Variant Of Squamous Cell Carcinoma Research Articles

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 The cases of verrucous carcinoma treated with Mohs micrographic surgery in the literature, as well as a previously unpublished case is summarized.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 A previously unpublished case treated at our institution was also reported.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.

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.

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.

Sarcomatoid Squamous Cell Carcinoma of Alveolus: A Rare Case Presentation

To describe a rare case of sarcomatoid squamous cell carcinoma of alveolus. A 53-year-old female with complaints of non-healing ulcerative growth over the left side of the hard palate, which was associated with pain for two months. She underwent extraction and a Histo-pathological examination of teeth with attached soft tissue was suggestive of Sarcomatoid Carcinoma. The patient underwent Left infrastructure maxillectomy with wide local excision with left modified radical neck dissection type II. Histopathology showed lympho-vascular infiltration and perineural infiltration. All margins were free. Out of 8 lymph nodes that were dissected, 1 showed metastatic disease. The patient received adjuvant concurrent radio-chemotherapy 66Gy in 33 fractions (2Gy/day) in two phases along with weekly Injection Cisplatin 40 mg/m2. Sarcomatoid squamous carcinoma is a rare and uncommon variant of squamous cell carcinoma. It is aggressive in nature and shows early recurrence and metastasis. Thus, associated with a poor prognosis. There is no defined treatment protocol for this variant. We have discussed a case of sarcomatoid carcinoma of the alveolus that was operated and followed by adjuvant chemo-radiotherapy.

Oral carcinoma cuniculatum, the great mimicker: Report of a challenging case and literature review

AbstractOral carcinoma cuniculatum (OCC) is a rare and locally invasive well‐differentiated variant of squamous cell carcinoma. To date, 74 cases affecting the oral cavity were reported in English‐language literature. We report a case of maxillary OCC in a 71‐year‐old woman and review the demographic, etiological, clinicopathological, therapeutic and prognostic features of the OCC cases published in the English literature. From the 75 cases evaluated, there was no predilection for sex, and the highest incidence was between the seventh and tenth decades of life. Use of alcohol (17.3%), tobacco (29.3%), both (6.7%), and betel chewing (5.3%) were related in some cases. The clinical presentation was variable, and the gingiva and mandibular alveolar ridge were the most affected sites (50.7%). Inconclusive result or misdiagnosis in the initial histopathological examination was reported in more than 40% of cases, which required deeper or more representative biopsies for the definitive diagnosis. Radical surgery was the treatment of choice for 88.0% of cases. Overall, 10.7% of cases had cervical lymph node metastasis and 17.3% had recurrence after initial treatment, with only one death (1.3% of the cases). In conclusion, the wide variety of clinical presentations, lack of cytological atypia in most cases and need for deep incisional biopsies make the diagnosis of OCC challenging. Radical surgery is the main therapeutic modality and local recurrence after initial treatment occurs in less than 20% of cases. Although locally aggressive, regional and distant metastases are rare and the prognosis is good.

Sarcomatoid carcinoma: A rare biphasic variant of OSCC: A case report

Sarcomatoid carcinoma is a type of spindle cell neoplasm. These varieties of neoplasms comprise of a diverse collection of benign and malignant neoplasms. Sarcomatoid carcinoma, also known by various other names such as Spindle cell carcinoma, Lane’s tumor, to name a few, is an exceedingly rare and aggressive variant of squamous cell carcinoma 3, 7, 8 The variation in its nomenclature reflects the divergent interpretation of the sarcomatoid component as reactive or neoplastic, mesenchymal or epithelial.8 It accounts for

Pathologic findings of acantholytic squamous cell carcinoma coexisting with cutaneous cryptococcosis in a Houbara bustard (Chlamydotis undulata)

A 2-year-old Asian Houbara bustard was presented with a solitary well-defined, firm cutaneous mass on the hock region. Grossly, the mass protruded from the surface was located on the hairless and unpigmented areas of the right hock joint with ulceration and dried hemorrhagic foci. On microscopic examination, ulceration, hemorrhage, as well as hyperkeratosis were observed. Large round, oval to polygonal neoplastic cells extended into the dermis were arranged to form cords, trabeculae, islands or glandular-like structures without keratin pearls. These pseudoglandular structures were composed of pseudolumina containing acantholytic and detached tumor cells. Necrosis of the neoplastic cells was accompanied by infiltration of inflammatory cells particularly heterophils. Unlike pleomorphic tumor cells, mitosis count was almost frequent. No evidence of other abnormalities and tumor metastasis was found. These gross and microscopic features appeared to be suggestive of a rare histologic variant of squamous cell carcinoma (SCC), acantholytic SCC.

