Basaloid Pattern Research Articles

AMELOBLASTOMA IN A 2-YEAR-OLD BOY: A CASE REPORT

A 2-year-old boy presented a normochromic swelling on the left cheek for an unknown period. Panoramic radiography revealed a well-circumscribed, unilocular, radiolucent area extending from body to angle and ramus of mandible, measuring around 4 cm. The exploratory puncture was negative, and an incisional biopsy was performed. In the histopathology, the sections revealed neoplastic proliferation of sheets and strings of odontogenic cells, in a solid arrangement. Epithelial cells had a hyperstained nucleus with a basaloid pattern. Peripheral cells occasionally showed reverse polarization and nuclei arranged in a palisade, and central cells were loosely arranged like the stellate reticulum of the enamel organ. The neoplasm is externally lined by a thin fibrous connective tissue capsule, and the presence of tumor cell nests was observed within the capsule. There were significant hypercellularity and multiple mitotic figures throughout the lesion. The patient was sent to treatment. A 2-year-old boy presented a normochromic swelling on the left cheek for an unknown period. Panoramic radiography revealed a well-circumscribed, unilocular, radiolucent area extending from body to angle and ramus of mandible, measuring around 4 cm. The exploratory puncture was negative, and an incisional biopsy was performed. In the histopathology, the sections revealed neoplastic proliferation of sheets and strings of odontogenic cells, in a solid arrangement. Epithelial cells had a hyperstained nucleus with a basaloid pattern. Peripheral cells occasionally showed reverse polarization and nuclei arranged in a palisade, and central cells were loosely arranged like the stellate reticulum of the enamel organ. The neoplasm is externally lined by a thin fibrous connective tissue capsule, and the presence of tumor cell nests was observed within the capsule. There were significant hypercellularity and multiple mitotic figures throughout the lesion. The patient was sent to treatment.

Clinicopathologic characterization of cervical metastasis from an unknown primary tumor: a multicenter study in Korea.

Research regarding cervical metastasis from an unknown primary tumor (CUP) according to human papillomavirus (HPV) and Epstein-Barr virus (EBV) status in Korea has been sporadic and small-scale. This study aims to analyze and understand the characteristics of CUP in Korea according to viral and p16 and p53 status through a multicenter study. Ninety-five cases of CUP retrieved from six hospitals in Korea between January 2006 and December 2016 were subjected to high-risk HPV detection (DNA in situ hybridization [ISH] or real-time polymerase chain reaction), EBV detection (ISH), and immunohistochemistry for p16 and p53. CUP was HPV-related in 37 cases (38.9%), EBV-related in five cases (5.3%), and unrelated to HPV or EBV in 46 cases (48.4%). HPV-related CUP cases had the best overall survival (OS) (p = .004). According to the multivariate analysis, virus-unrelated disease (p = .023) and longer smoking duration (p < .005) were prognostic factors for poor OS. Cystic change (p = .016) and basaloid pattern (p < .001) were more frequent in HPV-related cases, and lymphoepithelial lesion was frequent in EBV-related cases (p = .010). There was no significant association between viral status and p53 positivity (p = .341), smoking status (p = .728), or smoking duration (p = .187). Korean data differ from Western data in the absence of an association among HPV, p53 positivity, and smoking history. Virus-unrelated CUP in Korea had the highest frequency among all CUP cases. HPV-related CUP is similar to HPV-mediated oropharyngeal cancer and EBVrelated CUP is similar to nasopharyngeal cancer in terms of characteristics, respectively.

