Benign Squamous Cell Research Articles

Epidermal inclusion cyst in breast: Is it so rare?

Background:Epidermal inclusion cyst in the breast (EICB) is very rare. It presents as breast lump mainly in peri-areolar region and needs to be differentiated from other breast lesions with predominance of squamous cells.Aim:To analyze the role of fine needle aspiration cytology (FNAC) in patients presenting with breast lump.Materials and Methods:The present study is a retrospective study over the period of past 2 years, where the patients presented with firm breast lumps. Six of these cases were diagnosed as EICB on FNAC. Smears from these cases were reviewed for cytomorphological findings and correlated with clinico-radiological details.Results:Patients ranged in age from 25 to 60 years, and female to male sex ratio was 2:1 (female 4, male 2). Mammography was done in women (4), which showed solid, well-defined mass lesions in peri-areolar region and were suggestive of benign breast lesions (3) and infective lesion (1). FNA was performed; Giemsa-stained smears showed predominantly mature benign squamous cell and anucleated squames in all cases, thus one of the cytological diagnoses was EICB. Five of these cases had histological confirmation.Conclusion:EIC of breast is not that rare lesion as considered. The patients may not seek medical attention because of small painless swelling; unless the lump increases in size or becomes painful. FNAC is confirmatory in the presence of a typical pultaceous aspirate and cytomorphological features of EIC. Thus, FNAC plays a crucial role in its diagnosis and management. Symptomatic cases should be readily excised and need histological correlation to rule out any potential complications that can arise in these cysts.

Asphalt fume dermal carcinogenicity potential: II. Initiation–promotion assay of Type III built-up roofing asphalt

Clark et al. (accepted for publication) reported that a sample of field-matched fume condensate from a Type III built-up roofing asphalt (BURA) resulted in a carcinogenic response in a mouse skin bioassay, with relatively few tumor-bearing animals, long tumor latency and chronic skin irritation. This mouse skin initiation/promotion study was conducted to assess possible mechanisms, i.e., genotoxic initiation vs. tumor promotion subsequent to repeated skin injury and repair. The same Type III BURA fume condensate sample was evaluated in groups of 30 male Crl:CD1® mice by skin application twice per week (total dose of 50 mg/week) for 2 weeks during the initiation phase and for 26 weeks during the promotion phase. Positive control substances were 7,12-dimethylbenz(a)anthracene (DMBA, 50 μg applied once) as an initiator and 12-O-tetradecanoyl-13-acetate (TPA, 5 μg, applied twice weekly) during the promotion phase. During the 6 months of study with the asphalt fume condensate, eight skin masses were observed when tested for initiation, five of which were confirmed microscopically to be benign squamous cell papillomas. Only two papillomas were observed when tested for promotion. There was no apparent relationship between skin irritation and tumor development in this study. These results are more indicative of genotoxicity rather than a non-genotoxic mode of action.

Schemat postępowania i wstępne wyniki leczenia brodawczaków krtani dotkankowym preparatem cidofovir

Recurrent respiratory papillomatosis (RRP) is a rare disease in children and adults. It is characterized by proliferation of benign squamous cell papillomas within the respiratory-digestive tract, predominantly the larynx. Standard treatment consists of surgical excision of papillomata to maintain airway patency and voice quality. For last several years cidofovir is the most contemporary adjuvant anti-viral treatment for recurrent respiratory papillomatosis and its topical use is widely described. Intralesional cidofovir therapy was given to 20 patients treated for laryngeal papillomas in the Department of Otolaryngology in Poznan between I-XII.2009. The character of the lesion differed: from one anatomical site and moderate growth to four or five localizations with heavy extension. The number of cidofovir injections per patient varied from one to six times and the volume of solution ranges from 1-12 ml. The cidofovir injections were combined with laser or mechanical excision of the lesions. In disperse papillomata the injections administered in particular anatomical sites in 4-6 weeks period. In massive lesions injections were repeated in the same anatomical site. Complete remission was observed in 3 out of 20 patients. 12 patients show remission in a place of cidofovir injection. In 4 patients during the 4 week observation new foci of papillomatosis occurred. In two patients hepatic toxic side effect were observed. Intralesional cidofovir injection has been shown to be an effective an safe therapy for laryngeal papilloma and should be considered in those patients who experienced disease relapse.