MRNA expression pattern study of esophageal basaloid squamous cell carcinoma.

e16062 Background: Esophageal squamous cell carcinoma (SCC) is one of the most common cancers and the leading cause of cancer-related death in China, and esophageal basaloid squamous cell carcinoma (BSC) is a rare variant (2.2%-11.3%) of SCC with highly aggressive behavior due to its propensity for vessel invasion and distant metastasis. Most reports stated that BSCs had poorer prognosis than conventional esophageal SCC. However, because of the histological morphologic similarity and lacking of diagnostic approaches, esophageal BSC can easily result in misdiagnosis as SCC. Methods: To deepen our understanding of esophageal BSC and seek for diagnostic biomarkers, we analyze the difference of mRNA expression between esophageal BSC and conventional SCC. Nanostring nCounter PanCancer Progression gene expression panel was used on different tumor components from 36 patients diagnosed with esophageal BSC component (Ba) coexisting with conventional SCC component (Co), who underwent esophagectomy at our Hospital (Cancer Hospital, Chinese Academy of Medical Sciences, China). Immunohistochemistry (IHC) was used for verification of candidate biomarkers sFRP1 concluded from mRNA expression analysis. The expression of sFRP1 was evaluated by H-score = % cells staining (0-100%) * intensity (1 to 3). Results: Among 770 RNAs analyzed in the study, 22.9% (176/770) showed downregulation (FDR-adjusted p < 0.05) in Ba than Co, while 5.3% (41/770) showed upregulation. A set of significantly upregulated RNAs (FDR-adjusted p < 0.01, log2(fold change) > 2) were observed in Ba, including sFRP1, FGFR1, ITGA9, VIT, VWA2 and PROM1, which were associated with angiogenesis response, basement membrane, and epithelial-mesenchymal transition (EMT). Besides, significant downregulation (FDR-adjusted p < 0.01, log2(fold change) < -2) of KRT14 was observed in Ba, which was well known as a biomarker for squamous differentiation. Clustering analysis with different pathway scores according to mRNA expression results of Ba yielded two major clusters: Cluster1 with higher pathway scores with resembled to Co, and Cluster2 with lower pathway scores. Survival analysis revealed that patients in Cluster1 seemed to have a longer RFS and a longer OS than those in Cluster2 (Figure 4C&D), although with no statistically significance (RFS: p = 0.322, median RFS = 23.7 vs 10.8 months; OS: p = 0.217, median OS = 51.6 vs 26.5 months), which was probably due to the limited number of patients evolved (10 patients in Cluster1 and 26 in Cluster2). The most upregulated mRNA, sFRP1, was validated by IHC. Receiver operating characteristic (ROC) curve revealed that sFRP1 IHC could be a remarkable diagnosis biomarker to distinguish BSC from conventional SCC (area under ROC = 0.935, p < 0.001 95%CI = 0.871-1.000). Conclusions: Our results revealed BSC as a subtype with distinct RNA expression pattern compared with conventional SCC, and provided a remarkable biomarker, sFRP1, for diagnosis.

Clinicopathological and mutational analysis of esophageal basaloid squamous cell carcinoma.

Esophageal basaloid squamous cell carcinoma (EBSCC) is a poorly differentiated variant of esophageal squamous cell carcinoma (ESCC). We aimed to investigate the clinicopathological and molecular biological characteristics of EBSCC and enrolled 58 patients with EBSCCs. Clinicopathological factors including age, sex, tumor size and location, gross tumor type (superficial, protrusive, ulcerative, and unclassifiable), lymphovascular invasion, infiltrative growth, intramural invasion, TNM stage, and dominant histological type were examined. EBSCCs were classified into four types (solid, cribri, microcystic, and tubular) according to the dominant histology. Next-generation sequencing (NGS) of a cancer hotspot panel was performed in 19 cases. NGS identified TP53 as the most frequently mutated gene, and copy number variation analysis revealed the most frequent loss of heterozygosity (LOH) at the ataxia telangiectasia mutated (ATM) and retinoblastoma 1 (RB1) loci. Target sequencing for TP53 was performed for the remaining 39 cases. We also performed LOH analysis for TP53, ATM, and RB1 and immunohistochemical staining for p53, ATM, and Rb in all cases. The rates of TP53 mutations and LOH and p53 aberrant expression were high (79.3%, 63.2%, and 72.4%, respectively); however, the frequencies were similar to those reported for ESCC. LOH rates of the RB1 and ATM loci were also high (55.3% and 67.2%, respectively). Overall survival rate was 66.5%, and recurrence-free survival rate was 55.0%. Only conventional clinicopathological factors had a prognostic impact in EBSCC; the microcystic type had the poorest prognosis. Our findings could be useful in developing novel treatment strategies for EBSCC.

