Pure Squamous Cell Carcinoma Research Articles

Acute cholecystitis as the first manifestation of primary pure squamous cell carcinoma of the gallbladder; a case report

Background. SCC of the gallbladder is characterized by more rapid and invasive growth with infiltration of the adjacent organs and less spread to the lymph nodes compared to adenocarcinoma of the gallbladder. It is a rare neoplasm that accounts for 1.4–12.7 % of gallbladder tumors. SCC of the gallbladder has a poor prognosis. symptoms usually appear later when the disease has progressed and the malignancy has reached advanced stages. therefore, usually, the patients expire soon following the diagnosis. the etiology of the SCC of the gallbladder is complex and is mostly associated with gallstones. Case description. We report a case of a 56-year-old man that had been suffering from colicky abdominal pain in the right upper quadrant for about two weeks before his admission. He did not have nausea, vomiting, shortness of breath, fever, lack of appetite, or weight loss. after evaluation, a diagnosis of acute cholecystitis was established and antibiotic therapy was initiated. However, he did not respond to medical therapy and underwent surgery. A tumor mass was detected during surgery. therefore, cholecystectomy and extended right hepatectomy were performed. The pathological evaluation of the biopsy specimen revealed squamous cell carcinoma. consequently, he underwent radiotherapy and chemotherapy and was followed up for two years. He acquired complete tumor remission. Conclusion. The present case highlights the requirement of considering further investigation on the histogenesis of SCC of the gallbladder.

Identification of the Tumor Infiltrating Lymphocytes (TILs) Landscape in Pure Squamous Cell Carcinoma of the Bladder.

Simple SummaryTreatment options in squamous cell carcinoma (SCC) of the bladder are limited and prognosis is poor. In this report we investigated the impact of tumor-infiltrating lymphocytes (TILs) in SCC of the bladder in patients undergoing radical cystectomy. We found that subsets of TILs hold predictive value for OS and PFS. We conclude that TILs might stratify patients with bladder SCC for immunotherapy.Background: Tumor infiltrating lymphocytes (TILs) are known as important prognostic biomarkers and build the fundament for immunotherapy. However, the presence of TILs and its impact on outcome in pure squamous cell carcinoma (SCC) of the bladder remains uncertain. Methods: Out of 1600 patients undergoing radical cystectomy, 61 patients revealed pure bladder SCC in the final histopathological specimen. Retrospectively, immunohistochemical staining was performed on a subset of TILs (CD3+, CD4+, CD8+, CD20+). Endpoints were overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS). The Kaplan–Meier method was used to evaluate survival outcomes. Results: Strong infiltration of CD3+ was found in 27 (44%); of CD4+ in 28 (46%); of CD8+ in 26 (43%); and of CD20+ in 27 tumors (44%). Improved OS was observed for strong CD3+ (p < 0.001); CD4+ (p = 0.045); CD8+ (p = 0.001); and CD20+ infiltration (p < 0.001). Increased rates of PFS were observed for CD3+ (p = 0.025) and CD20+ TILs (p = 0.002). In multivariate analyses, strong CD3+ (HR: 0.163, CI: 0.044–0.614) and strong CD8+ TILs (HR: 0.265, CI: 0.081–0.864) were revealed as predictors for OS and the strong infiltration of CD20+ cells (HR: 0.095, CI: 0.019–0.464) for PFS. Conclusions: These first results of TILs in bladder SCC revealed predictive values of CD3+, CD8+ and CD20+.

