Elsevier

Human Pathology

Volume 44, Issue 9, September 2013, Pages 1811-1816
Human Pathology

Original contribution
Perilipin and adipophilin expression in sebaceous carcinoma and mimics

https://doi.org/10.1016/j.humpath.2013.02.003Get rights and content

Summary

Although adipophilin has been reported to be a sensitive marker for sebaceous carcinoma, others have noted its expression in squamous cell carcinoma and a variety of noncutaneous tumors, suggesting that lipid droplet accumulation is a frequent feature of neoplastic cells. We investigated the expression of adipophilin and perilipin in 101 cutaneous carcinomas. They included 30 cases of sebaceous carcinoma, 28 squamous cell carcinoma with clear cell change (18 invasive and 10 in situ tumors), 8 hidradenocarcinomas, 1 spiradenocarcinoma, 10 porocarcinomas, 4 malignant chondroid syringomas, 1 malignant cylindroma, 7 apocrine carcinomas, 6 eccrine carcinomas, 5 aggressive digital papillary adenocarcinomas, and 1 pilomatrical carcinoma. Adipophilin stained the rim of cytoplasmic lipid droplets in various tumor types, including sebaceous carcinomas (30/30, 100%), squamous cell carcinoma with clear cell change (21/28, 75%), and eccrine-apocrine carcinomas (25/43, 58%). On the other hand, perilipin expression was seen in 13 (43%) of 30 sebaceous carcinoma and only 1 hidradenocarcinoma. The remaining 28 squamous cell carcinomas with clear cell change and 42 eccrine-apocrine carcinomas were negative. Although specific for invasive sebaceous carcinoma, perilipin expression was not helpful in distinguishing sebaceous carcinoma in situ from squamous cell carcinoma in situ with clear cell change. The expression of adipophilin seen in variety of cutaneous tumors suggests that the biosynthesis of lipid is altered in these neoplasms.

Introduction

Lipogenic pathways are up-regulated in neoplasms as tumors rely on anaerobic glycolysis [1]. Cells using lipogenesis require one or more lipid droplet-associated proteins for the formation and maintenance of lipid droplets [2]. These include perilipin (perilipin 1), adipophilin (adipose differentiation-related protein or perilipin 2), tail-interacting protein of 47 kd (or perilipin 3), and myocardial lipid droplet protein (or OXPAT) [2]. Although adipophilin and tail-interacting protein of 47 kd are nearly ubiquitously expressed, the expression of perilipin is thought to be restricted to adipocytes and certain steroidogenic cells [2], [3].

Recently, adipophilin has been reported to be a sensitive marker for sebaceous carcinoma [4], [5]. Although Ostler et al [4] documented that tumors with clear cell change such as hidradenoma and trichilemmoma were negative for adipophilin, the malignant counterparts of these tumors were not included in this study. Although these authors reported squamous cell carcinoma (SCC) exhibiting background granular staining [4], others have noted adipophilin positivity in the cells of SCC and SCC in situ, representing a pitfall in its distinction from sebaceous carcinoma [6], [7]. In addition, the expression of adipophilin has been reported in a variety of tumors including colonic adenocarcinoma, renal cell carcinoma, hepatocellular carcinomas, pulmonary carcinomas, mammary carcinomas, pancreatic carcinoma, and prostatic adenocarcinoma [7], thus supporting the notion that lipid droplet accumulation is a frequent feature of neoplastic cells.

We sought to investigate whether SCC with clear cell change and eccrine-apocrine carcinomas would have positive staining for adipophilin and the sensitivity and specificity of perilipin in comparison with adipophilin in distinguishing sebaceous carcinomas from SCC with clear cell change and eccrine-apocrine carcinomas.

Section snippets

Materials and methods

This study has been approved by the Massachusetts General Hospital Institutional Review Board (IRB no. 2011-P-2489). Archival materials of sebaceous carcinoma, clear cell SCC, apocrine carcinoma, eccrine carcinoma, aggressive digital papillary adenocarcinoma, hidradenocarcinoma, malignant spiradenoma, porocarcinoma, adenoid cystic carcinoma, malignant chondroid syringoma, malignant cylindroma, and pilomatrical carcinoma diagnosed between 1987 and 2012 were retrieved from the pathology files of

Sebaceous carcinoma

Of the 30 sebaceous carcinomas, 22 localized to the head and neck region (14 from eyelid) and 8 to the trunk. The ages of the patients ranged from 46 to 93 years (median, 72 years). The female-to-male ratio was 8:7. Of the sebaceous carcinomas, 26 were invasive tumors with 3 containing both invasive and in situ components, and 4 were only in situ carcinomas. There were 5, 12, and 9 tumors with well, moderate, and poor differentiation, respectively. The tumors were graded according to criteria

Discussion

Sebaceous carcinoma is an uncommon cutaneous malignancy, yet it is a common malignant eyelid tumor (2%-4%) [9]. Sebaceous carcinoma, especially the invasive and poorly differentiated forms, can mimic basal and squamous cell carcinomas. Studies have reported the initial histologic diagnosis to be incorrect in 23% to 77% of the cases [10]. The main histologic differential diagnosis for sebaceous carcinoma in situ would be a clear cell SCC in situ. Immunohistochemical staining with androgen

Acknowledgment

We thank Juana Jones for her technical assistance and Ethel Mitchell for her administrative support.

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There was no funding for this work. The authors have no conflict of interest to declare.

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