Variant Of Squamous Cell Carcinoma Research Articles

An Update on WHO Classification of Thoracic Tumours 2021- Newly Described Entities and Terminologies

The 5th edition of the World Health Organisation (WHO) “Classification of Thoracic Tumours” replaces the previous edition from 2015, which was released in 2021. The new edition includes specific diagnostic criteria for each entity and lays a stronger emphasis on diagnostic molecular pathology. Immunohistochemistry (IHC) was heavily promoted in 2015, as a way to improve classification precision. The book places more attention on molecular pathology developments for all tumour types in 2021. Classification based on microscopic biopsy samples of the characteristics of lung cancer is an alternative to resection-based categorisation. A grading system for invasive non mucinous adenocarcinomas has been developed, using the percentage of distinctive histological patterns found inside each tumour. Lung adenocarcinoma is also predisposed by Tumour Spread Through Air Spaces (STAS). A basaloid variety of Squamous Cell Carcinoma (SCC) and lymphoepithelial carcinoma was added to the SCC group. The ciliated muconodular papillary tumour and thoracic SMARCA4-deficient undifferentiated carcinoma are recent inclusions. Therefore, the following new terms and entities have been added to the WHO classification of 2021: (1) Thoracic SWI/SNF related, matrix associated, actin dependent regulator of chromatin, subfamily a, member 4 (SMARCA4)-deficient undifferentiated tumour; (2) Bronchiolar adenoma/ciliated muconodular papillary tumour; (3) Primary pulmonary hyalinising clear cell carcinoma of lung; (4) Lypmphoepithelial carcinoma; (5) STAS.

Mixed warty and sarcomatoid squamous cell carcinoma of vulva: a rare occurrence

Vulvar cancer is a rare tumor accounting for <5% of female genital tract tumors. The most common type of vulvar malignancy is squamous cell carcinoma. There are many histological variants of squamous cell carcinoma, keratinizing type being the most common one. Sarcomatoid variant is an extremely rare variant in vulva and comprises both epithelial and mesenchymal features. Due to the rarity of this tumor in the vulva and limited cases reported in the literature, no proper management guidelines have been established yet. In the current case report, we describe a case of mixed warty and sarcomatoid squamous cell carcinoma of vulva.

CLEAR CELL VARIANT OF SQUAMOUS CELL CARCINOMA PENIS – A CASE REPORT

Carcinoma penis is a rare malignancy in males. The World Health Organization Classification of Tumors of the Urinary System and Male Genital Organs classifies squamous cell carcinoma of the penis into human papillomavirus (HPV) and non HPV related. Among the HPV-related Squamous cell carcinomas of the penis, clear cell variant is a rare. Here we report a case of clear cell variant of squamous cell carcinoma of penis with bilateral inguinal lymph node metastasis. We have treated this patient with radical surgery, wide excision and bilateral inguinal lymph node dissection followed by post operative chemo radiation. But during radiation itself the disease progressed, with rapid recurrence of inguinal lymph node metastasis, finally end up with palliative chemotherapy. Clear cell carcinoma is an aggressive form of cancer, with frequent metastasis to the inguinal lymph nodes, as seen in this case. Immunohistochemistry examination P16 was absent. So it is considered as clear cell variant of squamous cell carcinoma. Clinical experience with penile carcinoma is limited because of their rarity.

Histomorphological variants of oral squamous cell carcinoma and their relation with prognosis of the disease

The key to wealth is health but in present days cancer is going to exhaust mental, physical and economic conditions. Oral Cancer is the 6 most common cancer worldwide. Approximately 630,000 new patients diagnosed annually resulting in more than 350,000 deaths every year. Squamous cell carcinoma is by far the most important and the most common malignant mucosal neoplasm of the head and neck accounting for over 90% of all malignancies.Histomorphological features of oral squamous cell carcinoma (OSCC) and their relation with the pathological prognostic factors i.e. histological stage and grade of malignancy is the key feature, which help early and easy prognosis of OSCC. :To study the histomorphological features of oral squamous cell carcinoma and their relation with the pathological prognostic factors i.e. histological stage and grade of malignancy. Recent reports suggest an increase in oral squamous cell carcinoma (OSCC) frequency. To improve programs in public health, it is necessary to understand the epidemiological conditions. A retrospective review of all OSCC cases diagnosed by the Pathology Department was performed. Demographic data, in addition to anatomic zone and histological degree of differentiation were obtained. Central tendency, dispersion and prevalence rate per 100,000 individuals were determined. A total of 150 patients were diagnosed with OSCC and majority of them were men 118(79%) were men. OSCC were predominantly observed in the age of 40-60 years. The predominant anatomic zone was the Buccal mucosa, GBS, Angle of Mouth 99(66%), followed by the tongue and lip 42(28%) and Retromolar Triagone 09(06%).The most frequent histological degree was well differentiated in 110 cases (73.3%). The rates of OSCC prevalence showed similar patterns in terms across time.