Therapiekonzepte für histologische Varianten und nichturotheliale Histologie von Blasentumoren

BackgroundApproximately 30% of bladder tumors show a histological variant or a nonurothelial histology. The individual variants are rare, which complicates the design of studies for these entities and the design of treatment concepts. The frequency of a diagnosis of histological variants is increasing.ObjectivePresentation of current treatment concepts for urothelial variants and nonurothelial bladder tumors.Material and methodsNonsystematic search in PubMed with the keywords bladder cancer, variant histology and nonurothelial bladder cancer, taking the current guidelines of the specialist societies EAU, ESMO and NCCN into account.ResultsTreatment of squamous cell or glandular differentiation follows the same pathways as recommended for conventional urothelial carcinoma. Micropapillary, sarcomatoid and plasmacytoid variants as well as pure squamous cell carcinoma and adenocarcinoma should be treated by radical cystectomy and lymphadenectomy in both non-muscle-invasive and muscle-invasive stages. In cases of a pure squamous cell carcinoma, perioperative radiotherapy should be considered in the muscle-invasive stage. Localized small cell neuroendocrine tumors are treated with neoadjuvant chemotherapy followed by a consolidating local treatment.ConclusionHistological variants of urothelial carcinoma and nonurothelial bladder tumors often have a poor prognosis. The histopathological diagnosis is challenging but indispensable for a correct treatment decision. Established treatment guidelines for the individual entities do not usually exist. Efforts must be made to include such patients in randomized trials.

Variant histologies in bladder cancer: Does the centre have an impact in detection accuracy?

To compare the accuracy in detecting variant histologies (VH) at transurethral resection of bladder (TURB) and radical cystectomy (RC) specimen among tertiary referral centres, in order to investigate potential reasons of discrepancies from the pathological point of view. Clinical and histopathological data of TURB specimen and subsequent cystectomy specimen of 3,445 RC candidate patients have been retrospectively collected from 24 tertiary referral centres between 1980 and 2021. VH considered in the analysis were pure squamous cell carcinoma, urothelial carcinoma with squamous differentiation, pure adenocarcinoma, urothelial carcinoma with glandular differentiation, micropapillary bladder cancer (BCa), neuroendocrine BCa, and other variants. The degree of agreement between TURB and RC concerning the identification of VH was expressed as concordance, classified according to Cohen's kappa coefficient. A VH was reported in 17% of TURB specimens, 45% of which were not confirmed in RC. The lowest concordance rate was reported for micropapillary BCa with 11 out of 18 (61%) centres reporting no agreement, whereas neuroendocrine BCa achieved the highest concordance rate with only 3 centres (17%) reporting no agreement. Our results shows that even among centres with the advantage of a referent uropathologist the micropapillary variant is characterized by scarce accuracy between TURB and RC. Differences in TURB specimen acquisition by the urologist and in sampling methods among different centres are the main limitations of the study. Accuracy of TURB in detecting VH is poor for certain VH, in particular for micropapillary BCa, with evident variation among centres. Novel diagnostic tools are required to better identify these VH and drive patients toward a personalized treatment.

MP54-16 IMMEDIATE RADICAL CYSTECTOMY VS. BCG IMMUNOTHERAPY FOR T1 HIGH GRADE NON-MUSCLE-INVASIVE BLADDER CANCER: AN INTERNATIONAL MULTICENTRE COLLABORATION

MP54-16 IMMEDIATE RADICAL CYSTECTOMY VS. BCG IMMUNOTHERAPY FOR T1 HIGH GRADE NON-MUSCLE-INVASIVE BLADDER CANCER: AN INTERNATIONAL MULTICENTRE COLLABORATION

Basaloid squamous cell carcinoma of the rectum. Case report

Introduction: SCC is a subtype of epithelial origin tumors that are common in glandular organs such as the lungs and pancreas, but are relatively rare in the large intestine. Pure squamous cell carcinoma (SCC) of the colorectum is extremely rare. Case presentation: A 47-year-old woman was admitted to the hospital for surgical treatment of a rectal tumor initially diagnosed as a neuroendocrine tumor. She underwent neoadjuvant chemotherapy followed by laparoscopic abdomino-perineal resection of the rectum. Collected tissues of the tumor underwent histopathological evaluation in which the infiltration of BSCC (G2) was described. The p16 antigen were positively expressed in immunohistochemistry, which indicates an existing HPV infection with high oncogenic potential. Conclusions: It is certain that only histopathological diagnosis can give a reliable diagnosis of SCC and enable the implementation of appropriate treatment in the case of unresectable lesions. Keywords: squamous cell carcinoma, SCC, basaloid squamous cell carcinoma, BSCC

Oncologic Outcomes of Squamous Cell Carcinoma Versus Urothelial Carcinoma With Squamous Differentiation After Radical Cystectomy for Bladder Carcinoma.

