Squamous Elements Research Articles

Three Cases of Primary Adenosquamous Carcinoma of Stomach

Adenosquamous carcinoma of stomach is a mixed glandular-epidermoid tumor where both components are neoplastic. Its incidence is extremely rare. The five theories on the origin of squamous components are 1) island of ectopic squamous epithelium in the gastric mucosa, 2) squamous metaplasia of gastric epithelium, 3) squamous differentiation in a preexisting adenocarcinoma, 4) endothelial cell differentiated toward squamous elements, and 5) totipotential undifferentiated cells of the gastric mucosa. We experienced three cases of adenosquamous carcinoma. Case 1 was a 71-year-old female patient. ; an ulcerative lesion was present in the pylorus, measuring 5cm in diameter. Case 2 was a 57-year-old male patient. ; an ulcerative lesion is present in the pylorus, measuring 6 em in diameter. Case 3 was a 58-year-old female patient. ; an ulcerative lesion was present in the body and fundus, measuring 10cm in diameter. Microscopic examination revealed a mixed malignant squamous and adenomatous component.

A retrospective review of adenocarcinoma-in-situ and glandular atypia of the uterine cervix.

Between 1978 and 1985, 19 cases of adenocarcinoma-in-situ and 12 cases of glandular atypia have been identified at the Birmingham and Midland Hospital for Women. In 19 cases an associated dysplastic squamous element was identified, 20 of 28 pre-diagnosis smears correctly predicted a glandular lesion, 5 of 17 colposcopically directed biopsies predicted the findings in a larger biopsy (cone biopsy or hysterectomy). Colposcopy provided no additional information with regard to diagnosis. Twelve of 13 patients managed by cone biopsy and 16 of 17 by abdominal hysterectomy have been treated successfully as defined by subsequent normal cytology.

Squamous cell carcinoma of the breast: A clinicopathologic analysis of eight cases and review of the literature

Malignant neoplasms of the female breast composed of squamous cells are rare and constitute a particularly poorly understood facet of breast disease. Two pure squamous cell carcinomas ( SCCs ) of the breast and six tumors that displayed various combinations of malignant squamous elements and ductal breast adenocarcinoma were identified. Electron microscopy confirmed the diagnosis of SCC in two cases by the demonstration of regularly spaced desmosomes, tonofilament bundles, and keratohyaline granules. A review of the literature indicated that breast cancers with components of SCC are histologically variable. Approximately 30 cases of pure SCC and 80 cases of mixed adenocarcinoma and SCC (adeno-SCC) have been reported. Some of these squamous epithelium-containing tumors have displayed areas of cyst formation, spindle cell metaplasia, and pseudosarcomatous desmoplastic response, or origins in preexisting breast lesions, such as cystosarcoma phyllodes or dermoid cysts. Although this variability indicates a heterogeneous group of neoplasms, the overall prognosis for carcinomas of the breast with malignant squamous elements appears to be quite similar to that for ordinary breast adenocarcinomas of similar size and stage.

Hypercalcemia associated with gynecologic malignancies: biochemical characterization.

Fasting calcium excretion, renal phosphorus threshold, plasma 1,25 dihydroxyvitamin D, immunoreactive PTH, nephrogenous cyclic AMP excretion, and tumor burden were assessed in nine patients with gynecologic neoplasms and hypercalcemia. Gynecologic neoplasms were responsible for hypercalcemia in seven of 34 (20.5%) consecutive patients with malignancy-associated hypercalcemia. The tumor burden in each patient was large. Three of four endometrial carcinomas contained squamous elements. All patients displayed biochemical evidence of nonparathyroid humorally mediated hypercalcemia (bone resorption). Treatment of hypercalcemia did not appear to diminish production of the humoral calcemic factor but eradication of tumor eliminated biochemical evidence of the humoral syndrome. It can be concluded that (1) gynecologic neoplasms are a frequent cause of malignancy-associated hypercalcemia, (2) humoral mechanisms appeared to be responsible for the hypercalcemia in 100% of the patients in this series, (3) squamous features occur with unexpected frequency in hypercalcemic endometrial carcinoma, (4) the presence of hypercalcemia connotes a large tumor burden, and (5) treatment directed at the neoplasm (but not treatment directed at hypercalcemia) may eliminate evidence of ectopic calcemic hormone production.