BASALOID SQUAMOUS CELL CARCINOMA- A RARE METATYPICAL TUMOR- CASE REPORT

A rare kind of squamous cell cancer is called basaloid squamous cell carcinoma occurring in sixth to seventh decade of life with male predilection. It preferentially occurring in upper aerodigestive tract. Rare case reports are presented in the classical age group with a poor prognosis. A 46 year's senior old male patient showed up to otorhinolaryngology department with chief complain of growth on base on left side of tongue and supra-glottic growth. On radiological evaluation by Multislice CT Scanning, a heterogeneously enhancing mass lesion measuring approximately 25×38 mm was noted at the base of tongue. On cytological evaluation of the lesion, highly cellular smear showed malignant morphology of the cells. Histological evaluation reveals a tumour mass in which neoplastic cells were composed of two different cell types – the majority of the cells population consisted of basaloid cells with abrupt association of foci of squamous cells suggesting basaloid variant of Squamous cell carcinoma. We brought this case for acknowledgment due to its rare occurrence, lower age of presentation, poor prognostic value as well as high metastatic potential.

Mohs micrographic surgery in rare cutaneous tumors: a retrospective study at a Brazilian tertiary university hospital

BackgroundMohs micrographic surgery is an established technique in the treatment of cutaneous neoplasms. It offers higher cure rates and the main indications are non-melanoma malignant skin tumors. Few studies have been performed on the treatment of rare tumors through this technique. ObjectiveTo study rare skin tumors and rare variants of basal cell carcinoma and squamous cell carcinoma submitted to Mohs micrographic surgery in a tertiary service in relation to frequency, disease-free evolution, and applicability of this surgical procedure for this group of tumors. MethodsThis was a retrospective observational study including rare skin tumors and less common variants of basal cell carcinoma and squamous cell carcinoma treated using Mohs micrographic surgery, between October 2008 and April 2021. ResultsDuring the study period, 437 tumors were treated using Mohs micrographic surgery, and 22 (5%) rare skin tumors were selected. The tumors comprised three dermatofibrosarcomas protuberans, two atypical fibroxanthomas, two spiradenomas, two hypercellular fibrohistiocytomas, one primary cutaneous adenocarcinoma, one trichoblastoma, one porocarcinoma, one chondroid syringoma, one cutaneous angiosarcoma, one Merkel cell carcinoma, and one sebaceous carcinoma. Six other cases of rare basal cell carcinoma variants with trichoepitheliomatous differentiation, metatypical basal cell carcinoma, and clear cell squamous cell carcinoma were included. There were no cases of recurrence after an average of six years of follow-up. Study limitationsThis is a retrospective study on rare neoplasms carried out in a single referral center, and this surgical technique isn’t widely available in the public service. ConclusionThis retrospective case series showed that Mohs micrographic surgery is an appropriate treatment for rare skin tumors. They corresponded to 5% of the tumors treated by the technique during a 12-year-period, with no recurrences identified.

Radiation vs surgery for early-stage laryngeal verrucous carcinoma: A population-based propensity score matched-study.