Ghrelin and obestatin expression in oral squamous cell carcinoma: an immunohistochemical and biochemical study

The underlying molecular mechanism of carcinogenesis in oral squamous cell carcinoma (OSCC) is poorly understood and appears to be controlled on many genetic, environmental, and hormonal factors. Obestatin and ghrelin, two recently discovered hormones, are co-expressed in endocrine cells. The purpose of this investigation was to examine the immunohistochemical features of OSCCs in relation to the tissue concentration of ghrelin and obestatin. The association between OSCC and Epstein Barr Virus (EBV) status was also explored. The expression of ghrelin and obestatin was examined by immunohistochemistry and immunoassay in oral biopsy specimens: 10 benign squamous epithelial cell samples, 10 microinvasive squamous cell carcinomas, and seven well-differentiated and seven poorly differentiated OSCCs. The presence of EBV was evaluated in these samples using immunohistochemistry. The concentrations of ghrelin and obestatin in tissue homogenates were measured by RIA and ELISA, respectively. Squamous cell carcinomas and benign tissue samples were positive for anti-EBV antibody, and obestatin and ghrelin were shown to be co-expressed in all stratified squamous epithelium samples. Expression of ghrelin and obestatin was decreased or absent in OSCCs in relation to the invasiveness of the carcinoma; ghrelin and obestatin levels in cancerous tissue homogenates were lower than in benign tissue homogenates. These results indicate that the concentrations and distribution of immunoreactive obestatin and ghrelin might be helpful in distinguishing OSCC from benign tumors. Maintaining normal levels of these hormones might be required for regulation of normal cell division. However, detailed studies will be required for better understanding of the complex mechanism of carcinogenesis relating to OSCCs.

Performance of the Cytologic Examination for the Diagnosis of Endocervical Adenocarcinoma in Situ

To analyze the performance of cytologic examinations for the diagnosis of adenocarcinoma in situ (AIS) through the correlation between the cytologic and histologic findings.This study included 60 patients followed at the Brazilian National Cancer Institute from November 1998 to December 2007, with the cytopathologic diagnosis of AIS. The percentage of agreement between cytologic and histologic findings was evaluated.Histologic study confirmed AIS in 28.3% (17/60) and invasive endocervical adenocarcinoma in 38.3% (23/60) of the cases. In 21.7% (13/60) of the patients, the histologic examination revealed cervical intraepithelial neoplasia (CIN) 2/3 and in 5.0% (3/60) squamous invasive carcinoma; in the remaining 5.0% (3/60) the diagnosis pointed to other neoplasms, and 1.7% (1/60) showed exclusively benign squamous cell lesions. Cytology identified lesions in 98.3% of the patients; 51% was intraepithelial.Although cytomorphologic criteria for diagnosis of AIS have been published, there was significant difficulty in interpreting glandular lesions. However, despite the fact that cytology has shown a poor performance in identifying glandular lesions, in almost all cases (98.3%) the presence of a clinically significant injury was detected. As knowledge of this diagnosis increases, better performance is expected.

Gene profiling in Pap-cell smears of high-risk human papillomavirus-positive squamous cervical carcinoma

The purpose of the study was to investigate benign and malignant squamous cervical cells obtained by cervical swabs with regard to differentially expressed genes and gene expression profiling, in order to evaluate the biological behavior and clinical outcome of cervical malignancies. Cervical squamous cells from six women with high-risk human papillomavirus positive [HR-HPV(+)] cervical carcinoma and from six HPV-negative women with normal ectocervical cells were analyzed by cDNA array. cDNA over-expression of several genes such as MET (c-met), Nm23-H1 (NME1), EGFR, KGFR, Nm23-H2 (NME2), ERBB2 (c-erbB-2), cyclin-dependent kinase inhibitor 4 (CDKN2A, p16INK4A), cytokeratin 8 (KRT8), KRAS (K-ras), FLT1, KGF (FGF7), BCL2-like 2 protein (BCL2L2), ERBB4, MYCN (N-myc), cyclin D1 (CCND1), KIT (c-kit), secreted phosphoprotein 1 (SPP1) and STAT1, was significant in cervical squamous cell carcinoma (CSCC). Gene expression was downregulated for 13 genes in CSCC, such as interleukin 1 alpha (IL1A), the transforming growth factor receptor beta superfamily (TGFbeta; TGFB), some members of the insulin-like growth factor binding proteins (IGFBPs) and the integrin family (ITGA6, ITGB1). This study was focused on the gene expression profiling of HR-HPV(-) and (+) cervical squamous cells and CSCC obtained by cytobrush. We observed gene expression patterns and signaling pathways that permit the investigator to distinguish between benign squamous cervical cells and CSCC with and without HPV infection.