In this study we aim to compare clinicopathological characteristics and cancer specific survival between patients treated with radical cystectomy for pure squamous cell carcinoma (SCC) and urothelial carcinoma with squamous differentiation (SqD). We reviewed data of 1737 consecutive patients treated with radical cystectomy and urinary diversion between January 2004 and February 2014. Only patients with pure SCC or SqD were included in the analysis. Squamous differentiation was defined as intercellular bridges or keratinization in the tumor. Clinicopathological data and recurrence free survival (RFS) were compared between patients diagnosed with SCC and SqD. SCC and SqD were found in 318 and 223 patients, respectively. Mean age was 57 ± 8.3 years in SCC and 58.8 ± 7.8 in SqD (P=.008). A higher proportion of female patients was observed in SCC group compared to SqD (31.8% vs. 22% P < .0001). Patients with SqD were more likely to have extravesical (58.3% vs. 46.2%: P=.006) and nodal positive disease (34.5% vs. 14.5%: P < .0001) than pure SCC patients. Bilharzial eggs were found in 61% of SCC vs. 46% of SqD (P=.001).; The median (IQR) follow up period for SCC and SqD was 63 (12-112) months and 23 months (9-74.7), respectively. The 5-year RFS for SCC and SqD were 77% and 59.8 %, respectively (P < .0001).; Multivariate cox regression analysis identified advanced pT stage (OR: 1.9, 95% CI: 1.3-2.86, P=.0001), nodal positive disease (OR: 1.6, 95% CI: 1.1-2.48, P=.01) and SqD histology (OR: 1.6, 95% CI: 1.14-2.31, P=.007 as independent predictors of 5-year RFS. Patient with SCC had significantly higher 5-year RFS in comparison to SqD. The higher rate of extravesical disease and lymph node metastasis in SqD patients is indicative of aggressive behavior of this histologic type.

Molecular profile of pure squamous cell carcinoma of the bladder identifies major roles for OSMR and YAP signalling.

Pure squamous cell carcinoma (SCC) is the most common pure variant form of bladder cancer, found in 2–5% of cases. It often presents late and is unresponsive to cisplatin‐based chemotherapy. The molecular features of these tumours have not been elucidated in detail. We carried out whole‐exome sequencing (WES), copy number, and transcriptome analysis of bladder SCC. Muscle‐invasive bladder cancer (MIBC) samples with no evidence of squamous differentiation (non‐SD) were used for comparison. To assess commonality of features with urothelial carcinoma with SD, we examined data from SD samples in The Cancer Genome Atlas (TCGA) study of MIBC. TP53 was the most commonly mutated gene in SCC (64%) followed by FAT1 (45%). Copy number analysis revealed complex changes in SCC, many differing from those in samples with SD. Gain of 5p and 7p was the most common feature, and focal regions on 5p included OSMR and RICTOR. In addition to 9p deletions, we found some samples with focal gain of 9p24 containing CD274 (PD‐L1). Loss of 4q35 containing FAT1 was found in many samples such that all but one sample analysed by WES had FAT1 mutation or deletion. Expression features included upregulation of oncostatin M receptor (OSMR), metalloproteinases, metallothioneins, keratinisation genes, extracellular matrix components, inflammatory response genes, stem cell markers, and immune response modulators. Exploration of differentially expressed transcription factors identified BNC1 and TFAP2A, a gene repressed by PPARG, as the most upregulated factors. Known urothelial differentiation factors were downregulated along with 72 Kruppel‐associated (KRAB) domain‐containing zinc finger family protein (KZFP) genes. Novel therapies are urgently needed for these tumours. In addition to upregulated expression of EGFR, which has been suggested as a therapeutic target in basal/squamous bladder cancer, we identified expression signatures that indicate upregulated OSMR and YAP/TAZ signalling. Preclinical evaluation of the effects of inhibition of these pathways alone or in combination is merited.