Verrucous carcinoma (VC) is a rare variant of squamous cell carcinoma. Although VC is considered radioresistant, concrete evidence for this is absent. We obtained data on VC treated with surgery or radiation from the Surveillance, Epidemiology, and End Results database. Treatment selection bias was reduced by propensity score matching. Overall survival (OS) and disease-specific survival (DSS) rates were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were estimated using Cox proportional hazards models. Five-year OS rates in the radiation and surgery groups were 72.7% and 72.0%, respectively (P = 0.111); five-year DSS rates in the same were 86.7% and 88.4%, respectively (P = 0.234). HRs of radiation compared with surgery were 1.68 (95% confidence interval (CI), 0.96-2.95) for OS and 1.95 (95% CI, 0.69-5.53) for DSS. Similar prognoses were observed in patients with VC treated with radiation and surgery. VC can be treated using radiation.

Spindle Cell Carcinoma of the Head and Neck: Clinical Characteristics and Molecular Signatures.

Spindle cell carcinoma of the head and neck (HNSpCC) is a rare variant of head and neck squamous cell carcinoma (HNSCC). This study evaluated the clinical characteristics and molecular signatures of such tumors. Retrospective analysis. Medical records of patients diagnosed with HNSpCC from 1996 to 2018 were reviewed. The clinicopathologic features, treatment modalities, and survival status were carefully recorded. Whole exome sequencing (WES) was performed to evaluate the genetic signatures of HNSpCC. We found that among all 71 patients included in this study, the majority of them were male, with tumors developing predominantly in the oral cavity. The 1-, 3-, and 5-year disease-specific survival (DSS) rates were 64.6%, 49.5%, and 43.9%, respectively. A high local recurrence (LR) and distant metastasis (DM) rate (47.9%-25.3%, respectively) were observed. A significant proportion (28.2%) of patients with the worst prognosis had history of previous head and neck cancer (HNC) and had been treated with radiotherapy (RT). WES revealed that those post-RT SpCC shared common mutations with their previous HNC (pre-RT SCC), but gained additional genetic traits, such as hypoxia and cell-ECM interaction that were favorable for survival in an irradiated microenvironment. Distinct genetic landscapes in primary and post-RT SpCC were also found. This study demonstrates that HNSpCC is a unique entity with more aggressive behavior than conventional HNSCC. HNSpCC arising from a previously irradiated field is a predictor of dismal survival. Both genetic and microenvironmental factors contribute to this highly invasive tumor. 4 Laryngoscope, 133:2183-2191, 2023.

Outcomes of Patients with Adenosquamous Carcinoma of the Head and Neck after Definitive Treatment

<h3>Purpose/Objective(s)</h3> Adenosquamous carcinoma of the head and neck (ASC-HN) is a rare and aggressive variant of squamous cell carcinoma (SCC). Limited data suggests inferior outcomes compared to conventional SCC. We report one of the largest single institutional experiences of this disease in patients treated definitively to further elucidate oncologic outcomes. <h3>Materials/Methods</h3> Patients with non-metastatic ASC-HN treated definitively between 2003 and 2021 were identified retrospectively from an IRB approved database with histology verified by head and neck pathologists. All tumors of the oropharynx were tested for p16 and/or HPV to document HPV associated disease. For non-oropharyngeal lesions, a designation of HPV positivity required the presence of HPV DNA/RNA per CISH. Actuarial analyses were performed for PFS and OS. <h3>Results</h3> 29 patients with ASC-HN (72.4% male, 93.1% Caucasian) with median age of 66 (range 34-91) and a median follow up of 33 months (range 6.6-126.7) were identified. The most common primary tumor sites were: oropharynx (27.6%), oral cavity (20.7%), nasal cavity (17.2%), and larynx (17.2%). 3 patients had primaries in the hypopharynx, nasopharynx and parotid gland respectively. 11 patients (37.9%) were HPV positive of whom 8 had oropharyngeal primaries. The majority (n=23, 79.3%) were treated with primary surgery of whom 19 (82.6%) received adjuvant radiation (RT) to a median dose of 60 Gy (range 36-70 Gy) with 7 receiving concurrent chemotherapy. 6 patients were treated with definitive RT to a median dose of 70 Gy with two receiving concurrent chemotherapy. There were 10 recurrences (34.5%) which occurred at a median of 14.3 months (range 5.4-28) after diagnosis including 8 loco-regional and 2 distant recurrences. Recurrences were documented in patients with primary salivary gland, oral cavity, laryngeal, hypo-pharyngeal, and oropharyngeal tumors. 3 of the 10 recurrences were in patients with HPV positive disease. Among the 6 patients treated with definitive radiation or chemo-radiation no failures were observed. 9 patients (31%) were deceased at the time of analysis. Overall, 3-year PFS and OS were 54.2% and 72.9%, respectively. 3-year PFS and OS were 45.6% and 69.6% for primary surgery and 83.3% and 83.3% in the definitive RT group. 3-year PFS was 50% and 75% for HPV negative and positive patients respectively. <h3>Conclusion</h3> In our single institutional experience of 29 patients with adenosquamous carcinoma of the head and neck there was a 34.5% recurrence rate. Loco-regional recurrence was the primary mode of failure.