Features of lymph node metastasis depending on intratumoral heterogeneity of non-small cell lung cancer in patients with different morphological changes in the bronchial epithelium

The aim of the study: to examine the relationship between the morphological diversity of non-small cell lung cancer and the frequency of lymph node metastasis in groups of patients with different epithelial conditions in the bronchi adjacent to the tumor. Material and methods. Surgical specimens from 90 patients with non-small cell lung cancer, who were treated in the Thoracoabdominal Department Of The Research Institute Of Oncology Of The Tomsk National Research Medical Center in the period from 2009 to 2017 were studied. The histological type of cancer was determined according to the who classification (2020). Lepidic, acinar, papillary, micropapillary, solid and solitary tumor cells were isolated in the parenchymal component of adenocarcinoma. In the parenchymal component of squamous cell carcinoma, 5 types of structures were distinguished: with keratinization, consisting of atypical cells of the prickly type without keratinization, consisting of atypical cells of the basaloid type, built of atypical cells with pronounced polymorphism, single tumor cells. Results. In patients with isolated basal cell hyperplasia, acinar (37 %), papillary (29 %) and solid (27 %) patterns were found less frequently in cases with metastatic regional lymph nodes compared to those without metastatic lymph nodes (63 %; p=0.05; 71 %; p=0.05; 73 %; p=0.01, respectively). In patients with isolated basal cell hyperplasia of the bronchial epithelium, in cases with the presence of lymph node metastasis in the parenchymal component of squamous cell carcinoma, structures 1 (with keratinization) (17 %), 2 (spiky pattern) (33 %) and 4 (polymorphic pattern) (29 %) were less frequently detected compared to those without metastases in regional lymph nodes (83 %; p=0.01; 67 %; p=0.02 and 71 %; p=0.01, respectively). In patients with a combination of basal cell hyperplasia and squamous metaplasia, a spiny pattern (65 %), a basaloid pattern (100 %), a polymorphic pattern (82 %) and single tumor cells (89 %) were more frequently detected in cases with metastatic lymph nodes than in cases without metastatic lymph nodes (35 %; р=0.04; 0 %; р=0.01; 18 %; р=0.01; 11 %; р=0.01, respectively). Conclusion. The data obtained clarify the available information on the significance of the morphological heterogeneity of the tumor for predicting the course of adenocarcinoma and squamous cell carcinoma of the lung.

Genetic basis of SMARCB1 protein loss in 22 sinonasal carcinomas

SMARCB1-deficient sinonasal carcinoma (SNC) is an aggressive malignancy characterized by INI1 loss mostly owing to homozygous SMARCB1 deletion. With the exception of a few reported cases, these tumors have not been thoroughly studied by massive parallel sequencing (MPS). A retrospective cohort of 22 SMARCB1-deficient SNCs were studied by light microscopy, immunohistochemistry, fluorescence in situ hybridization (n = 9), targeted exome MPS (n = 12), and Fraction and Allele-Specific Copy Number Estimates from Tumor Sequencing (FACETS) (n = 10), a bioinformatics pipeline for copy number/zygosity assessment. SMARCB1-deficient SNC was found in 13 (59%) men and 9 (41%) women. Most common growth patterns were the basaloid pattern (59%), occurring mostly in men (77%), and plasmacytoid/eosinophilic/rhabdoid pattern (23%), arising mostly in women (80%). The former group was significantly younger (median age = 46 years, range = 24–54, vs 79 years, range = 66–95, p < 0.0001). Clear cell, pseudoglandular, glandular, spindle cell, and sarcomatoid features were variably present. SMARCB1-deficient SNC expressed cytokeratin (100%), p63 (72%), neuroendocrine markers (52%), CDX-2 (44%), S-100 (25%), CEA (4/4 cases), Hepatocyte (2/2 cases), and aberrant nuclear β-catenin (1/1 case). SMARCB1 showed homozygous deletion (68%), hemizygous deletion (16%), or truncating mutations associated with copy neutral loss of heterozygosity (11%). Coexisting genetic alterations were 22q loss including loss of NF2 and CHEK2 (50%), chromosome 7 gain (25%), and TP53 V157F, CDKN2A W110∗, and CTNNB1 S45F mutations. At 2 years and 5 years, the disease-specific survival and disease-free survival were 70% and 35% and 13% and 0%, respectively. SMARCB1-deficient SNCs are phenotypically and genetically diverse, and these distinctions warrant further investigation for their biological and clinical significance.

