Abstract
Background: Tumor associated tissue eosinophilia (TATE) has been described in a variety of neoplasms. In regard to squamous cell carcinoma, some studies worldwide done to assess stromal eosinophilia in oral and cervical squamous cell carcinoma. The objectives of this study is to evaluate the association of stromal eosinophilic infiltration of cutaneous squamous cell carcinoma and to detect the significance of this association.
 Aim of the study
 The aim of our study is to establish the relationship between the degree of stromal eosinophilia and the level of invasion and the histological grade in cutaneous squamous cell carcinoma.
 Methods: In this retrospective study done at the histopathology department of al Wasity teaching hospital for orthopedic and plastic surgery in Baghdad, all paraffin embedded blocks for excisional biopsies diagnosed as primary cutaneous squamous cell carcinoma from December 2015 to January 2017 were retrieved. Incisional biopsies and those with margin positive tumor cells were excluded. After a careful evaluation for histological grading and assessment of level of invasion according to an established histological criteria , the assessment of tissue eosinophils was done by three pathologist through counting eosinophils in tumor stroma in 10 high power field using a light microscope and categorized as none (0,),low (1-4),medium (5-19)and high (more than 20).
 Results : of 56 cases of primary cutaneous squamous cell carcinoma 48(85.7%) cases were conventional .The mean age was 43.14 ± 1.76 .Regarding conventional squamous cell carcinoma ,of 48 cases 30(62.5) were well differentiated,16(33.3%) had clarck level III,18(37.5%) had clarck level IV and 14(29.1%) had Clark level V .There is a significant statistical relationship between histological grading of tissue eosinophilia and level of invasion with p value 0.044 and a non-significant relationship with degree of differentiation.
 Conclusion :The majority of cutaneous squamous cell carcinomas were conventional well differentiated with a mean age in the fifth decade of life ,a male predominance and often had a degree of stromal eosinophilia that is strongly associated with the level of invasion .Thus more Intense tissue eosinophilia is correlated with a higher level of stromal invasion. The significance of such an association should be regarded as either a potential predictive tool for stromal invasion in small incisional biopsy or as a prognostic indicator that could be included in the pathology report for conventional squamous cell carcinoma
Highlights
Cutaneous Squamous cell carcinoma is the second most common type of skin cancer after basal cell carcinoma that arise from epidermal keratinocytes. 1 Actinic keratosis is regarded as the premalignant precursor for cSCC2,it has a strong association with ultraviolet light from sun exposure.3Men are more commonly affected, probably due to higher head and neck exposure to sun light (UVR).[4]
Tumor associated tissue eosinophilia (TATE) means the presence of eosinophils in tumor stroma and has been reported for almost 100 years in many carcinomas located in larynx, pharynx, lung, external genitalia, gastrointestinal tract and oral cavity.[10]
Eosinophils are regarded as destructive effector white blood cells with a cytotoxic activities and are participate in tissue remodeling and in innate and acquired immune response but the exact cause and mechanism of action of eosinophil infiltration in tumor stroma have remained unknown. 11. This is a retrospective study which done at the histopathology department of al Wasity teaching hospital for orthopedic and plastic surgery in Bagdad, where all paraffin embedded blocks for excisional biopsies diagnosed as primary cutaneous squamous cell carcinoma from December 2015 to January 2017 were retrieved from patient archives together with the associated clinical information such as age, gender, and tumor location
Summary
Cutaneous Squamous cell carcinoma (cSCC) is the second most common type of skin cancer after basal cell carcinoma that arise from epidermal keratinocytes. 1 Actinic keratosis is regarded as the premalignant precursor for cSCC2 ,it has a strong association with ultraviolet light from sun exposure.3Men are more commonly affected, probably due to higher head and neck exposure to sun light (UVR).[4]. The inflammatory cells in tumor stroma are mainly due to host response to tumour.[9] Tumor associated tissue eosinophilia (TATE) means the presence of eosinophils in tumor stroma and has been reported for almost 100 years in many carcinomas located in larynx, pharynx, lung, external genitalia, gastrointestinal tract and oral cavity.[10]. In regard to squamous cell carcinoma, some studies statistical relationship between histological grading worldwide done to assess stromal eosinophilia in oral of tissue eosinophilia and level of invasion with p and cervical squamous cell carcinoma. The objectives value 0.044 and a non-significant relationship with of this study is to evaluate the association of stromal degree of differentiation.
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