Sebase Hiperplazi
Özet
Sebase hiperplazi; sıklıkla orta yaş ve üzeri bireylerin yüz bölgesinde (alın, burun, yanak) sarı-beyaz renkli, merkezi göbeklenme gösteren papüllerle karakterize benign bir deri lezyonudur. Toplumda genel görülme oranı %1 civarındayken, yenidoğanlarda maternal hormonlar nedeniyle ve kronik immunsupresif (özellikle siklosporin) tedavi alan organ nakli hastalarında daha yüksek oranlarda gözlenir. Lezyonun neoplazi mi yoksa hamartom mu olduğu tartışmalı olup, Dünya Sağlık Örgütü sınıflamasında doğrudan bir sebase neoplazi olarak kabul edilmemektedir. Patogenezinde yaşlanma, azalan androjen seviyelerine bağlı sebosit döngüsündeki yavaşlama ve EGFR-RAS-MAPK sinyal yolağındaki genetik mutasyonlar rol oynar. Histopatolojik olarak, genişlemiş bir merkezi duktus çevresinde sayıca artmış normal görünümlü matür sebase lobüller ve çevrelerinde bir-iki sıralı bazal hücre katmanı izlenir. İmmünohistokimyasal analizlerde matür sebositler EMA ve sitokeratin 7 pozitifliği gösterirken, ayırıcı tanıda Faktör XIIIa, adipofilin ve GLUT 1 belirteçlerinden yararlanılabilir. Klinik olarak bazal hücreli karsinom; histopatolojik olarak ise Muir-Torre Sendromu ile ilişkili olabilen sebase adenom ve sebaseoma gibi malignite potansiyelli neoplazilerden ayırt edilmesi kritik önem taşır. Genellikle tedavi gerektirmeyen bu benign oluşumlar, kozmetik nedenlerle lazer veya kriyoterapi ile uzaklaştırılabilir.
Sebaceous hyperplasia is a common benign cutaneous lesion characterized by yellow-white, soft papules with central umbilication, typically localized on the face (forehead, nose, cheeks) of middle-aged and elderly individuals. While it occurs in 1% of healthy adults, its incidence increases significantly in newborns due to maternal hormone exposure and in organ transplant recipients receiving chronic immunosuppressive therapy, particularly cyclosporine. Whether it represents a true neoplasm or a hamartoma remains controversial, and it is not classified among sebaceous neoplasms by the World Health Organization. Its pathogenesis involves aging, altered hormonal environments leading to decreased androgen levels that trigger sebocyte proliferation via feedback mechanisms, and genetic mutations in the EGFR-RAS-MAPK pathway. Histopathologically, it presents as an increased number of morphologically normal, mature sebaceous lobules clustered around a dilated central duct, rimmed by one or two layers of basaloid cells. Mature sebocytes express EMA and cytokeratin 7, while markers like Factor XIIIa, adipophilin, and GLUT 1 aid in differentiation. Distinguishing it from basal cell carcinoma clinically, and from sebaceous adenoma or sebaceoma histopathologically, is crucial since the latter are associated with Muir-Torre syndrome. Although treatment is unnecessary, lesions are often managed with laser or cryotherapy for cosmetic reasons.
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