Adenosquamous Carcinoma of the Pancreas: A Light and Electron Microscopic Study

The light microscopic diagnosis of the tissue removed from the head of the pancreas of an 82-year-old woman was undifferentiated carcinoma. Ultrastructur-ally, the tumor was composed of poorly differentiated glandular and squamous epithelial elements. This is the first detailed electron microscopic study of an adenosquamous carcinoma of the pancreas.

The relevance of ultrastructural examination in the classification of primary lung tumours

Biopsies from 50 primary lung tumours were classified according to the World Health Organisation's Histological Typing of Lung Tumours. They were also subjected to electron microscopic examination. Comparison of the diagnoses made by these separate methods showed that many poorly differentiated squamous cell carcinomas had been incorrectly classified. Agreement was good in the diagnosis of adenocarcinoma whilst ultrastructural examination of small anaplastic carcinomas disclosed a neuroendocrine tumour with a combination of squamous and glandular elements. Large cell anaplastic carcinoma proved to be a 'waste-basket' containing tumours which displayed ultrastructural characteristics of poorly differentiated squamous cell carcinoma, poorly differentiated adenocarcinoma or neuroendocrine carcinoma. Electron microscopy was also valuable in characterization of other pulmonary tumours whose identity could not be resolved at the light microscopic level. Ultrastructural examination may provide a better understanding of the histogenesis and derivation of lung tumours, as well as their behaviour and therapeutic response.

Cancer of the Bladder in Spinal Cord Injury Patients

Since 1963, 10 cases of bladder carcinoma have been detected in 1,052 new admissions to our center. A high percentage of these patients had squamous cell carcinoma and/or squamous elements. This relatively high incidence stimulated a prospective study of 81 spinal cord injury patients either maintained on intraurethral catheter drainage for 10 years or an external appliance for 15 years. There were changes of squamous metaplasia in 19 per cent of the cases but no cancer was detected. It remains undetermined if squamous metaplasia is a pre-malignant lesion. However, the incidence of squamous metaplasia and squamous cell carcinoma in paraplegics with chronically infected bladders is not uncommon.Any spinal cord injury patient with hematuria needs a complete bladder evaluation and any long-term paraplegic with chronic infection should undergo cystoscopy and Papanicolaou smears as part of the yearly checkup.

The rhabdomyoblast in mixed Müllerian tumors of the uterus and ovary. An immunohistochemical study of myoglobin in 25 cases.

Forty per cent of 25 uterine and ovarian mixed müllerian tumors contained stainable myoglobin that was present in the abundant cytoplasm of large rounded tumor cells. Intracytoplasmic cross striations identified rhabdomyoblasts in 32% of the cases, but were difficult to find. The authors believe that the immunoperoxidase technic successfully demonstrates skeletal muscle differentiation in a high proportion of mixed müllerian tumors and may be employed as a suitable diagnostic aid. However, the nonspecific staining of benign and malignant squamous elements should be interpreted with caution.

Squamous carcinoma of the colorectum and its genesis

A case of pure aquamous carcinoma of the rectum is presented, and the literature reviewed. Squamous carcinomas of the colorectum are rare tumours which have clinicopathological features in common with adenocarcinomas. Evidence is presented to support the proposal that most tumours of the large intestine that consist partly or completely of squamous elements arise from areas of squamous differentiation in pre-existing adenomas. The pathogenesis of squamous carcinoma and adenosquamous carcinoma appears to be similar to that of adenocarcinoma.

Ultrastructure of the ultimobranchial follicles of the laying chicken.

The ultimobranchial gland of the laying chicken consists of groups of C cells interspersed among a collection of intercommunicating follicles and ducts of variable size and shape. The epithelium lining this system ranges from squamous to columnar and includes stratified squamous and pseudostratified columnar elements. Four cell types are distinguished in this epithelium: F, mucous, C, and basal cells. F cells show microvilli and microfilaments. Pinocytotic activity and images of fusion of coated vesicles with the plasma membrane are evident. The rough-surfaced endoplasmic reticulum (RER) and the Golgi complex are moderately developed. Dense bodies are encountered apically in some cells. Mucous cells possess microvilli and secretory material in the typical form of partially fused droplets. C cells contain secretory granules and are invariably separated from the follicular lumen by other cell types. The smaller, pyramidal basal cells contain filaments, RER, small Golgi complexes, free ribosomes and hemidesmosomes. The lumina contain flocculent or granular material, cellular debris and desquamated cells. Morphological evidence demonstrates that features of the pharyngeal epithelium are retained and that the majority of the cell types, with the exception of C cells, are presumably nonendocrine.