Immediate radical cystectomy versus BCG immunotherapy for T1 high-grade non-muscle-invasive squamous bladder cancer: an international multi-centre collaboration.

To compare cancer-specific mortality (CSM) and overall mortality (OM) between immediate radical cystectomy (RC) and Bacillus Calmette-Guérin (BCG) immunotherapy for T1 squamous bladder cancer (BCa). We retrospectively analysed 188 T1 high-grade squamous BCa patients treated between 1998 and 2019 at fifteen tertiary referral centres. Median follow-up time was 36months (interquartile range: 19-76). The cumulative incidence and Kaplan-Meier curves were applied for CSM and OM, respectively, and compared with the Pepe-Mori and log-rank tests. Multivariable Cox models, adjusted for pathological findings at initial transurethral resection of bladder (TURB) specimen, were adopted to predict tumour recurrence and tumour progression after BCG immunotherapy. Immediate RC and conservative management were performed in 20% and 80% of patients, respectively. 5-year CSM and OM did not significantly differ between the two therapeutic strategies (Pepe-Mori test p = 0.052 and log-rank test p = 0.2, respectively). At multivariable Cox analyses, pure squamous cell carcinoma (SqCC) was an independent predictor of tumour progression (p = 0.04), while concomitant lympho-vascular invasion (LVI) was an independent predictor of both tumour recurrence and progression (p = 0.04) after BCG. Patients with neither pure SqCC nor LVI showed a significant benefit in 3-year recurrence-free survival and progression-free survival compared to individuals with pure SqCC or LVI (60% vs. 44%, p = 0.04 and 80% vs. 68%, p = 0.004, respectively). BCG could represent an effective treatment for T1 squamous BCa patients with neither pure SqCC nor LVI, while immediate RC should be preferred among T1 squamous BCa patients with pure SqCC or LVI at initial TURB specimen.

Preoperative MRI of breast squamous cell carcinoma: diagnostic value of distinguishing between two subtypes

To retrospectively analyse the clinical and MRI data of primary squamous cell carcinoma (SCC), particularly pure squamous cell carcinoma (PSCC) and mixed squamous cell carcinoma (MSCC). The MRI data and clinicopathological characteristics of 20 patients with histopathologically confirmed SCC of the breast, including eight PSCC patients and 12 MSCC patients, from multiple centres between January 2013 and December 2020 were analysed retrospectively. Nine of 12 patients in the MSCC group showed hyperintensity on T1-weighted imaging (WI), while this feature was not observed in the PSCC group (p=0.001). Most of the PSCC group showed rim enhancement, whereas most of the MSCC group showed heterogeneous enhancement (p=0.007). In addition, there was no significant difference in the thickness of the rim enhancement and the percentage of necrotic components in the tumours between the two types of SCCs of the breast (p=0.545 and p=0.662, respectively). Four patients (4/12) in the MSCC group had sentinel lymph node metastasis, while only one patient (1/8) in the PSCC group showed lymph node metastasis (p=0.603). Metastatic disease occurred in 25% of patients with PSCC and in approximately 41.7% of patients with MSCC. The signal on T1WI and internal enhancement characteristics were the key features for differentiating PSCC and MSCC. Therefore, MRI phenotypes may provide additional information for the pathological classification of breast SCC.

Pure squamous cell carcinoma of the gallbladder in a patient with perforated calculus cholecystitis

Gallbladder carcinoma is one of the most common and aggressive malignancies to arise from the biliary tract. However, pure squamous cell carcinoma (SCC) originating from the gallbladder is exceptionally rare, reported to represent less than 1% of all malignancies. An 89-year-old Australian male presented with symptoms and imaging consistent with acute calculus cholecystitis. After failed conservative management he underwent a subtotal cholecystectomy. Diagnosis on histopathological examination demonstrated SCC of the gallbladder. This case highlights the importance of considering gallbladder malignancy including rare histological subtypes such as SCC in patients presenting with symptoms consistent with benign gallbladder disease particularly in the elderly population.