ORAL BASALOID PATTERN SQUAMOUS CELL CARCINOMA: CASE REPORT

A 72-year-old male patient was referred to the clinic with the major complaint of gum and tongue mouth ulcers with more than 6 months of evolution. Anamnesis revealed smoking and chronic alcoholism for 60 years. At the extraoral examination, submandibular lymph nodes were bilaterally enlarged, hardened, and fixed to palpation. Intraoral examination revealed total edentulism and extensive ulcer on the anterior mouth floor, involving the ventral surface of the tongue and anterior inferior alveolar ridge with volumetric enlargement, tongue without mobility, hardened to palpation, pain, and limitation of oral opening. Panoramic radiograph showed a radiolucent image in the anterior region of the mandible with irregular bone destruction similar to moth-eaten and approximately 4 cm in the largest diameter. Diagnostic hypothesis was squamous cell carcinoma. Incisional biopsy was performed. The histopathologic report confirmed the diagnosis of basaloid pattern squamous cells carcinoma. The patient was referred for cancer treatment.

Oropharyngeal Squamous Cell Carcinoma in 390 Patients: Analysis of Clinical and Histological Criteria Which Significantly Impact Outcome.

This study evaluates the prognostic impact of several factors in oropharyngeal squamous cell carcinoma (OPSCC), controlling for human papillomavirus (HPV)-associated tumors and stage (American Joint Committee on Cancer 8th edition). All patients in Southern California Permanente Medical Group diagnosed with OPSCC between 2006 and 2012 tested for p16 immunohistochemistry were included. Review of all pathology materials was combined with central p16 testing. Multivariable analyses were performed. The cohort of 390 patients included 342 p16-positive and 48 p16-negative tumors. For all-comers, on univariate analysis, the following factors, when present, were associated with improved patient survival: p16-positive tumor (n = 324, p < 0.001); crypt versus surface tumor location (n = 312, p = 0.004); nonkeratinizing type (n = 309, p < 0.0001); nonkeratinizing with maturation type (n = 37, p < 0.0001); basaloid pattern (n = 284, p = 0.005); and a broad, pushing border of infiltration (n = 282, p = 0.004). Inferior survival outcomes were observed with: age ≥ 55years (p < 0.0001); ≥ 10 pack-year smoking history (n = 183, p = 0.003); increasing tumor stage (p < 0.0001); overt radiographic extranodal extension (ORENE) (n = 58, p < 0.0001); low level IV/Vb lymph node involvement (n = 45, p = 0.0002); a jagged pattern of infiltration (n = 76, p = 0.0004); tumor ulceration (n = 76, p = 0.0004); absent lymphocytic infiltrate (p < 0.0001); and concurrent dysplasia (n = 125, p = 0.009). On multivariable analysis, accounting for patient age, smoking history ≥ 10 pack-years, and TNM stage, for patients with p16-positive disease, advanced TNM stage (p = 0.007), the presence of ORENE (p = 0.0002), and low-neck lymphadenopathy (p = 0.0001) were independent negative prognostic factors for disease free survival (DFS). Older age (p < 0.0001), smoking history ≥ 10 pack-years (p = 0.02), advanced TNM stage (p = 0.0002), ORENE (p = 0.004), and low-neck lymphadenopathy (p = 0.002) were independent negative prognostic factors for OS. Among patients with p16-positive OPSCC, older age, smoking history, advanced stage, ORENE, and low-neck lymphadenopathy were significant negative prognostic factors for DFS and/or OS. Further refinement of staging to incorporate additional lymph node findings may be warranted.