Primary adenosquamous carcinoma of the stomach: experience of 11 cases and its clinical analysis.

1) During the last 10 years, 11 cases of primary adenosquamous carcinoma of the stomach were operated on. 2) Histologically, the specimens from the stomach showed adenocarcinoma with squamous differentiation in all the cases. 3) All the patients but 1 were males and their average age was 61.2 years. 4) The duration of illness prior to treatment was relatively long period of time and the chief complaints in over half of the patients were abdominal pain. 5) Eight cases showed metastases at the time of operation. Metastasis to the regional lymph nodes was observed in 8 cases and the squamous element was present in 5 of these cases. 6) There was no operative death. Followup study was made in 9 cases. Only 2 are still alive and the remaining 7 died of recurrence. The length of survival averaged 10.7 months.

Adenosquamous carcinoma of the endometrium. An entity with an inherent poor prognosis?

Mixed adenosquamous carcinoma of the endometrium have been reported in recent years to have a steady increase in incidence, extreme aggressiveness, poor responses to radiation therapy, and a low five-year survival (less than 20%). In the present report, 87 mixed carcinoma (MC) are compared with 260 pure adenocarcinomas (AC) and 29 adenoacanthomas (AA). There were no basic differences in incidence, clinical history, responses to radiation therapy, and prognosis for any of these three entities. Adenocarcinomas of the endometrium with and without squamous elements should be regarded and approached as any pure AC. There is an overall tendency for endometrial carcinomas to be at an early stage at diagnosis and the five-year survival regardless of pathologic type, stage, grade, myometrial invasion, and therapy is 80%.

Pathology of bladder cancer related to occupational history, smoking habits and tryptophan metabolite excretion

This study was designed to investigate any possible relationship between the histology of bladder carcinoma and the three variables cited in the title. Histological sections were reviewed without knowledge of previous diagnosis or any relevant clinical data. Tumours were graded and classified according to their constitutional cell type only (transitional, squamous, mixed). Tissue sections were available from 49 patients with bladder tumour who had had assays or urinary tryptophan metabolites, 10 of which were abnormal. Similarly, 124 patients (98 male, 26 female) who had had bladder cancer were questioned closely concerning smoking and occupational history. This material formed the basis for this study. Results showed no statistical difference in distribution of histologic types between patients withnormal, as against abnormal tryptophan metabolite patterns. In the 6 males with possible industrial exposure, squarnous elements were prominent in 3, compared to a frequency of only 8 in the 92 males without exposure. Whilst there was no statistical difference in histology between smoking and non-smoking groups, tumours with squamous elements were more prominent in the former group. Of the 14 carcinomas with squamous areas, 12 patients (86%) were smokers as against a frequency of smokers of 66% (73 patients) in the remaining 110 tumours. The documentation of histological differences in bladder tumours related to occupational exposure and smoking history is important in any aetiological understanding of bladder neoplasma. More studies are needed in this area with emphasis placed on careful patient interview and relevant data collection and analysis.

Adenoacanthoma and mixed adenosquamous carcinoma of the endometrium. A clinicopathologic study.

Published reports of “adenoacanthoma” of the endometrium have usually included both those cases in which the squamous elements are histologically benign and those in which they are histologically malignant. In the present report, cases with the former appearance have been classified as adenoacanthoma (or adenocarcinoma with squamous metaplasia), but tumors with malignant-appearing squamous cells have been grouped separately as mixed adenosquamous carcinoma. Of 148 consecutive cases reviewed, 71 (48.0%) were adenocarcinomas (AC), 44 (29.7%) were adenoacanthomas (AA), 26 (17.6%) were mixed carcinomas (MC), and 7 (4.7%) were clear cell carcinomas. Clinically, there were no major differences among patients with the three predominant tumor types, but there was a tendency toward later menopause and lower gravidity among those women whose tumors contained squamous elements (AA and MC). Despite similar treatment regimens and clinical staging, actuarial 5-year survival was 56.3% for AC, 82.9% for AA, and 35.3% for MC. Patients with MC also had a higher incidence of persistent tumor after irradiation, deeper penetration of tumor in hysterectomy specimens, and a tendency to earlier recurrences. When the MC pateints were compared with only women with poorly differentiated AC (since the glandular elements were almost always poorly differentiated in MC tumors), these two groups were quite similar in most parameters, including 5-year survival. Similar comparisons between AA and well-differentiated AC reveal that, despite similarities in all other respects, the 5-year survival remains significantly higher in AA (82.9% vs. 60.6%). Thus, it appears that the poorly differentiated (i.e., histologically malignant) squamous elements in MC are a function of poorly differentiated glandular elements and may not significantly worsen an already unfavorable prognosis. The ability of a well-differentiated carcinoma to form histologically benign squamous elements, on the other hand, seems to improve a prognosis which is already relatively favorable. Tumors formerly indiscriminately classified as adenoacanthoma should now be separated into two distinct groups, and these relationships should be investigated further.

