Squamous Cell Carcinoma Presenting Research Articles

Penile Metastases from Lung Squamous Cell Carcinoma Presenting as an Initial Manifestation.

Penile Metastases from Lung Squamous Cell Carcinoma Presenting as an Initial Manifestation.

EARLY DIAGNOSIS AND MULTIPLE FACES OF ORAL SQUAMOUS CELL CARCINOMA

This is a case report of an unusual clinical presentation of squamous cell carcinoma (SCC). A 60-year-old man was referred for evaluation of pain in the posterior border of the tongue. The patient reported a previous biopsy in the same region, about 2 years ago, which was diagnosed as lichenoid dysplasia. Intraoral examination revealed a 5-mm reddish nodule of firm consistency and smooth surface with a painful symptomatology in the right side of the posterior border of the tongue. The diagnosis hypotheses were subgemmal neurogenous plaque, neurofibroma, or SCC. The histopathologic examination revealed superficially invasive SCC. The surgical treatment included the radical neck dissection, and lymph node metastases were found in the levels II and IV. The patient started radiotherapy and is under follow-up. This case emphasizes the importance of early diagnosis since SCC can present different patterns and, despite the small size, have the potential to metastasize. This is a case report of an unusual clinical presentation of squamous cell carcinoma (SCC). A 60-year-old man was referred for evaluation of pain in the posterior border of the tongue. The patient reported a previous biopsy in the same region, about 2 years ago, which was diagnosed as lichenoid dysplasia. Intraoral examination revealed a 5-mm reddish nodule of firm consistency and smooth surface with a painful symptomatology in the right side of the posterior border of the tongue. The diagnosis hypotheses were subgemmal neurogenous plaque, neurofibroma, or SCC. The histopathologic examination revealed superficially invasive SCC. The surgical treatment included the radical neck dissection, and lymph node metastases were found in the levels II and IV. The patient started radiotherapy and is under follow-up. This case emphasizes the importance of early diagnosis since SCC can present different patterns and, despite the small size, have the potential to metastasize.

Incidence, timing, presentation, treatment, and outcomes of second primary head and neck squamous cell carcinoma after oral cancer.

After their initial presentation of oral squamous cell carcinoma (SCC), patients have a lifelong risk of developing another new SCC of the head and neck. The aim of this study was to establish second primary rates, baseline characteristics (site, clinical or pathological stage, and smoking and alcohol history), timing, presentation, treatment, and outcomes. From the regional unit we analysed records of patients treated with curative intent for their first oral cancer between 2002 and 2007 inclusive. All patients had had at least 10 years of follow up either to death or the end of 2017. A total of 347 patients had been treated with curative intent, and of them, 29 had a second primary at a median (IQR) of 52 (30-79) months after the index operation. The incidence of developing a second primary tumour within two years was 1.7% (95% CI: 0.7% to 3.7%), within five years was 4.9% (95% CI: 2.9% to 7.7%), and within 10 years was 7.8% (95% CI: 5.1% to 11.1%). Early stage of first cancer was the only significant factor (p=0.001) for development of a second primary within 10 years, reflecting survivorship. Most second primaries (21 patients) were staged as early, and by visual inspection. Most (n=20) were within the oral cavity, one of which overlapped the oropharynx; eight others were in the oropharynx, and one in the larynx. Most patients (n=22) were treated by operation with curative intent. Three were treated palliatively. Patients need to be aware of the risk of a second primary and, as most are in the mouth or oropharynx, there is a role for surveillance by primary dental care practitioners.

