Well-differentiated Squamous Cell Carcinoma Research Articles

Clinical, histopathological and immunohistochemical study of keratoacanthoma.

Keratoacanthoma (KA) is an epithelial tumor of the skin, classically considered as having a malignant transformation risk of 15%; however, many authors and the new World Health Organization (WHO) Classification of skin tumors consider KA as an incipient variant of the cutaneous squamous cell carcinoma (SCC). The aims of the study were to assess the clinical, histopathological (HP) and immunohistochemical (IHC) aspects of the KA and the role of these factors in malignancy occurrence. The studied group comprises 194 patients diagnosed with KA or malignant KA, hospitalized in the Clinic of Dermatology, Emergency County Hospital, Craiova, Romania, between 2006 and 2019. There were 83 males and 111 females, aged 34 to 90 years, 57.21% of the patients being from the rural environment. The histopathology diagnosed 51 KAs and 143 malignant KAs (SCCs). Clinical diagnosis had a limited value in detecting the absence or presence of malignancy in the KA lesion, due to a low accuracy (36.08% and 29.89%, respectively) and specificity (23.07% and 27.02%, respectively); therefore, the HP exam of the surgical excision specimen has a paramount importance in establishing the diagnosis. IHC analysis revealed that the immunostainings for apoptosis-associated proteins and keratinocyte proliferative activity [p53, B-cell lymphoma-2 (Bcl-2), Ki-67 and proliferating cell nuclear antigen (PCNA)] provide some arguments to differentiate between KA and SCC in the studied cases. The correlation of clinical, HP and IHC data lead to an accurate diagnosis of KA; moreover, the clinical, HP and IHC data sustain the idea that KA is a particular form of well-differentiated SCC, which require an active therapeutic attitude.

Association of IHC p16INK4a expression and ELISA Plasma p16INK4a Protein in Squamous Cell Carcinoma of Uterine Cervix: A Concept of Liquid Biopsy

Introduction: Cervical cancer is the 3rd most common cancer among women worldwide. p16 biomarker is the surrogate marker in cervical cancer and can be detected by Immunohistochemistry (IHC). Aim: To evaluate the association of IHC p16INK4a expression in tissue sections and Enzyme-linked Immunosorbent Assay (ELISA) p16INK4a protein in plasma of paired samples in Squamous Cell Carcinoma (SCC) of uterine cervix. Materials and Methods: This laboratory-based observational, pilot study was conducted at Sri Devaraj Urs Medical College (tertiary health care centre) in South India from June 2020 to May 2021. Total 17 new cases of SCC of cervix diagnosed by histopathology were considered for the study. The cases were staged as per International Federation of Gynecology and Obstetrics (FIGO) staging system and classified by histopathology as keratinising and non keratinising types. IHC p16INK4a evaluation was done on tissue sections and classified as block positivity, ambiguity and negative. ELISA p16INK4a estimation was done using plasma from Dipotassium Ethylenediaminetetraacetic Acid (K2-EDTA) blood sample of same cases. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 22.0 software. Results: The age ranged from 30-80 years with mean of 54.3±12.0 years. Plasma ELISA p16INK4a level ranged from 3.4-19.6 ng/ mL with a mean of 7.2±2.35 ng/mL in SCC of cervix. The plasma p16INK4a ELISA levels of 5.1 to 6.2 ng/mL, 6.0 to 6.6 ng/mL and 5.5 to 9.7 ng/mL predicts negative, ambiguity and block positivity of IHC p16INK4a expression respectively in corresponding tissue biopsy. Plasma ELISA p16INK4a levels were maximum in Non Keratinising Squamous Cell Carcinoma (NKSCC) followed by Well Differentiated Squamous Cell Carcinoma (WDSCC), Moderately Differentiated Squamous Cell Carcinoma (MDSCC) and Poorly Differentiated Squamous Cell Carcinoma (PDSCC). Conclusion: The plasma ELISA p16INK4a levels and IHC p16INK4a expression were maximum in higher disease stage compared to lower stage. This was a pilot study to evaluate the association between tissue IHC p16 expression and plasma ELISA p16 levels. Further study has to be done on larger study population with standardised procedure to prove the hypothesis.

Evaluation of metastatic neck nodes search for primary and subsequent management.