A case of breast squamous cell carcinoma following breast augmentation with liquid silicone injection after 16\xa0years

BackgroundBreast augmentation has been linked to various complications, including cancerous tumors. The majority type of breast cancer associated with breast augmentation is adenocarcinoma. Primary squamous cell carcinoma (SCC) of the breast is extremely rare in both augmented and non-augmented women. Due to the low incidence, the possible origin and the mechanism of carcinogenesis of the breast SCC are not well understood. Here, we report a rare case of pure SCC 16 years after breast augmentation with liquid silicone injection.Case presentationA 51-year-old Japanese woman was suffered from prolonged breast fluid retention in her left breast. Multiple unknown foreign bodies caused difficulties to investigate the inflammatory focus with ultrasonography. After unsuccessful surgical drainage and antibiotics treatments, the long-standing fluid retention was surgically removed and pathologically investigated. SCC was found in the removed tissue, and the patient underwent a total left mastectomy followed by postoperative chemotherapy. Pathological analysis revealed multiple cystic structures with a hard shell which enclosed high viscous liquid. A qualitative analysis using a Fourier transform infrared spectroscope defined the liquid as pure silicon, which possibly caused the squamous cell carcinogenesis.ConclusionsAlthough liquid silicone injection is not a current option for breast augmentation, the injected silicone could result in cancerous tumor generation after years. This case revealed that unphysiological substances could lead to unexpected biological reactions, which caused difficulties in diagnosis with our routine examination. It will be required that accumulate information from more cases and develop novel diagnostic equipment and biomarkers to address these artificial substance-derived tumors.

Synchronous metastatic pure squamous cell carcinoma of the Gallbladder: A case report and review of literature

Gallbladder cancer is an uncommon disease, comprising 1.2% of cancers in the world, with squamous cell pathology of the gallbladder being even more uncommon, making up 1-3% of those cases. When diagnosed, squamous cell carcinoma carries higher mortality when compared to all other pathologies in the gallbladder. The consensus on treatment of this cancer is inconclusive. This manuscript presents a case of a 71-year old female with squamous cell carcinoma of the gallbladder that progressed rapidly, despite resection to negative margins. Keywords: gallbladder cancer; squamous cell carcinoma; incidental; oncology; chemotherapy.

Primary Squamous Cell Carcinoma of the Thyroid Coexisting with Tall Cell Variant Papillary Thyroid Carcinoma: Report of Two Cases

Primary squamous cell carcinoma of the thyroid (PSCCT) is a rare and aggressive neoplasm of the thyroid, usually presenting with a rapidly growing mass. In order to diagnose a tumor as PSCCT, tumor should entirely consist of cells with squamous differentiation without any evidence of other types of carcinomas. Tall cell variant papillary thyroid carcinoma (TCVPTC) is an aggressive variant of papillary thyroid carcinoma, composed of cells that are two-three times as tall as they are wide. We report two cases of PSCCT coexisting with TCVPTC. In the literature, there are less than 50 cases showing coexistence of PSCCT and TCVPTC. In all these cases, apart from the ones in which pure squamous cell carcinoma (SCC) is seen as a recurrence of TCVPTC, SCC and TCVPTC areas were intermingled. The 2 cases we report here are unique in the way that PSCCT and TCVPTC are seen concurrently in these patients but they are separate tumors, not admixed with each other.