Analysis of Human Papillomavirus (HPV) and Polyomaviruses (HPyVs) in Adenoid Cystic Carcinoma (AdCC) of the Head and Neck Region Reveals Three HPV-Positive Cases with Adenoid Cystic-like Features.

An aetiological role of human papillomavirus (HPV) and/or human polyomaviruses (HPyVs) has been proposed in adenoid cystic carcinoma (AdCC). Moreover, HPV-related multiphenotypic carcinoma (HMSC) was recently introduced as an emerging entity of the sinonasal region. Here, we primarily want to study the role of HPV/HPyV in a large AdCC cohort and, secondly, possibly identify and characterize HMSC. Tumour DNA from 68 patients initially diagnosed with AdCC between 2000 and 2012 was, therefore, tested for 27 HPV types and 10 HPyVs. HPV DNA-positive samples were micromorphologically re-evaluated, further stained for p16INK4a, S100, p63 and CD117 and tested for the presence of the MYB-NFIB fusion transcript. Notably, no samples were HPyV-positive, while one sinonasal and two tonsillar carcinomas were HPV- and p16-positive. After re-evaluating the micromorphology, immunohistochemistry and presence of fusion transcripts, all tumours had the same appearance and fitted within the diagnosis of HMSC, but in all these three cases, the morphology of the HMSC and basaloid squamous cell carcinoma was overlapping. We conclude that HPV and HPyV have no major role in AdCC. However, based on our data, we also suggest that HMSC should be considered as a basaloid variant of squamous cell carcinoma, and not its own entity, until better characterized.

Neuroendocrine differentiation distinguishes basaloid variant of lung squamous cell carcinoma

BackgroundNeuroendocrine (NE) differentiation is widely studied in non-small cell lung carcinomas (NSCLC) however, its significance remains unclear in basaloid squamous cell carcinomas (B-SqCC). This study aims to assess the extent of NE differentiation in B-SqCC and characterize the underlying molecular process.MethodsThis study evaluated resected B-SqCC, small cell lung cancer (SCLC) and poorly differentiated SqCC (PD-SqCC) from 2005 to 2020 at the Ottawa Hospital. Samples were subject to pathological review, immunohistochemistry (IHC) and survival analysis. Gene expression analysis was performed on B-SqCC samples exhibiting NE+ and NE- regions (paired samples) to identify differentially expressed genes (DEGs). These DEGs were subsequently validated in unpaired B-SqCC and TCGA samples.ResultsB-SqCC cases were more likely to exhibit nuclear molding, resetting and peripheral palisading than PD-SqCC. B-SqCC were also more likely to demonstrate NE differentiation compared to PD-SqCC (p = 0.006). Pure basaloid squamous cell carcinoma (PB-SqCC) experienced poorer disease-free survival (HR = 3.12, p = 0.043) adjusted for stage.Molecular characterization of paired B-SqCC samples demonstrated DEGs implicated in NOTCH signaling, SCLC and pulmonary neuroendocrine differentiation. Hierarchical clustering using discovered DEGs in unpaired B-SqCC samples distinguished tumors based on NE status (p = 0.048). Likewise, clustering The Cancer Genome Atlas (TCGA) samples with DEGs distinguished B-SqCC from SqCC samples (p = 0.0094).ConclusionThis study provides IHC and molecular evidence of significant NE-differentiation in B-SqCC and demonstrates their aggressive clinical behavior. These findings suggest that B-SqCC are biologically distinct from SqCC and share characteristics with SCLC.

Clear cell squamous cell carcinoma of the tongue exhibits characteristics as an undifferentiated squamous cell carcinoma

Clear cell squamous cell carcinoma (CCSCC), where cells show abundant clear cytoplasm, –is a variant of squamous cell carcinoma (SCC) and a rare entity in the oral cavity. The characteristics of CCSCC, especially in immunohistochemical features, remain unclear. We characterized a case of CCSCC arising from the oral mucosal epithelium of tongue, where the clear cell lesion accounted for a predominant portion of the tumor. This CCSCC, which was partially surrounded by conventional SCC, exhibited cellular atypia immunohistopathologically and histopathologically with a high Ki-67 index, increased number of mitotic figures and enlarged nuclei. Intravascular invasion of the carcinoma cells was also observed. Furthermore, the CCSCC recurred and metastasized to the cervical lymph nodes and both lungs three months after resection. Immunohistochemical analyses demonstrated decreased expression of p40 (an isoform of SCC marker p63), ADP-ribosylation factor (ARF)-like 4c (ARL4C), yes-associated protein (YAP) and 5-methylcytosine (5mC) in the CCSCC lesion compared with the surrounding SCC lesion, where the expression of ARL4C was upregulated compared with non-tumor region and YAP showed nuclear translocation. In addition, siRNA loss-of-function experiments revealed that p63 expression was required for ARL4C expression and DNA methylation was induced by p63 and YAP/transcriptional co-activator with PDZ-binding motif (TAZ) signaling in oral SCC cell lines. These results suggest that CCSCC, in which several markers of SCC-associated intracellular signaling pathways are downregulated, together with evidence of altered epigenetic regulation, is characterized as an undifferentiated SCC variant.