The variable morphological spectrum of penile basaloid carcinomas: differential diagnosis, prognostic factors and outcome report in 27 cases classified as classic and mixed variants

BackgroundBasaloid carcinomas of the penis, HPV-related tumors, are morphologically less homogenous than originally thought. The study objective was to evaluate the prognostic influence of the basaloid pattern in mixed tumors.MethodsWe studied 154 Mexican patients from the Hospital de Oncología, CMN, Mexico City (2000–2013) and found 27 with basaloid features in at least 20% of the sections classified as classic basaloid (8 cases), warty-basaloid (7), papillary-basaloid (5) and usual-basaloid squamous cell carcinomas (7). We evaluated patients’ age, site and size of tumor, histological classification, grade, thickness, anatomical level, vascular and perineural invasion, prognostic index score and node involvement. Penile intraepithelial neoplasia in adjacent epithelia was documented. Follow up ranged from 12–78 months. Statistical methods were Fisher’s exact test and Kruskal-Wallis test. Kaplan-Meier method and log-rank test were used for survival analysis. The cutoff for statistical significance was p <0.05.ResultsThere were not clinical differences. Microscopically types were distinctive and easy to separate. Usual-basaloid squamous cell carcinomas were smaller, thinner and rarely invaded corpora cavernosa, with a low prognostic index score. Classic basaloid, warty-basaloid and papillary-basaloid carcinomas had higher rates of vascular and perineural invasion and higher prognostic index scores. These findings correlated with the rate of nodal metastasis. The majority of patients with classic and papillary-basaloid neoplasms died from systemic metastasis (87.5 and 80%) whereas only 1 patient with usual-basaloid carcinoma died of the disease (14%).ConclusionsBasaloid carcinomas are not a single entity but a spectrum of variable histological architectures mixed with those of classic basaloid tumors. Identification of mature squamous cells in a basaloid carcinoma may be important to recognize and report because patients with these tumors may carry a better prognosis.

Comprehensive Pathological Analyses in Lung Squamous Cell Carcinoma: Single Cell Invasion, Nuclear Diameter, and Tumor Budding Are Independent Prognostic Factors for Worse Outcomes

For lung squamous cell carcinomas, there are no pathological findings that have been universally accepted as prognostic factors, with the exception of pathological stage. Tumor budding and nuclear grade have been recognized as a poor prognostic factor in other carcinomas. In this study, we investigated whether pathological findings could determine prognosis in lung squamous cell carcinomas. All available tumor slides from patients with surgically resected, solitary lung squamous cell carcinomas (1999-2009) were reviewed (n = 485; stage I/II/III, 281/136/68). Tumors were evaluated for differentiation, subtypes (keratinizing, nonkeratinizing, basaloid pattern, papillary growth, and clear cell feature), tumor nest size (tumor budding and single cell invasion), and nuclear grade (nuclear diameter and mitosis). Overall survival (OS) was estimated using the Kaplan-Meier method (stratified by pathological stage), and group differences were investigated using the stratified log-rank test and the Cox proportional hazards model. OS was significantly decreased in patients with versus without single cell invasion (p = 0.002 for the entire tumor and p = 0.001 for tumor edge), with large versus small nuclei (p = 0.011), and with high versus low grade tumor budding (p < 0.001 for maximum and p = 0.007 for total). In multivariate analyses, single cell invasion (hazard ratio [HR], 1.47-1.49), nuclear diameter (HR, 1.09-1.33), and tumor budding (HR, 1.04) were independent prognostic factors of OS. However, histologic subtyping including keratinizing, nonkeratinizing, basaloid, and clear cell subtypes did not show prognostic significance. Pathological factors can help stratify prognosis in patients with lung squamous cell carcinomas.

