Tumours are composed of multiple large foci and nests or sheets of cells with hyperchromatic nuclei and abundant clear to eosinophilic cytoplasm. Cellular pleomorphism and cytologic atypia are present to varying degrees and are much more prevalent than in sebaceous adenomas. Squamous differentiation is common. There may be areas of basa-loid differentiation, particularly at the periphery of cellular nests. Areas of necrosis and fibrosis are common. Perineural invasion is seen in greater than 20% of tumours; vascular invasion is infrequent. Rare oncocytes and foreign body giant cells with histiocytes may be observed, but lymphoid tissue with follicles or subcapsular sinuses is not seen.
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