The utility of GLUT-1 immunolocalization in cell blocks

Cytologic distinction of metastatic cystic squamous cell carcinoma (SCC) from benign squamous cell lesions, especially the ones with superimposed inflammatory atypia, can be very challenging. The authors evaluated the usefulness of glucose transporter-1 (GLUT-1) immunostaining as an adjunct to fine-needle aspirations of squamous lesions of the head and neck. Immunohistochemical staining for GLUT-1 was performed on paraffin-embedded cell blocks of 28 cases with the following cytologic diagnoses: 1) metastatic SCC (11 cases); 2) atypical squamous cells, SCC [corrected] cannot be excluded (6 cases); and 3) cytologic findings consistent with branchial cleft cyst (BCC) (11 cases). All 11 cases with an unequivocal cytologic diagnosis of metastatic SCC were positive for GLUT-1. Tissue follow-up confirmed metastatic SCC in all 11 cases. The squamous cells in all 11 cases with cytologic findings consistent with BCC were negative for GLUT-1; tissue follow-up confirmed diagnoses of BCC in 8 cases. In the remaining 3 cases, excision was not performed, and, clinically, no recurrences were identified at 28, 20, and 16 months of follow-up. Of the 6 cases with cytologic diagnosis of atypical squamous cells, 3 were negative and 3 were positive for GLUT-1. Subsequent excisional biopsies in these cases revealed 4 cases of metastatic SCC (3 positive and 1 negative for GLUT-1), 1 case of BCC (negative for GLUT-1), and 1 case of thyroglossal duct cyst (negative for GLUT-1). GLUT-1 immunostaining is a useful adjunct in differentiating benign and malignant squamous lesions in cell-block material. Although negative staining for GLUT-1 does not exclude malignancy, positive immunoreactivity for GLUT-1 may aid in accurate diagnosis of malignancy in cytomorphologically equivocal squamous lesions of the head and neck.

Significance of Squamous Cells in Fine Needle Aspiration Cytology of the Breast

To delineate the significance of detecting squamous cells in fine needle aspiration biopsy of breast lesions. The authors reviewed 15 cases of fine needle aspiration cytology of the breast with a discernible number of squamous cells from the files of Pamela Youde Nethersole Eastern Hospital, Hong Kong, during a seven-year period from the start of 1994 to the end of 2001. The cytologic features were correlated with clinical, radiologic and histologic findings, if any. Among the 15 fine needle aspirates of the breast with a discernible number of squamous cells, 5 of them represented metaplastic carcinoma. The remaining consisted of 3 cases of fibroepithelial tumors, 1 case of duct ectasia, 3 cases of subareolar abscess, 2 cases of sclerosed intraduct papilloma and 1 case of benign breast cyst. In general, benign squamous cells were bland looking and often associated with anucleated squames. They were mitotically inactive and could show a good maturation pattern. Tumor cell cannibalism was rare. The presence of abundant, foamy macrophages in the background suggested a benign lesion. The primary diagnosis could be deduced by recognition of other features, such as the presence of myxoid stromal tissue and papillary structures. In contrast, malignant squamous cells in metaplastic carcinoma were more pleomorphic and mitotically active. Dyskeratosis and tumor cell cannibalism were obvious. Tumor diathesis and bizarre-shaped cells were sometimes found. Squamous cells occur in fine needle aspirates from a number of benign and malignant breast lesions. Benign conditions with abundant squamous cells may sometimes mimic malignant squamous lesions and vice versa. Careful assessment of the cytologic features of squamous cells and background appearance is crucial for achieving a correct diagnosis.