Cutaneous verrucous carcinoma: A clinicopathological study of 21 cases with long-term clinical follow-up.

BackgroundCutaneous verrucous carcinoma (CVC) is a rare variant of squamous cell carcinoma and sometimes shares similar clinical and histopathological features with other verrucous lesions.MethodsWe performed a retrospective study of 21 patients diagnosed with CVC between 2012 and 2022 by reviewing clinical and histopathological data. We also compared the clinicopathological features of patients with CVC, giant condyloma acuminatum (GCA), and pseudoepitheliomatous hyperplasia (PEH). We obtained follow-up data by reviewing medical records and telephone interviews.ResultsThe average age of patients with CVC was 63.6 years, with a male predominance. The location of disease is mostly found in the foot, followed by the lower legs. Histologically, CVC is characterized by an exo-endophytic growth pattern with severe keratinization and a blunted rete ridge with pushing margins. Clinical features including exudation and crusting, induration, irregular borders, and warty surface, as well as pathological features including growth pattern, koilocytotic cells, depth and morphologic features of acanthosis, severe keratinization, and degree of dermal inflammation, were significant in distinguishing cutaneous CVC, GCA, and PEH.ConclusionIdentification of the clinicopathological features is essential to distinguish CVC from its mimics and to make an early diagnosis. Because of the potential for recurrence and metastasis, CVC requires aggressive treatment.

Role of TNFSF15 variants in oral cancer development and clinicopathologic characteristics.

Tumour necrosis family superfamily (TNFSF) member 15 (TNFSF15), encoded by TNFSF15, regulates immune responses and inflammation. However, the roles of TNFSF15 single-nucleotide variants (SNVs; formerly SNPs) in oral cavity squamous cell carcinoma (OCSCC) remain unclear. This case-control study included 2523 participants (1324 patients with OCSCC [52.5%] and 1199 healthy controls [47.5%]). The effects of TNFSF15 rs3810936, rs6478108 and rs6478109 on cancer development and prognosis were analysed by real-time PCR genotype assay. The Genotype-Tissue Expression (GTEx) and The Cancer Genome Atlas (TCGA) databases were used to validate our findings. The results demonstrated that the patients with altered TNFSF15 SNVs had poorer histological differentiation than did those with wild-type alleles. TNFSF15 SNVs were significantly associated with moderate-to-poor histological differentiation in univariate logistic regression. In the GTEx database, the expression of altered TNFSF15 SNVs in whole blood was lower than that of wild-type alleles. However, the expression of altered SNVs in the upper aerodigestive mucosa was higher than that of wild-type alleles. In the TCGA database, the patients with higher TNFSF15 expression had shorter overall survival than did those with lower TNFSF15 expression, especially for human papillomavirus-negative and advanced staging groups. In conclusion, although TNFSF15 SNVs did not affect OCSCC development, the patients with altered TNFSF15 SNVs exhibited poorer histological differentiation. The patients with higher TNFSF15 expression had poorer prognosis than did those with lower TNFSF15 expression.

Clear Cell Variant of Squamous Cell Carcinoma of Skin: A Case Report and Review of the Literature

Clear cell squamous cell carcinoma (SCC) is a rare variant of SCC of skin in which ultraviolet radiation has been suggested as possible etiology. We report a case of a 51-year-old male patient who presented with a 4 months history of a non-healing ulcer on the left side of his face. Histopathology and immunohistochemistry studies showed Clear cell variant of squamous cell carcinoma. This case showed an aggressive and bizarre clinical presentation but more report of cases are needed to have a better characterization of the clinical presentation and prognosis of this variant of this squamous cell carcinoma variant.