Squamous Cell Carcinoma and Adenoacanthoma of the Colon

Carcinoma of the colon is almost always adenocarcinoma, (Greek adenos gland) which arises from the glandular mucosa lining this viscus. Squamous cell carcinoma or acanthoma (Greek akantha , thorn or prickle) occurs in the anal canal, the lining of which is squamous epithelium, or in the lower part of the rectum adjacent to the anal canal where it may have originated from the nearby squamous or transitional cells. Adenocanthomas are carcinomas in which both glandular and squamous elements are present. Rarely has squamous cell carcinoma been reported to occur in the colon above the peritoneal reflection although it is possible that this tumor may occur more frequently than the number of published case reports would indicate. From 1907, when Herxheimer 1 presented the case of a patient with adenoacanthoma of the cecum, to 1966, only two squamous cell carcinomas and five additional adenoacanthomas of the colon, excluding the rectum, had been

Pathology as Related to Tryptophan Metabolite Excretion, Occupational History, and Smoking Habits in Patients With Bladder Cancer<xref ref-type="fn" rid="FN1">1</xref>

There were no significant histologic differences between the bladder cancers in 39 patients with normal urinary excretion of tryptophan metabolites and those in 10 patients with abnormal metabolite excretion patterns. Neither were there statistically significant differences in histology between “occupational” and “spontaneous” tumors, nor between tumors in patients who had “ever smoked” cigarettes and those who had “never smoked” cigarettes. However, in both the “occupational” and the “ever-smoked” groups, apparently greater numbers of carcinomas were either wholly or partially composed of squamous elements, and further study of this point in larger series of cases seems indicated. For such studies, case material will be needed, not only from industries in which employees have had known exposures to materials later shown to be bladder carcinogens, but from nonindustrial sources after careful direct, personal interviews have divided cases into those with possible or definite occupational exposure and those with no history of exposure to the currently known occupational carcinogens.

Malignant teratoma of the ethmoid sinus. Report of a case.

A case of malignant teratoma arising in the ethmoid sinus of a 39-year-old man is presented. It led to the patient's death within 3 months after the onset of nasal symptoms. Histologically, the lesion contained young squamous, glandular and neural elements with abundant smooth muscle. Focal areas resembling esthesioneuroblastoma were present. The authors believe it to be the first documented case of a malignant teratoma arising in this location.

Adenoacanthoma of the Ovary

Summary Two instances of a rare, primary ovarian neoplasm, adenoacanthoma, have been reported. The various histogenetic possibilities regarding the origin of squamous elements in columnar epithelial carcinoma of the ovary have been discussed. It is suggested that the term adenoacanthoma be used in naming these peculiar ovarian carcinomas, in keeping with the use of this term in the designation of adenosquamous tumors elsewhere in the body.

Mixed adenocarcinoma and squamous cell carcinoma of the uterus

Twenty-eight cases of mixed adenocarcinoma and squamous-cell carcinoma of the uterus have been described. Eleven of these were located in the body of the uterus and 17 in the cervix. They form approximately 1 per cent of the entire group of uterine carcinomas. The symptoms and signs do not differ appreciably from those of the more common varieties of carcinoma found in the uterine fundus and cervix. Eighty-three per cent of the mixed adenocarcinoma and squamous cell carcinoma of the cervix were Graded 3 and 4, according to Broders' classification, whereas 82 per cent of the carcinomas of the uterine body were Graded 1 and 2. In mixed cell carcinomas of the cervix neither glandular nor squamous cell elements predominated, whereas the adenomatous clement was predominant in all cases of carcinoma of the body of the uterus.