Extra ocular sebaceous adenocarcinoma in HIV-positive patient - case\nreport
A forty-two year old male patient, diagnosed with AIDS on the previous year, sought\nmedical attention after presenting with daily fever, watery diarrhea, generalized\nmyalgia and weight loss for a week.\nBesides these symptoms, the patient reported an asymptomatic facial mass, growing in the\nlast four weeks.\nOn physical examination the patient had a poor general status, was emaciated and\nfebrile. On the right mandibular region an exophytic tumor (3 x 1.5 cm) was noticeable,\npresenting with an infiltrated base and exulcerated areas (). The exam also detected generalized lymphadenomegaly.\nLaboratory exams showed: HIV viral load: 55,986; CD4 count: 96; anemia (hemoglobin:\n9.2mg/dl) and lactic dehydrogenase (LDH): 1,965mg/dl.\nTissue obtained from the excisional biopsy was stained with hematoxiline eosine (HE) and\nrevealed an ulcerated neoplasm, formed by stacks of basaloid cells with eosinophilic\ncytoplasm, centered by a population of cells with micro vacuolated cytoplasm and\nirregular, hyperchromic nuclei with mitotic Figures and necrotic areas, characteristics\nconsistent with ACS ( and ).\nTo confirm the diagnosis, we performed an immunohistochemistry study (IMQ) that revealed\nexpression of cytokeratin and protein p63 on the basaloid cells and EMA on the micro\nvacuolated cells, findings that were consonant with ACS ().\nDuring admission, a computerized tomography of the chest showed signs suggestive of\neither bronchiolitis or endobronchial dissemination of pulmonary tuberculosis.\nTherefore, treatment with antiretroviral therapy, antibiotics and COXCIP 4 (rifampicin,\nisoniazid, pyrazinamide and ethambutol) were initiated, however, there was a progressive\ndeterioration on the clinical status and the patient died due to respiratory failure,\nafter seventy days of hospitalization.