2117 Anal Squamous Cell Carcinoma Presenting as a Rectal Mass

INTRODUCTION: Anal squamous cell carcinoma (SCC)typically presents as an anal mass. It rarely presentsin the rectumalone. Limited literature exists to discuss regarding optimal management for this unique presentation. We present a patient withanal SCC manifesting as a rectal mass and reviewher management. CASE DESCRIPTION/METHODS: A 73 year-old woman with esophageal reflux presented to our office with chronicrectal bleedingand constipation.She denied anal pain. Colonoscopy revealed a 1.2 cm massin the anterior rectum, 2 cm from the anal verge (Figure 1). Biopsies revealed focally invasive nonkeratinizing SCC (Figure 2). On rectal endoscopic ultrasound (EUS), the mass was confined to the anus andextended from the anorectal canal into the rectum (Figure 3). Submucosal invasion was noted, but not through the rectal muscularis propria. PET CT showed no perirectal invasion, lymphadenopathy, metastatic disease orother sources of primary SCC. Final staging was T2N0. She underwentchemoradiationwith5-fluorouricil and mitomycin. Surgery was deferred to preserve anal function.Her tumor showed a complete response after 6 weeks and she is currently being followed with routine surveillance. DISCUSSION: Anal SCC makes up2.6% of digestive system cancers in the United States, but its incidence is rising in men and women, possibly due to changes in sexual behavior and increasing rates of HPV exposure. Gastroenterologists should recognizeatypical presentations ofanal SCC, especially in high-risk populations: men who have sex with men, HIV positive patients, and women with high risk HPV. Rectal bleeding and altered bowel habits arethe most commonlyreported symptoms. Other symptoms include anal mass, pain, itching, and mucous discharge, but up to 20% of patients with anal cancer are asymptomatic. The absence of anal pain and external lesions as well as the rectal mass on in our patient suggested an alternative diagnosis. Given that management of rectal cancer has traditionally centered around resection, this emphasizes the utility of EUS to make the correct diagnosis and direct management. The management of this unique presentation of anal SCC has not been fully established, but our patient received standard chemoradiation with good results. Anal SCC has a range of presentations and can present as a rectal mass. Given that anal SCC rates are increasing, our case highlights the importance of disease screening, recognition, and prevention.

Unusual Presentation of Metastatic Cervical Squamous Cell Carcinoma with Serum Positive Beta Human Chorionic Gonadotropin.

Abstract We present a case of a 30-year-old female who presented with one month of worsening dyspnea. On admission she was having pleuritic chest pain with associated cough and worsening dyspnea. CTA showed a moderate sized pleural effusion with two hypodensities noted in the liver. Patient received several thoracenteses and had abdominal distension that required paracentesis, which showed transudative fluid initially. There was a noted supraclavicular lymph node, however the patient refused lymph node biopsy. Retroperitoneal lymph node, which was seen on CT abdomen, was eventually biopsied which showed metastatic carcinoma with squamoid differentiation with unknown primary. Beta subunit of human chorionic gonadotropin (b-HCG) was rechecked for the biopsy and was mildly elevated to 33. The patient refused gynecological evaluation, pelvic ultrasound revealed a distended endometrial cavity with heterogeneous contents and a complex left adnexal cyst. Pelvic MRI noted a large cervical mass (4.6x4.5x3.8cm) with parametrial invasion. Subsequently her status declined, and she was intubated for hypoxic respiratory failure. Patient unfortunately passed away. Autopsy confirmed metastatic cervical cancer with significant tumor burden as evidence of >80% of the liver with tumor. Although the patient’s pap smear previously did not culture for HPV, the lymph node biopsy stained positive with Pap stain and shown that the carcinoid cells were most affected by HPV. Later is was found that 3.5 years prior the patient had a Pap smear positive for low-grade squamous intraepithelial lesion however was lost to follow up. Although there have been studies that have examined cervical cancer and the intracellular expression of b-hCG, serum b-hCG is not known to be elevated in squamous cell carcinoma of the cervix. For women presenting with wide spread disease, gynecological malignancies should be ruled out regardless of age.