Cancers in the head-and-neck region are the sixth most common cancers worldwide with an increasing incidence in developing countries. This study was carried out in the department of ENT and head-and-neck surgery in collaboration with the department of radiotherapy for a period of 1 year extending from May 01, 2014, to April 30, 2015. A total of 48 cases of metastatic secondary nodes were included in the study. The male-to-female ratio in the present study was 4.33:1. Maximum number of patients were seen in the seventh decade. The youngest patient was a female 30 years old and the oldest was a male of 80 years. About 95.84% of primary tumors were squamous cell carcinomas and 40.47% of the patients of head-and-neck cancer with metastatic lymph nodes had well-differentiated squamous cell carcinomas. Majority of cases presented with N2 nodes, while N1 nodes were highest in cases of carcinomas larynx. Metastatic neck disease is a major problem in patients with head-and-neck cancer. The therapeutic goal includes not only known disease but also the elimination of possible subclinical disease. The judicious use of moderate doses of irradiation and modified surgical procedures should be used in specific clinical situations to significantly decrease neck recurrences while eliminating morbidity.

E-cadherin as a Prognostic Biomarker in Oral Squamous Cell Carcinoma: A Pilot Study at Tertiary Care Hospital

Introduction: In a recent survey of cancer mortality in India, oral cavity cancer was listed as the leading cause of mortality in men, causing 29% of cancer-related deaths. Objective: The aim is to investigate the expression of E-cadherin to elucidate its role in determining the biological activity of the disease as a reliable and potential marker. Materials and Methods: E-cadherin immune-reactivity was evaluated in ten randomly selected fields in consecutive 50 cases diagnosed with oral squamous cell carcinoma (OSCC) and in each case, its mean was taken for the evaluation of E-cadherin expressing cells. The distribution and intensity of immunostaining E cadherin were also semi-quantitatively evaluated. Results: The most prevalent age group involved was the fifth decade and alveolus was the main site. The most common histological subtype was found to be well-differentiated squamous cell carcinoma and stage IV was the most common subtype in our study. The P value was significant for association between differentiation of tumor, staining location, and expression of E-cadherin (P value-0.002). E cadherin expression was compared with mortality; we found five out of seven death cases showing strong E cadherin expression, however, this was not statistically significant. Conclusions: Clinical and histopathological characteristics of malignancy, such as metastasis, recurrence, low survival, and poor tumor differentiation, have been associated with low expression of E-cadherin in OSCC.

Study of expression of epithelial cadherin in benign and malignant epithelial lesions of uterine cervix

Context: Epithelial cadherin (E-cadherin) is inversely proportional to the histologic grade of squamous cell carcinoma (SCC) of the cervix and is reduced with the increasing grade of cervical intraepithelial neoplasia, with downregulation upon transition to cervical intraepithelial neoplasia and further to invasive cancer. Aims: The aim of the study was to study the expression of E-cadherin in benign and malignant epithelial cervical lesions and to compare the results statistically. Settings and Design: The cross-sectional study was hospital based conducted in the department of pathology from January 2018 to March 2019. Methods: The study was carried out on sixty biopsy specimen of cervix (33 malignant, 4 premalignant, and 23 benign lesions). Two sections were taken; one for hematoxylin and eosin and other for E-cadherin immunohistochemical staining. Statistical Analysis Used: Statistical analysis was done using Chi-square test and Fisher's exact test. Results: In well-differentiated SCC, the majority cases (40%) revealed membranous staining while in moderately differentiated SCC and poorly differentiated SCC, the most common staining pattern was membranous and cytoplasmic (70% and 45.4%, respectively). In adenocarcinoma, 66.6% of cases had membranous pattern of staining, whereas two cases (33.3%) were negative. In High-grade Squamous Intraepithelial Lesion (HSIL), 75% of cases had membranous staining. Pure membranous pattern of staining of E-cadherin showed a progressive decline with a loss of differentiation while pure cytoplasmic revealed a reverse pattern. Conclusions: We concluded that, in malignant lesions, there is a loss of membranous E-cadherin pattern as compared to benign lesions. Furthermore, there is a progressive decline in pure membranous staining of E-cadherin with increase in shift to cytoplasmic staining as differentiation decreases.

A Rare Case of Verrucous Carcinoma of Foot

Verrucous carcinoma is a rare, locally invasive, well-differentiated, and low-grade squamous cell carcinoma, with low metastatic potential. To our knowledge such cases reported are only finger counting numbers. In this case report, we present a rare case of a patient with an ulcerative lesion in the plantar foot that clinically and radiographically faced with a dilemma whether it was an osteomyelitis or deep mycosis or viral warts with secondary infection. The initial surgical approach consisted of wide excision of the malignant neoplasm including some normal tissue too. Definite diagnosis is by histopathology only.