Mohs micrographic surgery for verrucous carcinoma: a review of the literature.

Verrucous carcinoma is a rare, low grade variant of squamous cell carcinoma that rarely metastasizes but tends to display aggressive local behavior. Wide local excision is the most common treatment, but has high rates of local recurrence, ranging from 19 to 75% in the literature. The cases of verrucous carcinoma treated with Mohs micrographic surgery in the literature, as well as a previously unpublished case is summarized. PubMed was searched for terms related to verrucous carcinoma and Mohs micrographic surgery, and articles reporting cases of verrucous carcinoma treated with Mohs were reviewed and summarized. A previously unpublished case treated at our institution was also reported. Thirty-eight cases of verrucous carcinoma treated with Mohs surgery were analyzed. The average age of patients was 52.1, and 50% were male. The most common sites were the foot (47%) and the anogenital region (34%). Lesion duration ranged from 0.17 to 40years with a mean of 4.8years, and tumor diameter ranged from 1 to 10cm with a mean of 4.6cm. The local recurrence rate following Mohs was 16%, with nodal metastasis occurring in 3% and no cases of distant metastasis. As verrucous carcinoma demonstrates locally aggressive behavior and a high risk of local recurrence, Mohs micrographic surgery should be considered as first line treatment. Further research directly comparing wide local excision to Mohs surgery is needed.

Adenoid (Acantholytic) squamous cell carcinoma of the alveolar ridge: A rare case report

Adenoid squamous cell carcinoma (ASCC) is a one of the histological variants of oral squamous cell carcinoma with a rare occurrence of less than 4% of all the cases. The tumour has a slight male predilection with lower lip being the most affected site. ASCC is said to have a varied biologic behaviour which accounts for its ability to metastasize to distant sites and hence has poor prognosis. The histopathology shows numerous duct-like structures with central acantholytic cells. Distinct cytological atypia is seen which aids in diagnosis of SCC. Special stains help in differentiating the tumour from other variants of SCC. The presented case of a 70-year-old female emphasizes the importance of histopathogical examination of the unusual and rarely observed ASCC which can be missed due to similarities with other entities. Recurrence rates being very high, proper treatment starting with definitive diagnosis is imperative.

SATB2 Positive Sarcomatoid Carcinoma of the Oral Cavity With Rapid Recurrence After Surgical Resection: A Case Report and Literature Review of a Rare Entity

Sarcomatoid carcinoma is a rare and aggressive variant of squamous cell carcinoma. This lesion is unique in that it presents as a biphasic tumor characterized by a dysplastic epithelial component with a stromal element with invasive spindle cells, which acquires a mesenchymal phenotype. This malignancy accounts for 3% of all head and neck squamous carcinomas and for less than 1% of oral cavity tumors with just a few cases reported in the literature.1 Sarcomatoid carcinoma may be difficult to discern from osteosarcoma as the epithelial cells in the sarcomatous metaplasia may not retain any identifiable markers via immunohistochemical staining and may start to express aberrant mesenchymal markers leading to a false sarcoma diagnosis.

Histomorphology and Molecular Profiling of Well-Differentiated Squamous Cell Carcinoma of the Esophagus Including its Unusual Variants

Esophageal verrucous squamous cell carcinoma and esophageal carcinoma cuniculatum are rare variants of extremely well-differentiated squamous cell carcinoma. These rare tumors share similar risk factors and clinical presentations with conventional esophageal squamous cell carcinoma. However, these tumors have distinct morphological features, molecular mutation profiles, and clinical outcomes. Diagnosis of esophageal verrucous squamous cell carcinoma and esophageal carcinoma cuniculatum can be challenging, requires high clinical suspicion, and often can only be diagnosed on a deep mucosal biopsy or resection specimen. Surgical treatment or endoscopic resection can be curative in early disease. This review presents the histomorphology and molecular profiling of the conventional type and the rare variants of the esophageal well-differentiated squamous cell carcinoma.