Imaging feature and clinical histological analysis of 12 adenoid cystic carcinoma of the lacrimal gland

To study the imaging and histologic features of adenoid cystic carcinoma (ACC) of the lacrimal gland. It was a retrospective case series study. Twelve patients with ACC of the lacrimal gland were surgically treated in Tianjin First Center Hospital from September 2009 to November 2011. The 5 men and 7 women aged from 22 to 63 years (average 42.6 years). The imaging and histologic features of 12 cases with ACC of the lacrimal gland pathologically confirmed were retrospectively reviewed. Twelve cases were performed with CT scan, 10 cases with MRI scan. All patients were followed up by telephone and reexamination in the outpatient service, and 2 patients were lost to follow-up. The lesions originated in the orbital lobe of the lacrimal gland. The most common presenting symptom was pain; it was followed by proptosis, ptosis, decreased visual acuity and diplopia. The 7th Edition of the American Joint Committee on Cancer TNM Classification system for Lacrimal Gland Tumors stages were as follows: T1N0M0 1 patients, T2N0M0 4 patients, T4N0M0 7 patients. Preoperative CT imaging suggested that bony involvement of the lacrimal gland fossa in 7 patients;this was histologically confirmed in 6 of the 7. Preoperative CT imaging suggested no bone involvement in 5 patients, 1 of whom had bone involvement by histology. The positive rate of CT scan was 6/7. Preoperative MRI imaging suggested that bony involvement of the lacrimal gland fossa in 7 patients;this was histologically confirmed in 6 of the 7. Preoperative MRI imaging suggested no bone involvement in 3 patients who were confirmed by histology. The positive rate of MRI scan was 6/7. Overall, 7 of 12 histologically evaluable cases had bone invasion. Five of the histologically proven 7 patients with bone involvement had a predominantly basaloid pattern, 2 mixed pattern. Three patients had local recurrence. The imaging for ACC of the lacrimal gland is characteristic. ACC of the lacrimal gland is associated with the high rate of bone invasion. The basaloid variety has more aggressive biologic behavior. The risk of local recurrence may be associated with the histologic types and stages of lacrimal gland adenoid cystic carcinoma.

Mesenchymal–Epithelial Differentiation of Adamantinoma of Long Bones: An Immunohistochemical and Ultrastructural Study

Three cases of adamantinoma were studied by electron microscopy and immunohistochemistry. In the tubular pattern, well-differentiated epithelial cells and glandular structures were present, in addition to ill-defined glands. In the basaloid pattern, less differentiated epithelial cells with discohesion were seen in the central epithelial masses. This study established the epithelial nature of some tubular structures with slit-like lumina, easily misinterpreted as capillaries by light microscopy. Results also showed that the irregular spaces observed within the basaloid pattern probably result from cell discohesion. Moreover, this investigation demonstrates the epithelial nature of a subset of spindle cells within the stroma of adamantinoma and offers ultrastructural evidence for a probable mesenchymal–epithelial transformation as its histogenesis.

Fine‐needle aspiration cytology of ameloblastoma and malignant ameloblastoma: A study of 12 cases

Ameloblastoma is an odontogenic tumor with aggressive biological behavior, high recurrence rate, and a complex microscopic appearance with many different histologic patterns. Primary ameloblastoma is also described in extragnathic locations. Because of its wide morphologic spectrum, which is mirrored also in cytologic smears, a thorough study of distinctive features is required to reach a reliable diagnosis. Twelve cases of ameloblastoma were examined both cytologically and histologically. The patients were seven women and five men 24-85 years old, mean age being 64 years. Eleven cases were primary tumors of the mandible and maxilla, and one case was a lung tumor metastatic from the tibia. The epithelial element in the cytologic smears of the various cases was morphologically diverse. The basaloid pattern and minimal nuclear atypia were rather constant findings, and the most helpful features toward reaching a cytological diagnosis. However in most cases, careful consideration of the clinical, radiological, cytological, and occasionally immunocytochemical data was required to rule out other entities with similar cytological findings. In some cases, the final diagnosis was only possible by histologic examination. Due to their variable microscopic morphology, ameloblastomas are quite often misdiagnosed for other entities, both benign and malignant. Nevertheless, when one is aware of their distinctive features, an accurate diagnosis can be made by fine-needle aspiration cytology, in conjunction with clinical and radiological findings. Both the preoperative surgical planning and the postoperative follow-up of the patients benefit significantly from this method.