Selected Problems in Fine Needle Aspiration of Head and Neck Masses

A wide variety of masses in the head and neck, including those in the major salivary glands, can be approached by fine needle aspiration. In many instances, a correct definitive diagnosis con be rendered after examination of smears or cell block material. However, several significant but uncommon areas can lead to diagnostic difficulties, with the potential for clinically important diagnostic errors. Many of these occur in salivary gland lesions. The most frequent problems involve variations in the expected cytology of pleomorphic adenoma. Then, there are several benign–malignant “look-alike” pairs of lesions. The first of these is related to small-cell epithelial neoplasms of low nuclear grade; the most frequent problem is between basal cell adenomas and adenoid cystic carcinoma, particularly the solid (anaplastic) type. The next area contrasts mucoepidermoid carcinoma with its cytologic mimic, benign salivary gland duct obstruction. The final difficulty in salivary gland aspiration contrasts large-cell epithelial lesions of low nuclear grade: oncocytic proliferations and acinic cell carcinoma. The clinical implications of cytologically benign squamous cell–containing cyst aspirates from the lateral neck will be discussed. Finally, a brief consideration of methodological optimization for thyroid aspirations will be offered.

Topical Mitomycin C and Radiation Induce Conjunctival DNA-Polyploidy

Introduction: Atypical cell changes often occur following treatment of premalignant or malignant conjunctival neoplasias with topical mitomycin C (MMC) and/or radiation. These reactive, non‐neoplastic alterations of the conjunctival epithelium can be a differential diagnostic problem. Our aim was to investigate changes in the nuclear DNA‐distribution of conjunctival epithelial cells after MMC‐ and radiation therapy by DNA‐image‐cytometry. Methods: Conjunctival brush smears were obtained from 13 patients (13 eyes) with squamous cell carcinomas and six patients (6 eyes) with conjunctival malignant melanomas in situ before, during and after treatment. The patients were treated with MMC‐drops (0.02% or 0.04%) alone (n=12), with radiation therapy (n=3) or both (n=4). At first, the obtained brush smears were evaluated by cytology. Secondly, after Feulgen restaining, the DNA content of reactively changed cells was determined using the AutoCyte‐QUIC‐DNA® workstation. Results: We observed euploid DNA‐polyploidy and cytomorphological changes in all patients (19/19). We considered these alterations as reactive to treatment. Four patients showed their greatest DNA‐stemline at 4c and 15 patients at 8c. This effect was observed during and following MMC‐drops and/or radiation and remained stable in 94% of all patients after a mean follow‐up of 22.5 months (SD 15.4). In five cases image cytometry additionally demonstrated DNA‐stemline aneuploidy as an evidence of tumor recurrence. Conclusion: Measurements of DNA‐content revealed euploid polyploidisation of morphological suspicious but benign squamous cells which is the biologic correlate of well known secondary morphologic changes following topical chemotherapy and/or radiation. DNA‐image‐cytometry is a useful tool in the differention of euploid polyploidization as a sign of reactive cell changes following treatment and tumor recurrences.

UPPER URINARY TRACT CHOLESTEATOMA MISDIAGNOSED AS A URETERAL TUMOR

Cholesteatoma of the upper urinary tract is a rare nonmalignant condition histologically characterized by keratinizing desquamative squamous metaplasia. Cholesteatoma has microscopic features of squamous metaplasia of the transitional epithelium and keratinization. These changes with subsequent desquamation of the superficial epithelial layers explain clinical manifestations of the disease. Flank pain, passage of cornified material in the urine and a filling defect on excretory urography (IVP) constitute the characteristic triad. Most cases are managed by extensive ablative surgery due to the potential for malignancy. A 60-year-old woman presented with a 3-year history of intermittent right flank pain in September 1999. These episodes recurred at 3 to 4-month intervals, and the pain was sometimes colicky. Medical history included hypertension and transabdominal hysterectomy for uterine myoma in 1992. Physical examination was unremarkable. Urine microscopy revealed hematuria. Urine cultures, including cultures for acid-fast bacilli, were negative. Serum blood urea nitrogen and creatinine were normal. Plain abdominal radiographs showed multiple linear calcification in the right 4th lumbar paravertebral area. IVP revealed a coarse linear filling defect in the calcified area of the proximal ureter and ureteral dilatation proximal to the involved area. A right retrograde pyelogram demonstrated a large filling defect in the proximal ureter with focal segmental narrowing and dilatation just distal to the involved area. This configuration resembled the “goblet sign” often associated with ureteral tumors (fig. 1). Computerized tomography showed right hydronephrosis with a focal filling defect in the right renal pelvic area and 1 3 1 3 5 cm. calcified mass in the right proximal ureter. Urine cytology demonstrated a moderate number of benign squamous cells and a few suspicious cells. From these findings we could not rule out a ureteral tumor. Right nephroureterectomy with bladder cuffing was done. The specimen showed a dilated pelvicaliceal system filled with whitish keratinous material extending into the proximal ureter. The mass was attatched loosely to the mucosa of the renal pelvis (fig. 2). Microscopically, there was keratinizing desquamative squamous metaplasia of the mucosa of the renal pelvis with marked keratinized debris in the renal pelvis and proximal ureter.