An unexpected clinical presentation of primary squamous cell carcinoma of the thyroid gland

Primary squamous cell carcinoma of the thyroid gland (PSCCT) is a rare disease which accounts less than 1% of all thyroid cancers. Patients usually present with enlarging neck mass. In this paper we presented a 76-year-old female patient with PSCCT whose initial finding was a cervical abscess. To our knowledge this is the first PSCCT case in the literature presenting as cervical abscess. The patient was referred to our clinic with dysphasia, shortness in breathing and hyperemic right neck mass, growing in size for 1 week. On physical examination a fluctuant and hyperemic mass was observed at the right cervical region. Magnetic resonance imaging of neck and upper thorax revealed a mass in the area of right thyroid gland, including cystic and necrotic component, progressing to the retrosternal area, surrounding right jugular vein and common carotid artery. An open biopsy was performed. The histopathological diagnosis was squamous cell carcinoma. Because of the extended invasion and infiltration of adjacent tissues, the patient was accepted as inoperable in oncologic council. PSCCT is a rare and aggressive neoplasm of the thyroid gland with poor prognosis. In a patient with deep neck spaces abscess, an underlying PSCCT should be kept in mind to avoid delays in the diagnosis and treatment.

Superficially Invasive Oral Squamous Cell Carcinoma Presenting With Features Of Oral Verrucous Hyperplasia – A Case Report

Brief Background : Verrucous lesions of the oral cavity with warty and exophytic clinical presentations can have varied histopathology. Oral Verrucous hyperplasia (OVH) is a potentially malignant disorder, which may transform into oral carcinoma. Case Report : We report a 56-year-old male patient who presented with a verruco-proliferative pinkish white growth on the lateral border of the tongue. The patient was diagnosed with superficially invasive squamous cell carcinoma in verrucous hyperplasia based on histopathological features. Summary and Conclusion : The diagnosis of this entity poses difficulty as it can be underdiagnosed as oral verrucous hyperplasia particularly in superficial biopsies. Key words : Verrucous hyperplasia, Squamous cell carcinoma, superficially invasive.

Rare presentation of squamous cell carcinoma: A case report

Rare presentation of squamous cell carcinoma: A case report

Uncommon presentation of an intraosseous squamous cell carcinoma

Uncommon presentation of an intraosseous squamous cell carcinoma

A Rare Case of Synchronous Presentation of Acute Myeloid Leukemia and Lung Cancer

Background: There are very few publications on synchronous presentation of dual malignancies in the literature. Occurrence of second malignancy in a patient with a known malignant tumor is not uncommon, though synchronous primary malignancies are unusual. Case Presentation: A 77-year-old man was diagnosed elsewhere as squamous cell carcinoma of lung came to our oncology department for further management. He underwent bone marrow evaluation with the suspicious of metastasis in view of pancytopenia. On bone marrow evaluation, found to have prominence of blasts more than 20%, which were CD34 positive and CD117 positive and. Conclusion: Here we describe an unusual rare combination of synchronous presentation of acute myeloid leukemia and squamous cell carcinoma of lung.

A White Man Carrying Red Card-An Unusual Presentation of Oral Squamous Cell Carcinoma

A White Man Carrying Red Card-An Unusual Presentation of Oral Squamous Cell Carcinoma

Pattern of Gynaecological Malignancies in a Tertiary Care Hospital

Background: Gynaecological malignancies are the second most common cancer of females after cancer breast. Gynaecological malignancies contribute significantly to cancer burden and have a higher rate of mortality and morbidity. Carcinoma cervix is the commonest gynaecological malignancy in developing countries while in developed countries, ovarian cancer is the commonest. Comprehensive statistics on gynecologic malignancies reported from Bangladesh are deficient. This study was performed to ascertain the profile of gynecologic cancers reported at our center regarding demography, the frequency of involvement at various sites, clinical presentation, incidence, histologic subtypes and stage at presentation. Methods: This is a retrospective study where the records of the Departments of Gynecology and Pathology at Enam Medical College & Hospital, Dhaka, Bangladesh were retrospectively reviewed to identify all cases of Gynecologic malignancies and to determine the pattern of gynaecological malignancies identified between January 2015 and December, 2018. Results: Cervical cancer (53%) was the most common gynaecological malignancy, followed by ovarian cancer (29%), uterine cancer (8%), vulvar cancer (5%) and gestational trophoblastic neoplasm (GTN 5%). In the case of cervical and ovarian cancer the most common age group was 41 - 50 years and gestational trophoblastic neoplasm (GTN). The majority of patients presented at the ages of 31 - 40 years while uterine cancer presented in the elderly (>60 years). Among the patients studied 88% were multiparous. Of the cervical cancer cases, 96.22% was squamous cell carcinoma and commonest presenting complains were contact bleeding (33.96%) and excessive and irregular menstruation (26.41%). Among ovarian tumor cases 69% had epithelial while 31% had non-epithelial cancer and predo&