Focal neuroendocrine differentiation in prostatic gland carcinoma with basaloid pattern

Prostatic gland basal cell proliferations exhibit morphological continuum ranging from basal cell hyperplasia to basal cell carcinoma. In the following report, we described clinical features, morphological spectrum, neuroendocrine differentiation and histogenesis of prostatic gland basal cell carcinoma in our patient. Hematoxylin-eosin (HE), Alcian blu-periodic acid schiff (AB-PAS) at pH 2.5 stained sections and the avidin-biotin-peroxidase complex (ABC), were performed on prostate gland paraffin-embedded tissue. Monoclonal antibodies directed against cytokeratin (34betaE12) which selectively stains basal cells, prostate specific antigen (PSA), chromogranine A, neuron-specific enolase (NSE), synaptophysin and CD56, were used. Basal cell proliferations exhibited a morphological continuum ranging from basal cell hyperplasia to prostatic gland carcinoma. In these prostatic lesions, positive reactivity was demonstrated for 34betaE12 and CD56. These findings indicate that the basaloid cells of basal cell hyperplasia, florid basal cell hyperplasia, atypical basal cell hyperplasia and basal cell carcinoma are derived from basal cells of the normal prostate gland suggesting a continuum in the progression of hyperplasia to benign and then malignant neoplasia. The presence of CD56 protein in the discovered lesions may be related to their neuroendocrine differentiation. The fact, that our patient was well six years after the radical prostatectomy supports the belief of some authors that basal cell carcinoma represents a low grade carcinoma with an excellent prognosis.

Basal cell cystadenoma of the lacrimal gland: diagnostic pitfalls of a basaloid pattern in lacrimal tumours

An 85-year-old male experienced a painless swelling along the left lateral orbit for one year. A computed tomography scan demonstrated a cystic mass in the orbit adjacent to the lacrimal gland. There was a concern for malignancy considering the large size and the patient's age, so the tumour was excised. Histopathology of the tumour showed nests with basaloid patterns, but a definitive diagnosis was not rendered. The uncertainty of tissue diagnosis coupled with the basaloid pattern, which carries a grim prognosis in some salivary gland tumours, led us to refer this case to an authority on lacrimal gland pathology, who suggested that this tumour be called a basal cell cystadenoma. To the best of our knowledge, a basal cell cystadenoma of the lacrimal gland has not been reported in the literature. We present histopathological features that distinguish this tumour from malignant tumours with a basaloid pattern. We also discuss the management differences associated with basaloid patterns in lacrimal tumours.

Adamantinoma of Long Bones: A Long-term Follow-up Study of 11 Cases

The aim of this study was to evaluate the clinicopathological features and prognostic significances of 11 histologically proven adamantinoma cases based on an average 12,7 year long follow-up. The male: female ratio was 8:3, aged between 4 and 80 years (mean 29,3 years). The initial diagnosis at referral was other than adamantinoma in six patients (fibrous dysplasia, carcinoma metastasis, osteofibrous dysplasia, bone cyst, non-ossifying fibroma), referring to the differential diagnostic problems. All tumors were localized to the mid part of tibia. By histological evaluation, basaloid pattern on a background of fibrotic stroma dominated in six patients, while spindle and squamous features were less frequently seen. All adamantinoma were positive for cytokeratins often in coexpression with vimentin. No correlation was experienced between histology and clinical outcome. Intralesional curettage (2 pts) was followed by recurrence of the tumor. Wide resection was performed in eight patients with reconstruction using intercalary fibula autografts in seven patients. Reconstruction-related complications occurred in two third of the cases, all of them could however be controlled by repeated surgery. Six recurrences occurred in four patients, two of these recurrences occurred 20 and 16 years after initial surgery. One patient died 9 years after recognition of the tumor of pulmonary metastases. Adamantinoma of the long bones is a low grade malignant tumor, which clinical outcome is difficult to predict based on histology or surgical stage of the tumor. Wide surgical margin, e.g. resection the tumor reduces the rate of recurrence. This study underlines that recurrences do occur even decades after recognition the tumor, therefore a life-long follow-up of the patient is necessary.

