Androgen Receptor Identification in the Diagnosis of Eyelid Sebaceous Carcinomas – Accepted Manuscript

Abstract: Purpose: To assess the role of androgen receptor detection in diagnosing eyelid sebaceous carcinomas and compare it with that of adipophilin.Design: Retrospective clinicopathologic study.Methods: Ten sebaceous carcinomas (eight invasive, two intraepithelial only) were immunohistochemically stained for androgen receptors and compared with adipophilin staining. Receptor staining was also performed on benign sebaceous tumors (a sebaceoma and an adenoma), and as controls on eyelid basal cell carcinomas, eyelid squamous cell carcinomas, conjunctival squamous dysplasias and conjunctival melanomas.Results: All eight patients with an invasive component of sebaceous carcinoma had a biopsy in which the tumor cells were diffusely androgen receptor positive (>20% of cells and usually >40%) and adipophilin positive. Eight cases displaying an intraepithelial (“pagetoid”) component of spread were also diffusely androgen receptor- and adipophilin-positive in at least one of multiple biopsies from each patient. However, in eight of 21 separate conjunctival biopsy specimens with intraepithelial cytologic atypia, adipophilin was negative. A sebaceoma and a sebaceous adenoma were also positive for both of these biomarkers. Among the controls, squamous carcinomas and melanomas were androgen receptor- and adipophilin-negative. Basal cell carcinomas displayed focal receptor positivity in fewer than 5% of cells and were adipophilin-negative.Conclusions: Androgen receptors and adipophilin can immunohistochemically separate sebaceous tumors from squamous carcinomas and melanomas, which were negative for both, and from basal cell carcinomas, which were receptor-positive in a distant minority of cells. Regarding intraepithelial (“pagetoid”) spread, androgen receptor detection was more sensitive and reliable than adipophilin in highlighting this component of the disease.