Synchronous carcinomas of primary origin: Squamous cell carcinoma of the skin and clear cell renal cell carcinoma

Introduction: Synchronous carcinomas are defined multiple primary neoplasms occurring in different locations belonging to different morphologic or histologic origin ocurrin at the same time in a patient. This is the first report of a cutaneous squamous cell carcinoma presenting synchronically with a clear renal cell carcinoma, confirming is not a metastatic process.

Primary Gastric Squamous Cell Carcinoma Presenting as a Huge Subepithelial Tumor: A Case Report

Primary Gastric Squamous Cell Carcinoma Presenting as a Huge Subepithelial Tumor: A Case Report

Expectant Management of High-Grade Anal Dysplasia in People with HIV: Long-term Data.

Both ablation and expectant management of high-grade squamous intraepithelial lesions have been proposed. Expectant management would be reasonable if 1) the rate of high-grade squamous epithelial lesion progression to anal squamous cell carcinoma were low, and 2) anal squamous cell carcinoma arising under surveillance had a better prognosis than anal squamous cell carcinoma presenting without an identified precursor. This study aims to quantify aspects of high-grade squamous epithelial lesion/anal squamous cell carcinoma clinical evolution in a surgical practice. This is a retrospective cohort study. This study was performed in 1 colorectal surgeon's practice over a 20-year period. Consecutive patients with high-grade squamous intraepithelial lesion and anal squamous cell carcinoma were included. We looked at the rate and timing of progression to anal squamous cell carcinoma, and the stage, treatment, and outcome of anal squamous cell carcinoma. We reviewed a comparison group of HIV-positive patients presenting de novo with anal squamous cell carcinoma (no prior history of high-grade squamous intraepithelial lesion). With consideration of only HIV-positive patients, 341 patients had a mean 5.6 years follow-up from high-grade squamous intraepithelial lesion diagnosis to the most recent documented anal examination. Twenty-four of these surveillance patients developed anal squamous cell carcinoma, yielding a progression rate of 1.3% per patient-year. Mean follow-up was 7.3 years from the initial cancer diagnosis to the most recent contact. Forty-seven patients who presented de novo with anal squamous cell carcinoma developed 74 lesions, with a mean follow-up of 5.7 years after initial diagnosis. This de novo group had higher anal squamous cell carcinoma-specific mortality (3% per patient-year vs 0.05%). Our study did not show a significantly higher rate of high stage (stage III or IV) at anal squamous cell carcinoma diagnosis in the de novo group in comparison with the surveillance group (25.5% vs 8.3% (p = 0.09)). This study was retrospective in nature and had a predominately male population. The progression of untreated high-grade squamous intraepithelial lesion to anal squamous cell carcinoma approximates 1% per patient-year. Anal squamous cell carcinoma developing under surveillance tends to be of an earlier stage and to require fewer major interventions than anal squamous cell carcinoma presenting de novo. Cancer-specific mortality was lower for malignancies that developed under surveillance. We suggest that expectant management of patients with high-grade squamous intraepithelial lesion is a rational strategy for preventing anal cancer morbidity. See Video Abstract at http://links.lww.com/DCR/A699.