Expression of GATA3 and Cytokeratin 14 in Urinary Bladder Carcinoma (Histopathological and Immunohistochemical Study)

BACKGROUND: Urothelial carcinoma (UC) with squamous differentiation (SD) is the most common histologic variant of bladder carcinoma and its presence is associated with poor prognosis which may need early radical cystectomy to avoid progression and recurrence. It is difficult to detect few foci of SD, especially nonkeratinizing or early switch from urothelial to squamous epithelium on only morphological basis. Combination of GATA3 and Cytokeratin 14 (CK14) could be helpful in differentiating pure UC, UC with SD and pure squamous cell carcinoma (SCC). AIM: Assessment of GATA3 and CK14 expression in urinary bladder carcinoma and correlation with clinical and histopathological variables, for both diagnostic and prognostic purposes. MATERIALS AND METHODS: Sixty cases of archived paraffin blocks of urinary bladder carcinoma were tested for GATA3 and CK14 expression by immunohistochemistry using a rabbit monoclonal antibody against human CK 14 and mouse monoclonal antibody against GATA3, respectively. RESULTS: There is a significant correlation between GATA3 immunohistochemical expression and histological tumor subtypes of bladder carcinoma (p &lt; 0.001), i.e. the GATA3 is a useful marker for urothelial origin especially in papillary UC. There is a significant correlation between GATA3 immunohistochemical expression and UC grade (p &lt; 0.001). CK14 showed positive cytoplasmic staining in 9/14 (64.3%) cases of UC with SD and (13/13) (100%) cases of pure SCC and negative in 33/33(100%) cases of UC other than UC with SD. CK14 had sensitivity (64.3%) and specificity (100%) for areas of SD. CONCLUSION: GATA3 is a specific immunohistochemical marker for urothelial origin. CK14 is a highly specific and sensitive immunohistochemical marker of squamous cell carcinoma.

Prognostic Radiological Tools for Clinical Stage IA Pure Solid Lung Cancer.

In this study, we analyzed prognostic radiological tools and surgical outcomes for radiologically pure solid adenocarcinomas (AD) and squamous cell carcinoma (SQ) in clinical stage IA. We retrospectively investigated 130 patients who underwent surgical resections. We assessed the predictive risk factors for recurrence and pathological lymph node metastasis (LNM). There was no statistical difference in recurrence free survival (RFS) or cancer-specific survival (CSS) between AD and SQ groups (p = 0.642 and p = 0.403, respectively). In the whole cohort, tumor size on lung window and mediastinal settings, and tumor disappearance ratio using high-resolution computed tomography (HRCT) were not prognostic parameters (p = 0.127, 0.066, and 0.082, respectively). The maximal standardized uptake value (SUVmax) using positron emission tomography-CT was associated with recurrence (p = 0.016). According to the receiver operating characteristic curve, the cut-off value of SUVmax for recurrence was 4.6 (p = 0.016). The quantitative continuous variables using any radiological tools were not associated with LNM. However, tumor diameter on mediastinal setting ≥8 mm with SUVmax ≥2.4 could be a risk factor for LNM. Pure solid AD and SQ were equivalent for the RFS and CSS. SUVmax was useful to predict recurrence. The tumor diameter on a mediastinal setting and SUVmax were useful in predicting pathological LNM.