Ancillary methods for the detection of recurrent urothelial neoplasia

Ancillary methods for the detection of recurrent urothelial neoplasia

Argyrophilic nucleolar organizer regions (AgNOR) in tumours of pharynx and larynx

Benign and Malignant squamous cell tumours from pharynx and larynx have been studied by silver colloidal staining technique for quantitative analysis of argyrophilic nucleolar organizer regions (AgNOR) per nucleus and to assess its significance in differentiating the benign from malignant tumours. A total of 23 neoplasms including 8 squamous papillomas from larynx, 5 squamous cell cracinomas from larynx and 10 squamous carcinomas from pharynx have been studied. AgNOR count from benign papillomas showed a mean count of 2.56 whereas that in squamous cell carcinoma of Pharynx and larynx was 12.61 and 11.43 respectively. This simple staining method can be used to differentiate benign from malignant tumours in pharynx and larynx.

Automated sputum screening with papnet system: A study of 122 cases

The use of interactive, computerized PAPNET system (Neuromedical Systems, Inc, Suffern, NY) for screening of cervicovaginal smears has been favorably evaluated in several studies. In this article, the authors report on the performance of this apparatus on smears of sputum. One hundred twenty-two randomly selected, single slides of sputum specimens from an equal number of patients were subjected to PAPNET scanning. These Papanicolaou-stained slides were previously classified as inadequate, six; negative, 81; atypical, three; suspicious, one; and positive for malignant cells, 31. Images selected by PAPNET were reviewed by two observers, who were blinded to earlier interpretation and triaged into two categories: negative and review. Of the 31 smears with cancer cells, 30 were appropriately identified by PAPNET (sensitivity: 97.1%). The only case missed by PAPNET was that of small-cell carcinoma that contained a single cluster of neoplastic cells. PAPNET also triggered the review of 20 of the “negative” cases, which on re-evaluation were identified as bronchial cells with squamous metaplasia and altered benign squamous cells of inflammatory type. A prospective study of PAPNET for screening of sputum samples is needed to establish the clinical value of this methodology.

A histological morphometric study of nuclear size in benign and malignant neoplasms of the human cheek.

This report describes the application of simple morphometric methods to generate quantitative data on nuclear size from tissue sections of normal, benign and malignant oral epithelium of the cheek. Measurements of nuclear areas of basal and spinous cells from cheek mucosa were made on haematoxylin and eosin-stained sections using a Zeiss VIDAS image analyser. The lesions examined comprised benign squamous cell papillomas and islands of cells from invasive squamous cell carcinomas. Normal control epithelium was obtained from the biopsy margins of non-neoplastic lesions. The nuclear areas (AN) were obtained by direct measurement whereas the nuclear diameters (DN) were determined automatically. In both basal and spinous strata, values for both these nuclear parameters were lowest in normal tissue and increased progressively through benign papillomas, with the highest values being found invariably in carcinomas. Statistically significant differences were detected between both normal and carcinoma and between papilloma and carcinoma. The morphometric parameters AN and DN are of value in distinguishing benign from malignant lesions of the human cheek.

The predictive value of human papilloma virus (HPV) typing in the prognosis of bronchial squamous cell papillomas.