Lung carcinomas with a basaloid pattern: a study of 90 cases focusing on their poor prognosis

Lung carcinoma with a basaloid pattern (BC) is classified as either a basaloid variant of squamous cell carcinoma (SCC) or as variant of large cell carcinoma (LCC) depending on the presence of a squamous component. In a previous study of 37 cases, the present authors showed that BC presented with a shorter median and overall survival. In order to confirm its clinical significance in a larger series, 90 BC, including 46 basaloid variants of LCC and 44 basaloid variants of SCC, were compared with 1,328 other nonsmall cell lung carcinoma (NSCLC) with regard to clinical features and survival. The survival of basaloid variants of LCC and SCC was comparable. Median and overall survival were significantly lower for BC than for NSCLC in stage I-II patients, with a median survival of 29 and 49 months, respectively, and 5-yr survival rates of 27 and 44% for BC and NSCLC. When disease-specific survival was considered, BC had a shorter survival than both NSCLC and SCC. Basaloid pattern confers a poor prognosis in nonsmall cell lung carcinoma, especially in stage I-II patients, suggesting that lung carcinoma with a basaloid pattern is not only a variant of squamous cell carcinoma or large cell carcinoma, but is a unique entity with a significantly poor prognosis.

Undifferentiated carcinoma arising from the Stensen's duct: a case report and review of the literature

Primary carcinoma arising in Stensen's duct is an extremely rare and poorly understood tumor. A 38-year-old man was referred with a malignant lesion situated in the right cheek. The patient was treated by local resection, total parotidectomy, and modified radical neck dissection. Microscopic examination revealed tumor cells of basaloid pattern with squamous differentiation in some areas. The tumor showed a very aggressive behaviour with early local recurrence and metastatic disease. The histological and radiological findings suggest the origin from the Stensen's duct. Primary carcinoma of Stensen's duct should be histologically consistent with epidermoid, mucoepidermoid, or undifferentiated carcinoma. The diagnosis of true Stensen's duct carcinoma can be performed on the basis of clinical presentation, radiological findings, and tumor histology. Criteria for determination of origin in the duct are revised and compared with this case.

Squamous Cell Carcinoma of the Vulva in Brazil: Prognostic Importance of Host and Viral Variables

Background. Certain clinicopathologic features of vulvar squamous cell carcinoma have been correlated with adverse prognosis. However, few large-scale studies have addressed their role in patient survival. This study examined the relationship between multiple variables and prognosis in a large group of vulvar cancers in Brazil.Methods. One hundred eighty-four Brazilian women with vulvar carcinoma were studied and the following variables recorded: age, pathologic TNM stage, survival, histologic grade, tumor histologic pattern, invasion pattern, tumor thickness, and tissue stromal and inflammatory response. Human papillomavirus (HPV) was detected by polymerase chain reaction amplification of extracted archival DNA. Data were analyzed using Cox proportional hazards modeling.Results. After controlling for age, the probability of cancer survival decreased with increasing age, stage, grade, and tumor thickness, a fibromyxoid stromal response, infiltrative growth pattern, and basaloid histologic pattern. With the exception of fibromyxoid stromal response, each of these variables remained prognostically significant after adjustment for several other predictors in a multivariate model. Women whose tumors displayed a basaloid pattern were 3.5 times as likely to die from cancer than those with keratinizing tumors [hazard ratio (HR) = 3.5, 95% CI(1.3–9.2)]. An infiltrative invasion pattern strongly increased the probability of cancer death [HR = 4.6, 95% CI(1.9,11.4)]. HPV status did not influence survival, despite its association with basaloid histology.Conclusions. Previously reported associations of negative HPV status and fibromyxoid response with adverse prognosis in vulvar cancer were not confirmed by multivariate analysis. Basaloid variants, and particularly diffusely infiltrative tumors, carry an adverse prognosis.