SARCOMATOID CARCINOMA: A CASE REPORT

Sarcomatoid carcinoma (SC) is an infrequent variant of squamous cell carcinoma. A 62-year-old male patient with a long smoking and drinking history reported difficulty swallowing due to a rapidly growing mass in the floor of the mouth for 5 weeks. Intraorally, an exophytic mass of 2 cm was observed. After biopsy, histopathologic examination revealed a proliferation of neoplastic cells with epithelial differentiation, organized in nests and islands, as well as fascicles of spindle cells, exhibiting intense cellular pleomorphism and the presence of numerous atypical mitoses. Neoplastic cells with epithelial morphology were positive for anti-AE1/AE3 antibody and the spindle cell component strongly positive for vimentin and alpha-SMA. The anti-Ki67 antibody showed 38% of positivity in the epithelial component and 22% in the spindle cell component. The diagnosis of SC was made. The patient underwent chemotherapy but died after 12 months of treatment. Sarcomatoid carcinoma (SC) is an infrequent variant of squamous cell carcinoma. A 62-year-old male patient with a long smoking and drinking history reported difficulty swallowing due to a rapidly growing mass in the floor of the mouth for 5 weeks. Intraorally, an exophytic mass of 2 cm was observed. After biopsy, histopathologic examination revealed a proliferation of neoplastic cells with epithelial differentiation, organized in nests and islands, as well as fascicles of spindle cells, exhibiting intense cellular pleomorphism and the presence of numerous atypical mitoses. Neoplastic cells with epithelial morphology were positive for anti-AE1/AE3 antibody and the spindle cell component strongly positive for vimentin and alpha-SMA. The anti-Ki67 antibody showed 38% of positivity in the epithelial component and 22% in the spindle cell component. The diagnosis of SC was made. The patient underwent chemotherapy but died after 12 months of treatment.

SARCOMATOID CARCINOMA: CASE REPORT

Sarcomatoid carcinoma (SC) is a malignant tumor characterized by double malignant histology with differentiation of epithelial and mesenchymal components, a rare variant of squamous cell carcinoma. The report is of a 40-year-old female patient who presented pain in the upper gingival mucosa on the left side. The intraoral exam showed extensive ulceration on the hard palate that extended from the buccal mucosa to the midline. An incisional biopsy was performed and the anatomopathologic diagnosis was SC. The patient was treated with chemotherapy, with no significant effect. According to some authors, these tumors are known for the high incidence of local recurrences and distant metastases. Wide surgical excision is the treatment of choice and radiotherapy can be discussed in cases of surgically irresistible lesions. The prognosis is quite reserved because it is an aggressive tumor with rapid progression and destruction.

VERRUCOUS CARCINOMA IN DORSAL REGION OF THE TONGUE: CASE REPORT

Verrucous carcinoma (VC) is a clinical-histopathologic variant of squamous cell carcinoma. The objective of this work is to report a clinical case of a 39-year-old brown-skinned male patient with an injury 10 years ago who sought the stomatology service complaining of "white spot on the tongue." During the anamnesis, the patient reported being a smoker for 20 years. On intraoral examination, a white plaque was noted on the dorsal region of the tongue, with a white color, sharp edges, firm consistency, and warty surface, measuring 3.0 × 2.0 cm. The clinical hypothesis was verrucous leukoplakia. An incisional biopsy was performed, and histopathologic sections revealed areas of epithelial neoplasia with keratin formation that invaded the lamina propria with minimally invasive VC compatibility. The patient was referred to the oncologist. This case reinforces the importance of the stomatologist in the elucidation of cases with potential for malignancy and in the direction of treatment.

SPINDLE CELL CARCINOMA: CASE REPORT

Spindle cell carcinoma (SCC) consists of biphasic, malignant, and rare neoplasm, with a poor prognosis due to the high probability of metastasis and recurrence. A 55-year-old White male patient, a drinker and smoker, presented with a mass on his tongue with a 6-month evolution that caused a burning sensation. Clinically, an exophytic, ulcerated, and hemorrhagic nodular lesion was observed in the left lateral edge of the tongue with the hypothesis of squamous cell carcinoma. An incisional biopsy was performed, allowing the diagnosis of SCC, a variant of squamous cell carcinoma, due to fusiform cells with atypia and cellular pleomorphism. Surgical excision was performed as treatment, but the patient died prior to the start of chemotherapy and radiotherapy.