Five solitary squamous papillomas of bronchus with variable degrees of dysplasia, one combined with a laryngeal papilloma and with a neuroendocrine carcinoma in the contralateral lung, and five papillomas combined with invasive squamous cell carcinomas were investigated for their expression of human papilloma virus DNA by in situ hybridization. Benign squamous cell papillomas showed an association with papilloma virus type 11 and rarely type 6, whereas types 16 or 18, sometimes in combination with types 31/33/35 were found in papillomas associated with carcinomas. In one patient a benign papilloma containing human papilloma virus type 18 and 31/33/35-positive preceded a recurrence combined with carcinoma by 2 years; this recurrent papilloma and the carcinoma were also positive for human papilloma virus 18 DNA. We suggest that human papilloma virus typing should be performed in every squamous cell papilloma of bronchus. Patients with papillomas exhibiting human papilloma virus 16 or 18 positivity are at high risk for the development of squamous cell carcinoma. Furthermore, virus typing may be of prognostic importance in relation to the development of squamous carcinoma.

Human papillomavirus (HPV) infections and their associations with oral disease

More than 65 distinct types of human papillomavirus (HPV) have been identified to date. Several of the HPV types have been proposed as etiologic agents of squamous cell carcinoma. In the oral cavity, HPVs have been found associated with several benign squamous cell proliferations. Evidence from histology and DNA hybridization studies suggests that HPV is also involved in oral carcinogenesis. It is apparent, however, that substantial amount of confusion exists in the diagnosis of oral HPV infections. The keratotic, papillary lesions in the oral cavity are usually small and easily overlooked. The gross appearance of these viral lesions is not distinct enough to be readily diagnosed by the clinicians. Degenerative changes found on oral mucosa frequently simulate koilocytosis. Thus, caution should be exercised to avoid overdiagnosis of HPV infection in the oral cavity. The present review summarizes the current evidence available on HPV infections in general and on oral HPV infections in particular. The diagnostic techniques available as well as the problems encountered in the distinction of these lesions are also discussed in short.

The pathology of tumours at the limbus.

The histopathology of tumours originating at the corneoscleral limbus is reviewed with special reference to some 636 specimens examined over a 40 year period at the Institute of Ophthalmology, London. Over half the lesions involved melanocytes (351 cases) derived from the limbal conjunctiva and of these two-thirds were benign naevi. Conversely, benign squamous cell tumours were rare, only five unequivocal papillomas having been seen compared with 137 premalignant lesions and 73 carcinomas. Solid dermoids accounted for approximately 10 per cent of all tumours involving the limbus.

Histogenesis and Progression of Ultraviolet Light-Induced Tumors in Hairless Mice<xref ref-type="fn" rid="fn2">2</xref>

Tumor histogenesis and progression were studied in UV-irradiated albino (Skh:hairless-1) and lightly pigmented (Skh:hairless-2) hairless mice. A strongly carcinogenic dose of UV light was used, producing 100% tumor incidence by 35 weeks. The light source emitted mainly UV radiation in the range of 280-320 nm and the less energetic UV radiation up to 400 nm. The resulting epidermal changes and neoplasms resembled those seen in the actinically damaged skin of humans. Microscopic lesions included benign hyperplasia, actinic keratoses, and squamous cell carcinoma in situ and with microinvasion. Clinical tumors were epithelial papillomas, fibropapillomas, keratoacanthomas, cystic keratomas, benign pigmented macules, cutaneous hornlike growth, exophytic and endophytic squamous cell carcinomas of several cytologic types, and fibrosarcomas. Even with this high dose of UV radiation, not all of the small tumors progressed to cancer. Many regressed, including some keratoacanthomas, whereas others remained small and benign for the lifetime of the mouse.

Histiocytes in vaginal smears: as prognostic parameter in carcinoma of the uterine cervix.

Pretreatment vaginal smears of 251 patients with carcinoma of the cervix were counted for the percentage of histiocyte count in relation to benign squamous epithelial cells. No correlation was found between the percentage of histiocyte count and the age of the patient, clinical stage, cell type of squamous cell carcinoma, and clinical radiation response. Also a high histiocyte count is found to be unrelated to 5-year survival, recurrence, metastasis, or death of these patients. The present study indicates that the histiocyte number appears to have no relationship with immediate or remote prognosis in patients with carcinoma of cervix uteri.