Abstract ID: 26-496
Sebaceous carcinoma of the caruncle: from inflammatory masquerade to orbital exenteration
Author: Leonor Barreira Base Hospital / Institution: Hospital del Mar
Presentation Type: ePoster Presentation
Purpose
To report a rare case of sebaceous carcinoma (SC) arising exclusively from the caruncle — a presentation with scarce reports in the literature — mimicking ocular inflammation, and to discuss the diagnostic challenges and complex surgical decision-making it entails.
Methods
A 71-year-old woman was referred for left caruncular inflammation treated empirically with topical antibiotics. Slit-lamp examination revealed a hyperaemic retrocaruncular mass. Incisional biopsy, orbital MRI, and PET-CT were performed. Multidisciplinary evaluation involved Medical Oncology and a Head & Neck Tumour Board. The patient initially declined radical surgery; multidisciplinary consensus was instrumental in achieving informed acceptance.
Results
Biopsy confirmed SC with positive margins (adipophilin+, PRAME+, p40+, diffuse p53 overexpression). Orbital MRI: 13×6 mm medial canthal nodule, no apparent adjacent invasion. PET-CT: no distant metastases. Left orbital exenteration was performed. Final pathology: G2 SC (11×8 mm) infiltrating tarsus, striated palpebral musculature and palpebral fat; no globe invasion; no lymphovascular or perineural invasion; free surgical margins (closest 0.5 mm), despite positive margins on initial biopsy. Staging: pT2b pNX (AJCC 9th edition). Postoperative course was uneventful aside from a self-limited seroma.
Conclusion
Caruncular SC is an exceptionally rare, potentially lethal masquerade. Early biopsy of any atypical caruncular lesion is mandatory. Modern IHQ markers (PRAME, adipophilin, p53) are key diagnostic tools. The shift from positive biopsy margins to clear exenteration margins underscores the importance of adequate surgical planning. Multidisciplinary board involvement proved decisive both in oncological staging and in guiding patient acceptance of radical surgery — a critical and often underreported dimension of exenteration management.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Yasmin | Cartagena | Hospital del Mar |
| Laura | Barbosa-Luz | Hospital del Mar |