Basaloid squamous carcinoma of esophagus:a clinicopathological, immunohistochemical and electron microscopic study of sixteen cases.

AIM:To further clarify the clinicopathological, immunohistochemical and electron microscopic features, and prognostic aspect of basaloid squamous carcinoma (BSC), a rare esophageal carcinoma.METHODS:We reviewed 763 documented cases of esophageal malignancies from year (1977-1996) from our hospital, and discovered 16 (2.1%) cases of BSC. The clinicopathological features of these cases were evaluated. Immunohistochemistry (S-P method), histochemical stains, and electron microscopy were used to further characterize the neoplasm.RESULTS:The tumors were classified into stages I(n =1), II A (n =6), II B(n =2), II (n =5), and IV(n =2) according to the criteria of the UICC TNM classification system of malignant tumors (1987). Most neoplasms were located in the mid third of the esophagus. Grossly, they had a similar appearance of conventional esophageal carcinoma, but showed a typical cytoarchitectural pattern of BSC histologically. The most important histologic feature of this tumor is carcinoma with a basaloid pattern, intimately associated with squamous cell carcinoma, dysplasia, or focal squamous differentiation. The basaloid cells were round to oval in shape with scant cytoplasm, arranged mainly in the form of solid, smooth-contoured lobules with peripheral palisading.A panel of immunostains were used for the basaloid component of the tumor with the following results:CK(Pan) 14/16(+); EMA 16/16 (+); Vimentin 4/16 (+); S-100 protein 7/16 (+). CEA and smooth muscle actin were negative. Electron microscopy (EM) revealed that the basaloid cells were poorly differentiated, with a few desmosomes and fibrils, and numerous free and polyribosome. Of the 11 patients with adequate follow-up 8 died within 2 years, with an average survival time of 16.2 months.No stage II,III or IV cases survived beyond 5 years. The one-year survival rate was 60% and two-year 20%.CONCLUSION:The BSC of esophagus is a distinct clinicopathological entity with poor prognosis. The cellular differentiation and biologic behavior of esophageal BSC were assumed to occupy a station intermediate between that of conventional squamous cell carcinoma and small undifferentiated cell carcinoma.

Detection of human papillomavirus in anorectal squamous cell carcinoma. Correlation with basaloid pattern of differentiation.

Polymerase chain reaction (PCR) and in situ hybridization were used to test for the presence of human papillomavirus (HPV) DNA in cases of anorectal squamous cell carcinoma. Human papillomavirus was detected by PCR with L1 consensus sequence primers in 22 of 27 cases, including 10 of 11 cases with a prominent basaloid pattern and 12 of 16 cases without basaloid patterns of differentiation. Slot blot hybridization identified HPV type 16 as the most common type, present in 7 of 10 cases of basaloid carcinoma and 10 of 12 cases without basaloid features. In situ hybridization confirmed the presence of HPV in tumor cell nuclei of five cases of basaloid carcinoma and in eight cases of squamous cell carcinoma without basaloid pattern. The authors conclude that the prevalence of HPV in cases of anorectal squamous cell carcinoma is unrelated to the presence or absence of a basaloid pattern of differentiation.

Basaloid squamous carcinoma of the oral cavity: Report of a case

A case of basaloid squamous carcinoma that involves the posterior buccal mucosa is described. The major histopathologic feature is a carcinoma with a basaloid pattern in association with squamous differentiation. The basaloid cells exhibit large and vesicular nuclei and eosinophilic clear or vacuolated cytoplasm. Cells are distributed in cords, trabeculae, or lobules that occasionally show glandular arrangement. The majority of the tumor cells are positive for keratin and a large group of cells distributed in glandular arrangement are positive also for vimentin.