CASO DA REUNIÃO

DE ONCOPATOLOGIA
ABRIL 2010:

CARCINOMA SEBÁCEO METASTÁTICO

Patologista: Celso Rubens Vieira e Silva

Exames anatomopatológicos:

3872/99 - externo oral

7084/99 - externo oral
3665/99 - gengiva
3582/01 - gengiva
3778/01 - gengiva + osso maxilar
3142/05 - metástase pulmonar
1163 /09 - metástases em linfonodos
3132/09 - gengiva
HISTOPATOLOGIA
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Tem diagnóstico
DIFERENCIAL?
Os tumores de células claras da cavidade
oral constituem um grupo heterogêneo de
lesões que podem ser:

salivares,

odontogênicas,

ou metastáticas.
 Neoplasias odontogênicas:

• Carcinoma odontogênico de células claras,

• Ameloblastoma
• Tumor epitelial odontogênico calcificante
(Pindborg).
 Neoplasias odontogênicas:

• Carcinoma odontogênico de células claras,

• Ameloblastoma
• Tumor epitelial odontogênico calcificante
(Pindborg).
Carcinoma odontogênico de células claras
PAS (+) glicogênio
Tumores de origem salivar:

são quase sempre de natureza maligna, mas incluem duas lesões benignas:
O oncocitoma e o mioepitelioma.

Carcinoma de células acinares,

Carcinoma mucoepidermóide
Carcinoma mioepitelial
Carcinoma hialinizante de células claras
Tumores de origem salivar:

são quase sempre de natureza maligna, mas incluem duas lesões benignas:
O oncocitoma e o mioepitelioma.

Carcinoma de células acinares,

Carcinoma mucoepidermóide
Carcinoma mioepitelial
Carcinoma hialinizante de células claras
 PAS (+) glicogênio

Carcinoma hialinizante de células claras

Neoplasia metastática de
células claras :

A mais comum para a cavidade oral e mandíbula

é o carcinoma de células renais.

Entretanto, metástases de melanoma, de carcinoma da

próstata, intestino, tireóide e fígado também devem ser
considerados.
 PAS (+) glicogênio

carcinoma de células renais

Carcinoma sebáceo bem diferenciado
Carcinoma sebáceo pouco diferenciado
Mas glândula sebácea na
boca ... não é estranho?
 Glândulas sebáceas ectópicas são
encontradas frequentemente na mucosa
oral, como múltiplas e discretas pápulas
IMUNO-HISTOQUÍMICA
Adicionais
C-kit,
EGFR,
Cerb-2:
negativos
KI-67:
5%
Esta reatividade, por
acaso, é específica para
o Carcinoma sebáceo??
E EXISTEM
MELHORES
RECURSOS?
Am J Dermatopathol. 1999 Oct;21(5):426-31. Bayer-Garner IB, Givens V, Smoller B
.
Immunohistochemical staining for androgen
receptors: a sensitive marker of sebaceous
differentiation.
 
As neoplasias sebáceas, incluindo o carcinoma sebáceo,
mostram positividade nuclear para os receptores de
andrógenos (RA).

Portanto esse pode ser um marcador confiável de

diferenciação sebácea e o melhor marcador para esse
tipo de neoplasia
J Clin Pathol. 2006 Nov;59(11):1166-70.
Muthusamy K, Halbert G, Roberts F.
.

Immunohistochemical staining for

adipophilin, perilipin and TIP47.
Adipophilin
Carcinoma sebáceo na
boca???
Isso não é incomum?
1: Gomes CC, Lacerda JC, Pimenta FJ, do Carmo MA, Gomez RS. Intraoral
sebaceous carcinoma. Eur Arch Otorhinolaryngol. 2007 Jul;264(7):829-
32. Epub 2007 Feb 7. PubMed PMID: 17285332.

2: Alawi F, Siddiqui A. Sebaceous carcinoma of the oral mucosa: case

report and review of the literature. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod. 2005 Jan;99(1):79-84. Review. PubMed PMID: 15599352.