Squamous cell carcinoma of the head and neck in children

ObjectiveTo discuss the presentation, evaluation, and management of squamous cell carcinoma of the head and neck in the pediatric population. MethodsMedical records of pediatric (≤20 years) patients treated for squamous cell carcinoma of the head and neck between 1996 and 2016 were reviewed. Data pertaining to clinical presentation, diagnostic methods, treatment plan, complications, recurrence, follow-up, or outcome were collected. ResultsEleven patients were diagnosed with squamous cell carcinoma. Seven of these patients had medical histories significant for prior malignancies, immunosuppressant therapy, and/or genetic syndromes. Lesions were identified in the oral cavity (n = 5, 45.5%), lip/upper lip (n = 3, 27.3%), larynx (n = 2, 18.2%), and nasal cavity (n = 1, 9.1%). Tumors were most commonly treated with surgical excision alone. Three patients underwent irradiation (2 adjuvant and 1 without surgery) and chemotherapy (1 adjuvant, 1 neoadjuvant, and 1 without surgery). Of these patients, one reported complications of hearing loss, loss of dentition, and laryngeal stenosis. Two patients developed local recurrence at 1 month and 5 years post-operatively, respectively. One patient developed an orocutaneous fistula and subsequently died. No other complications were reported. Median follow-up time was 4.6 years (interquartile range: 2.4–8.4 years). Complications of radiation included: laryngeal stenosis, wound breakdown, and orocutaneous fistula. ConclusionSquamous cell carcinoma is rare in the pediatric population. Most frequently, it is associated with previous malignancies, immunosuppressant therapy, and/or genetic conditions. Complete surgical excision is recommended to obviate the need for radiation whenever possible.

PULMONARY VEIN INVASION: NOT YOUR TYPICAL PULMONARY EMBOLISM

SESSION TITLE: Lung Cancer 3 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Lung cancer is one of the leading causes of death, however invasion of a primary pulmonary tumor into the pulmonary vessels is very rare. To date, few cases of tumor invasion involving the pulmonary vessels have been reported. CASE PRESENTATION: We report a 67-year-old male with presentation of cough, wheezing, and shortness of breath with extensive squamous cell lung carcinoma on PDL-1 therapy. He subsequently under went Computed Tomography Angiography (CTA) of the chest which demonstrated a large filling defect in the left atrium suspicious for tumor thrombosis measuring 2.5 cm x 3 cm in diameter extending into the right pulmonary vein. Lower extremity venous doppler was negative to suggest deep vein thrombosis. Initial treatment consisted of intravenous heparin however after detailed review, it was concluded that the filling defect was due to extension of squamous cell carcinoma into the left atrium and proximal pulmonary vein, rather than pulmonary thromboembolism (PE). DISCUSSION: Pulmonary vessel invasion causing thrombosis and occlusion due to primary pulmonary tumor is extremely rare. The most common incidence of vascular thrombosis is seen in angiosarcoma, however can be also seen in extra thoracic malignancies and pulmonary thromboembolism (1). Typically, microscopic vascular invasion by tumor is often seen, but gross invasion into pulmonary vascular structures is a rare entity (3). To date, there is only a handful cases reported in the literature, with various clinical presentations.Presenting symptoms vary and can include non-productive cough, dyspnea, fever, syncope and hemoptysis (3). Patients are often misdiagnosed and initiated on anti-coagulation (3). Limitations arise with diagnostic modalities such as CT imaging as tumor invasion is difficult to distinguish from PE in vascular structures. Tumor invasion can be a primary manifestation but in most reported cases occurs in the setting of known diagnosis of lung cancer. The prognostic significance of invasion into the pulmonary veins is not well studied. Invasion of the pulmonary artery is believed to lead to dissemination into the pulmonary circulation, however invasion into the pulmonary artery portends better prognosis compared to invasion into other mediastinal structures (1). CONCLUSIONS: Although rare in clinical practice, pulmonary vein invasion from extension of primary lung malignancies should be considered in any patient with known lung cancer and new onset filling defects on CTA imaging. This case represents the diagnostic challenges in patients with primary lung malignancies with typical PE symptoms and radiologic findings of thrombosis. Further use with intrapulmonary vascular catheter biopsy or surgical biopsy at the time of presentation is essential to distinguish PE from vascular invasion of malignant disease. Reference #1: 1. Goto, T., Maeshima, A., & Kato, R. (2012). Lung adenocarcinoma with peculiar growth to the pulmonary artery and thrombus formation: report of a case. World journal of surgical oncology, 10(1), 16. Reference #2: 1. 2. Pang, J., Nair, G. B., Ilowite, J., Hoffman, J., & Chawla, S. (2013). An unusual presentation of squamous cell carcinoma of lung in an immunocompromised patient mimicking pulmonary artery embolism. Chest, 144(4), 616A. Reference #3: 1. Çakır, H., Öcal, L., Öcal, A. G., Çakır, H., Akkuş, E. E., & Kahveci, G. (2014). Unusual presentation of a recurrent squamous cell lung cancer. QJM: An International Journal of Medicine, 108(3), 231-232. DISCLOSURES: No relevant relationships by Sara Ali, source=Web Response No relevant relationships by Brandon Hooks, source=Web Response