PD53-07 RISK OF INGUINAL LYMPH NODE METASTASES IN MEN WITH T1G2 PENILE CANCER STRATIFIED BY LYMPHOVASCULAR INVASION

You have accessJournal of UrologyPenile & Testicular Cancer: Penile & Testicular Cancer II (PD53)1 Sep 2021PD53-07 RISK OF INGUINAL LYMPH NODE METASTASES IN MEN WITH T1G2 PENILE CANCER STRATIFIED BY LYMPHOVASCULAR INVASION Christian Fankhauser, Hielke M. de Vries, Eduard Roussel, Jakob Kristian Jakobsen, Allaudin Issa, Esther W. C. Lee, Pedro Oliveira, Maurice Lau, Arie Parnham, Maarten Albersen, Nicholas A. Watkin, Ben E. Ayres, Oscar R. Brouwer, and Vijay Sangar Christian FankhauserChristian Fankhauser More articles by this author , Hielke M. de VriesHielke M. de Vries More articles by this author , Eduard RousselEduard Roussel More articles by this author , Jakob Kristian JakobsenJakob Kristian Jakobsen More articles by this author , Allaudin IssaAllaudin Issa More articles by this author , Esther W. C. LeeEsther W. C. Lee More articles by this author , Pedro OliveiraPedro Oliveira More articles by this author , Maurice LauMaurice Lau More articles by this author , Arie ParnhamArie Parnham More articles by this author , Maarten AlbersenMaarten Albersen More articles by this author , Nicholas A. WatkinNicholas A. Watkin More articles by this author , Ben E. AyresBen E. Ayres More articles by this author , Oscar R. BrouwerOscar R. Brouwer More articles by this author , and Vijay SangarVijay Sangar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002080.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In men with penile cancer, early detection and removal of inguinal lymph nodes (ILN) with metastatic disease is important as most patients can be cured with ILN dissection at this early metastatic stage. Current guidelines recommend invasive ILN staging in men with >T1G2 penile cancer and surveillance in ≤T1G1. In men with T1G2, the European Association of Urology guideline does not clearly specify whether invasive ILN staging is needed whereas the National Comprehensive Cancer Network guidelines only recommend invasive ILN staging in T1G2 with lymphovascular invasion (LVI). The aim of this analysis was to reassess the risk of ILN metastases in T1G2 disease and whether the stratification based on LVI is helpful in predicting ILN metastases and should influence the decision to perform invasive ILN staging. METHODS: We performed a retrospective cohort analysis of men presenting with localised T1G2 penile cancer with non-palpable lymph nodes and no local recurrence during follow-up at five European institutional high-volume centres. Patient characteristics, pathological and survival outcomes were extracted from electronic health records. ILN involvement was defined as cancer detected during ultrasound guided fine needle aspiration or core needle biopsy, dynamic sentinel lymph node biopsy, ILN dissection or inguinal recurrence during follow-up. Descriptive analyses and binary regression analyses were performed. RESULTS: The cohort included 477 men with a mean age of 65 years (±13), with pure squamous cell carcinoma in 90%, basaloid/warty/sarcomatoid variants in 7% and other variants or missing in 3%. During a median follow-up of 27 months (IQR 11-62), any ILN involvement was observed in 42/477 men (9%, 95% confidence interval (CI) 6-11%) of which 17/42 died, 5 because of penile cancer and 12 because of non-cancer associated reasons. LVI was present in 30, absent in 417 and missing in 30 men. Men with LVI patients had higher odds for ILN metastases compared to men without LVI (OR 3.9, 95% CI 1.5-6.5, p-value<0.01). Expressed as proportions, men with LVI had a ILN metastases risk of 23% (95% CI 10-42%) compared to 7% in men without LVI (95% CI 5-10%, p-value <0.01). CONCLUSIONS: In men with T1G2 cN0 penile cancer, LVI is a rare but strong risk factor for ILN metastases. Further analyses are required to balance the risk and benefits of invasive ILN staging in men with T1G2 without LVI. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e918-e919 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Fankhauser More articles by this author Hielke M. de Vries More articles by this author Eduard Roussel More articles by this author Jakob Kristian Jakobsen More articles by this author Allaudin Issa More articles by this author Esther W. C. Lee More articles by this author Pedro Oliveira More articles by this author Maurice Lau More articles by this author Arie Parnham More articles by this author Maarten Albersen More articles by this author Nicholas A. Watkin More articles by this author Ben E. Ayres More articles by this author Oscar R. Brouwer More articles by this author Vijay Sangar More articles by this author Expand All Advertisement Loading ...

