Ch40aP32a Atypical Sebaceous Cyst

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F1Ch40a (G6108): The lesion, in part, qualifies as a keratin-filled cyst. The lining epithelium varies in the number of cell layers. In the more hyperplastic areas, to the left and near the bottom of the field, the epithelium shows papillomatosis. The epithelium is of a specialized basaloid type; along the luminal surface, the differentiated cells are sebaceous cells. The vacuoles in the keratinized debris are lipid deposits that are representative of the sites in which sebaceous cells have degenerated. The cyst is supported by a fibrous membrane.

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F2Ch40a (G6108): Basophilic cells are admixed among more differentiated cells. The basaloid cells are germiniative cells. Cells of an intermediate type have cytoplasmic vacuoles but show a faint cytoplasmic acidophilia.

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F3Ch40a: Germinative cells have basophilic or faintly lavender cytoplasm; nuclei are plump and rounded with delicate chromatin patterns. Nucleoli of the germinative cells are prominent and acidophilic. Intermediate cells have vacuolated, pale pink cytoplasm with smaller nuclei and denser chromatin patterns. The lesion qualifies as a sebaceous cystadenoma.

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F4Ch40a: With reduced brightness and contrast, the germinative cells have lavender cytoplasm. Intermediate cells and a few mature sebaceous cells are represented.

Ch40aP32a Sebaceous Adenoma
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F5Ch40a: This is a more characteristic configuration for a sebaceous adenoma. Short ductal components have ostia that open along the skin surface. Sebaceous gland lobules are attached to the ductal components. The lobules are individually enlarged. At the deep extremity of the ductal components, clusters of sebaceous cells protrude into the lumen in association with compact keratinized debris. One lobule to the right of the center of the field is partially cystic. Cystic alterations of this type are common in sebaceous lobules in lesions of nevus sebaceus, but may be seen in other disorders.

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F6Ch40a: There is irregular hyperplasia of germinative cells at the periphery of the lobules. The germinative cells are most prominent in the less developed lobules. Along the lumens of some of the ducts the compact keratinized debris focally interdigitates with degenerating sebaceous cells; as a result, the heaps of keratinized debris among the degenerating sebaceous cells creates the appearance of a corrugated surface.

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f7Ch40a: A portion of the cystic lobule is represented. There are scattered lobules showing germinative cell hyperplasia. Many of the sebaceous cells bordering the cyst show advanced features of degeneration with loss of the nucleus or alteration of nuclear staining. Some of the cells along the surface have been converted to lipid filled microcysts. The lesion is a sebaceous adenoma.

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