Epithelial-Mesenchymal Transition Marker Brachyury Is Not Expressed in Spindle Cell Carcinoma of the Head & Neck

Introduction. Epithelial-mesenchymal transition (EMT) is a complex biologic process by which epithelial cells lose their cytomorphologic characteristics and assume the phenotype of mesenchymal cells. EMT is essential to normal human embryogenesis, and also occurs in wound healing, tissue repair and cancer progression. Acquisition of a mesenchymal phenotype via EMT enhances the migratory capacity of carcinoma cells, increasing their metastatic capability and worsening prognosis for patients. One emerging marker of EMT is brachyury, a T-box transcription factor protein. Recent studies have demonstrated upregulation of brachyury in several carcinoma types, includ- ing squamous cell carcinoma (SCC). Spindle cell carcinoma (SpCC) is a variant of SCC in which cancer cells have a predominantly spindled phenotype. Whether brachyury is expressed in SpCC and contributes to this pheno- typic change is not clear. Objective.To examine brachyury expression by immunohistochemistry in SpCC of the head & neck, hypothesizing that brachyury expression is increased in SpCC, as compared with other forms of SCC. Methods.Immunohistochemical staining for brachyury was performed on 20 head and neck carcinoma cases per group in each of four groups: SpCC; moderately- to well-differentiated SCC; moderately- to poorly-differentiated SCC; and verrucous carcinoma (VC). Uninflamed fibroma was the negative control; and human chordoma, along with a 14.5-day-old mouse embryo, were positive controls. Evaluation of brachyury reactivity was completed by light microscopy. Results.Brachyury expression was not seen in any of the experimental groups. Nuclear reactiv- ity was present in both positive controls, including within chordoma cells, and within the nucleus pulposus of the mouse embryo. Conclusions.Brachyury does not appear to be involved in the cytomorphologic changes present in SpCC, nor is it expressed in any head & neck SCC variants. Our results are contrary to those found in previous reports. This result supports the hypothesis that an alternate mechanism contributes to the phenotype of SpCC.

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 FISH. 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.

Ocular surface squamous neoplasia with orbital tumour extension: risk factors and outcomes.

To describe the risk factors, clinical features, histopathology, treatment, and outcomes of patients with orbital tumour extension of ocular surface squamous neoplasia (OSSN). Retrospective study of 51 patients with orbital tumour extension (cases) and 360 patients without orbital extension (controls). Of 1,653 patients with OSSN, orbital tumour extension was noted in 51 (3%) cases. The risk factors for orbital tumour extension included outdoor occupation (p < 0.03; Odds ratio (OR) = 1.96), Human Immunodeficiency Virus (HIV) infection (p < 0.0001; OR = 5.81), prolonged duration of symptoms (p = 0.01; OR = 1.02), tumour bilaterality (p = 0.02; OR = 2.92), forniceal and tarsal conjunctival involvement, diffuse tumour (p < 0.0001; OR = 9.13), inferior quadrantic location (p < 0.0001; OR = 7.51), increased tumour thickness (p = 0.04; OR = 1.59), higher % of ocular surface involvement (p = 0.002; OR = 1.12), nodular (p = 0.002; OR = 2.61) and nodulo-ulcerative (p < 0.0001; OR = 11.05) tumour morphology, poorly differentiated tumours (p = 0.006; OR = 4.23); invasive squamous cell carcinoma (SCC) (p < 0.0001; OR = 29.76), spindle cell and mucoepidermoid variant (p = 0.02; OR = 16.94) tumours. At a mean follow-up period of 27 months, tumour recurrence in the socket was noted in 1 (2%), locoregional lymph node metastasis (LNM) in 15 (29%) patients, and nine (18%) patients died due to systemic metastasis (SM). T4 tumour at presentation was a risk factor for LNM (p = 0.01; Hazard ratio (HR) = 5.60) and SM (p = 0.0003; HR = 5.09). Orbital extension of OSSN is rare. Outdoor occupation, HIV infection, larger and thicker tumours in the inferior quadrant with forniceal and/or tarsal conjunctival involvement with nodular or noduloulcerative morphology, poor tumour differentiation, SCC, spindle cell and mucoepidermoid variants on histopathology are at increased risk for orbital tumour extension.