3: Handschel J, Herbst H, Brand B, Meyer U, Piffko J. Intraoral sebaceous

carcinoma. Br J Oral Maxillofac Surg. 2003 Apr;41(2):84-7. PubMed
PMID: 12694699.

4: Liu CJ, Chang KW, Chang RC. Sebaceous carcinoma of buccal mucosa.
Report of a case. Int J Oral Maxillofac Surg. 1997 Aug;26(4):293-4.
PubMed PMID: 9258724.
5: Li TJ, Kitano M, Mukai H, Yamashita S. Oral sebaceous carcinoma:
report of a case. J Oral Maxillofac Surg. 1997 Jul;55(7):751-4. PubMed
PMID: 9216510.

6: Abuzeid M, Gangopadhyay K, Rayappa CS, Antonios JI. Intraoral

sebaceous carcinoma. J Laryngol Otol. 1996 May;110(5):500-2. Review.
PubMed PMID: 8762330.

7: Damm DD, O'Connor WN, White DK, Drummond JF, Morrow LW,
Kenady DE. Intraoral sebaceous carcinoma. Oral Surg Oral Med Oral
Pathol. 1991 Dec;72(6):709-11. Review. PubMed PMID: 1812454.

8: Batsakis JG, el-Naggar AK. Sebaceous lesions of salivary glands and

oral cavity. Ann Otol Rhinol Laryngol. 1990 May;99(5 Pt 1):416-8.
PubMed PMID: 2337322.
Nossa!
É raro
mesmo!!!
7. Oral Surg Oral Med Oral Pathol. 1991 Dec;72(6):709-11.
Intraoral sebaceous carcinoma. Damm DD, et al
Division of Oral Pathology, College of Dentistry, University of
Kentucky, Lexington 40536.
An instance of sebaceous carcinoma that presented as a mass in
the left buccal mucosa is described. This is the first known report
in the English-language literature of a sebaceous carcinoma
presenting as an intraoral tumor. The light and electron
microscopic findings are described. The histologic differential
diagnosis, clinical behavior, and appropriate therapy are
discussed. Previously reported intraoral sebaceous neoplasms and
sebaceous carcinomas of the parotid are reviewed.
PMID: 1812454 [PubMed - indexed for MEDLINE]
Eur Arch Otorhinolaryngol. 2007 Jul;264(7):829-32
Gomes CC, Lacerda JC, Pimenta FJ, do Carmo MA, Gomez RS.
Department of Oral Surgery and Pathology, School of Dentistry,
Universidade Federal de Minas, Belo Horizonte, Brazil.
Abstract
Intraoral sebaceous carcinoma (SC) is a rare tumour in the oral
cavity thought to arise from malignant transformation of oral
sebaceous glands. To our knowledge, only six cases of intraoral
SC have been reported in the English language literature. The
purpose of the present article is to report an additional case and
review the literature.
8. Ann Otol Rhinol Laryngol. 1990 May;99(5 Pt 1):416-8.
Sebaceous lesions of salivary glands and oral cavity. Batsakis JG,
JG
Naggar AK.University of Texas M. D. Anderson Cancer Center,
Houston 77030.
Sebaceous differentiation in the oral mucosa and major salivary
duct epithelium is an expected normal finding in humans. These
usually asymptomatic and incidental collections of sebaceous cells
can also be found in intimate or close relationship with definable
classes of salivary gland neoplasms, or as sebaceous neoplasms of
salivary glands. The neoplasms are uncommon and are classified
as sebaceous lymphadenoma, sebaceous adenoma, and
sebaceous carcinoma. The two adenomas have a low recurrence
potential; the carcinomas have a biologic behavior like that of
ocular sebaceous carcinomas.
PMID: 2337322 [PubMed - indexed for MEDLINE]
PATOLOGIA EXTREMAMENTE RARA
DE
COMPORTAMENTO BIOLÓGICO DESCONHECIDO
FINAL