for both local recurrence and distant metastasis.
Surgery followed by chemotherapy is common
A sebaceous breast carcinoma is normally excised completely. A modified mastecomy is sometimes necessary, and depending on the situation an axillary lymph node dissection might be prudent. Follow-up should be frequent in order to look for possible metastasis. Sebaceous carcinoma of the breast is also commonly treated with chemical agents such as interferon with retinoids.
Radiation therapy has also been utilized to treat breast sebaceous carcinoma, but without the full surgical removal of the carcinoma these attempts tend not to be that successful.
The main concern with sebaceous breast cancer is a delay in diagnosis
The main factor effecting the outcome of sebaceous cell cancer of the breast will likely be an unfortunate delay in proper diagnosis and treatment if the lesions was initially dismissed as a mild skin disease. If there is some doubt, it is best to obtain a biopsy. The rate of local recurrence for breast sebaceous carcinoma can be estimated as high as in the 30% range, and will likely happen within the first five years following treatment.
If there is no regional metastasis and no local or regional progression of the disease, then the outlook for breast sebaceous carcinoma is good. If a patient with sebaceous breast carcinoma has experienced metastatic disease, then the chances of surviving beyond five years are unfortunately probably in the 50% range only.
For further reading, I suggest you visit this page which has a little bit of information on sebaceous cysts of the breast, and this page as well for pure squamous cell carcinoma within the breast.
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