Merkel Cell Polyomavirus‒Negative Merkel Cell Carcinoma Originating from In Situ Squamous Cell Carcinoma: A Keratinocytic Tumor with Neuroendocrine Differentiation

Although virus-negative Merkel cell carcinoma (MCC) is characterized by a high frequency of UV-induced mutations, the expression of two viral oncoproteins is regarded as a key mechanism driving Merkel cell polyomavirus‒positive MCC. The cells in which these molecular events initiate MCC oncogenesis have yet not been identified for both MCC subsets. A considerable proportion of virus-negative MCC is found in association with squamous cell carcinoma (SCC), suggesting (i) coincidental collision, (ii) one providing a niche for the other, or (iii) one evolving from the other. Whole-exome sequencing of four combined tumors consisting of SCC in situ and Merkel cell polyomavirus‒negative MCC showed many mutations shared between SCC and MCC in all cases, indicating a common ancestry and thereby a keratinocytic origin of these MCCs. Moreover, analyses of the combined cases as well as of pure SCC and MCC suggest that RB1 inactivation in SCC facilitates MCC development and that epigenetic changes may contribute to the SCC/MCC transition.

Diagnostic Relevance of GATA 3 Expression in Urinary Bladder Carcinoma of Divergent Differentiation and Other Histological Variants.

GATA binding protein 3, a zinc finger transcription factor, has now been demonstrated as a valuable and sensitive marker for conventional urothelial carcinoma with sparse literature related to its expression in various histological variants. It is a prospective study where 74 consecutive cases of bladder carcinoma were included between August 2016 and January 2017 followed by immunohistochemistry to assess GATA 3 expression in conventional as well as different urothelial carcinoma (UC) variants. Overall, 57 of the 74 lesions (77%) demonstrated nuclear staining for GATA 3. GATA 3 expression significantly correlated with histological grade (P < 0.001) and muscle invasion (P = 0.005). Divergent differentiation was observed in 54% (40/74) of the total cases. The study included 12 different variants of urothelial carcinoma. All or majority of the cases of clear cell (6/6, 100%), glandular (6/8, 75%), and sarcomatoid (4/6, 66.7%) variants expressed GATA 3 in a moderate to strong fashion and belonged to group III or IV. Nested variant, small cell carcinoma, pure squamous cell carcinoma, and squamous component of urothelial carcinoma with squamous differentiation do not show any GATA 3 expression. GATA 3 was expressed more intensely as well as in greater number of tumor cells at lymph node metastatic tumor deposits as compared to the primary tumor. GATA 3 expression was not significantly associated with tumor stage or patients' clinical outcomes. GATA 3 is expressed in majority of variants of UC albeit with variable staining; however, situation is challenging in some variants known to be associated with poor prognosis like nested variant, small cell carcinoma, and squamous cell carcinoma where it is not expressed. Hence, the sensitivity of this determinant is diminished in these variants, which may affect the interpretation of GATA 3 stains at metastatic sites as well as their distinction from secondary bladder involvement, by tumors of non-urothelial origin.

"Squamous Cell Carcinoma of the Breast: A Case Report and Review of Literature"

Background: Despite the variety of epithelial malignancies seen in the breast, primary squamous cell carcinoma (SCC) of the breast is rare. It was often classified as one of the metaplastic carcinomas of the breast, although it can arise denovo from benign cysts in the breast. The reported incidence is less than 0.1% of all the ductal carcinomata. It has no distinct clinical features and radiological appearances are also unremarkable. Case report: We managed a 43-year-old housewife at the General Surgery Unit of University of Maiduguri Teaching Hospital Borno State-Nigeria, who presented with an 11-month old left breast lump that developed malignant features 2 months prior to presentation. A diagnostic Ultra Sound Scan revealed a 10cm retroareola cystic mass with irregular margins and no colour flow on Doppler interrogation, with a provisional diagnosis of a chronic breast abscess. A Fine Needle Aspiration Cytology was equivocal. A wide local excision with axillary dissection was done and postoperative histopathologic analysis showed a primary squamous cell carcinoma. The resection margins were free and only one lymph node showed metastatic deposit. Conclusion: Adenocarcinoma of the breast is the most common malignancy in the breast. The absence of primary squamous cells in the breast renders pure squamous cell carcinoma a rarity. The presentation of squamous cell carcinoma could be similar to that of an adenocarcinoma or bears a benign outlook. It is imperative therefore to subject all benign lesions of the breast to pathological analysis after removal.