An Atypical Presentation of an Esophageal Squamous Cell Carcinoma With Pancreatic and Bone Metastases

Background Consideration of pancreatic malignancy is divided between an exocrine versus an endocrine neoplasm. Within the umbrella of exocrine pancreatic malignancies, adenocarcinoma predominates at a rate of up to 80% of all pancreatic malignancies. The normal pancreas entirely lacks squamous cells. A finding of squamous cells in a discrete pancreatic lesion usually denotes an undiagnosed primary squamous malignancy from a distant anatomic site. We present a case of a metastatic squamous cell carcinoma of the esophagus with metastasis to the pancreas. Case presentation A 67-year-old man was transferred to our medical facility after presenting to an outside hospital with dyspnea, dysphagia and weight loss. The outside hospital's computed tomography (CT) images revealed a 9.6 cm cavitary lung lesion with air-fluid levels, pretracheal lymph nodes, hepatic mass as well as vertebral osteolytic lesion. Initial laboratory values at our hospital showed a white-blood cell count of 25200, hemoglobin of 10.3 mg/d with normal bilirubin and aminotransferases. An abdominal CT scan was obtained revealing a loculated right lower lobe fluid collection with multiple air-fluid levels. A large 9.0 x 8.7 x 10.0 cm cystic mass in the head of the pancreas was seen along with focal distal esophageal thickening and destructive soft tissue lesions in the L3 vertebral body and left lateral 6th rib. Endoscopy revealed a fungating mass in the distal esophagus with suspicion of fistulization to the lung. The lesion was biopsied. EUS revealed a hypoechoic lesion suggestive of a cyst in the head of the pancreas measuring 8.5 x 12.1 cm in maximal cross-sectional diameter. A diagnostic fine-needle aspiration was performed using a Boston ScientificTM 19-gauge needle using a trans-gastric approach. Pathology results showed the distal esophageal mass to be squamous cell carcinoma. Cytology examination of the pancreatic cyst revealed squamous cell carcinoma presumed to be from the primary esophageal squamous cell carcinoma. The vertebral lytic lesion biopsy was consistent with this histopathology as well. Discussion We present an unusual case of squamous cell carcinoma of the esophagus presenting with metastasis to the bone and pancreas as well as fistulization to the lung. The finding of squamous cells in the pancreas suggests a likely metastatic lesion.1761_A Figure 1. Endoscopic view of esophageal mass1761_B Figure 2. CT scan depicting liver fluid collection as well as pancreatic cyst. Endoscopic ultrasound view of complex pancreatic cyst

Unique Presentation of Squamous Cell Carcinoma as Giant Cutaneous Horn

Cutaneous horn is a conical, dense, and hyperkeratotic protrusion that often appears similar to the horn of an animal. Giant cutaneous horns are rare; no incidence or prevalence has been reported. The significance of cutaneous horns is that they occur in association with, or as a response to, a wide variety of underlying benign, premalignant, and malignant cutaneous diseases. Herein we report a unique case of a 60-year-old male with a giant cutaneous horn (size: 10 cm × 2 cm) projecting from the left angle of mouth, which is extremely rare. Wide local excision of the growth was done. Histopathologic examination showed verrucous carcinoma with negative margin. There is no recurrence after follow-up of 2 years.

Incidence and presentation of squamous cell carcinoma in renal transplant patients after rejection episodes

Incidence and presentation of squamous cell carcinoma in renal transplant patients after rejection episodes