Afatinib-induced acneiform eruptions

Epidermal growth factor receptor (EGFR) inhibitors are being increasingly used in the treatment of non-small cell carcinoma of the lung. Cutaneous toxicity of various EGFR inhibitors is being increasingly noticed by dermatologists. We hereby report a case of papulopustular eruption in a male patient who had received oral afatinib for well-differentiated squamous cell carcinoma of the lower lip. The offending drug was continued and the papulopustular eruption was treated with oral doxycycline and local care.

A case of well-differentiated squamous cell carcinoma in vulval lichen sclerosus

Lichen sclerosus (LS) et atrophicus is a known premalignant condition affecting both sexes. Squamous cell carcinoma is the most common malignancy seen in LS et atrophicus. We report a case of 42-year-old female suffering from vulval LS et atrophicus for 12 years who developed squamous cell carcinoma. It is imperative to counsel the patients with LS regarding the malignant potential and actively monitor them for better outcome in terms of survival as well as quality of life.

Expression of Cyclin D1 in Oral Squamous Cell Carcinoma

Background: Cyclin D1 expression regulates normal cell cycle. Its deregulation or overexpression may cause disruption in the normal cell cycle control and lead to cancer progression. In this study, we aimed to study the expression of cyclin D1 in oral squamous cell carcinoma (OSCC) and find its association with the different grades of oral tumors, if any. 
 Methods: This cross-sectional study included 40 formalin-fixed paraffin-embedded tissue blocks specimens of OSCC with variable grades. The expression of cyclin D1 was evaluated through immunohistochemical (IHC) staining.
 Results: There were 9 female and 31 male samples, with a male-to-female ratio of 3.4:1. The age ranged between 25 and 90 years with an average age of 65.5 years. Twenty-five (62.5%) samples were diagnosed as well-differentiated squamous cell carcinoma (WDSCC) and fifteen (37.5%) as poorly differentiated squamous cell carcinoma (PDSCC). No cases of moderately differentiated squamous carcinoma were included in the study. The expression of cyclin D1 was detected in the cases of WDSCC and a lesser expression was seen in the PDSCC with a P-value of 0.0003, OR 1581 and 95% CI (29.8239 to 83810.7113).
 Conclusion: Cyclin D1 is expressed in OSCC and stronger expression was detected in WDSCC.

Adipofascial Turnover Forearm Flap for a Large Defect in Hand after Squamous Cell Tumor Extirpation. A Case Report

Squamous cell carcinoma is a cancer that is rare in the hand. The extirpation of this cancer can leave an important cutaneous defect in many cases. The cutaneous covering at the back of the hand is a challenge for any surgeon, especially when there are large skin defects with exposure of tendons, bones or neurovascular structures. Here, we describe a clinical case where an adipofascial turnover forearm flap and full thickness skin graft were performed, after the extensive extirpation of the well-differentiated squamous cell carcinoma has been made.

Giant peripheral ossifying fibroma with coincidental squamous cell carcinoma: a case report

BackgroundPeripheral ossifying fibroma is an inflammatory or reactive hyperplasia of the gingiva that is usually small. It is formed by hard tissue in fibrous tissue, and the name “neoplastic lesion” has tended to be used frequently in Europe and America. Clinically, peripheral ossifying fibromas are painless, solitary, exophytic, sessile, or pedunculated and more frequently found in females than in males. To the best of our knowledge, there have been no reports of malignant cases. We herein report the case of giant peripheral ossifying fibroma with squamous cell carcinoma.Case presentationThe patient was an 83-year-old Japanese woman who visited our hospital with a gingival massive mass. She was referred to us for an examination and treatment because it was difficult to perform tracheal intubation for surgery of sigmoid colon cancer at another hospital. The mass measured 83 × 58 × 35 mm, and it protruded to the extra-oral region from the right maxillary premolar alveolar region. Panoramic X-ray revealed the shadow of the mass in the right maxillary premolar region, which included some hard tissue. Computed tomography showed scattering calcified images in the mass. Magnetic resonance imaging was not performed because she had vertebral artery clips and screws in her forehead. Given the above findings, we performed a biopsy under local anesthesia. However, we were unable to diagnose absolutely whether the dysplastic squamous epithelia were pseudocarcinomatous hyperplasia of the gingiva or well-differentiated squamous cell carcinoma. Therefore, tumor resection was performed under general anesthesia. The histopathological diagnosis was peripheral ossifying fibroma with coincidental squamous cell carcinoma. There have been no signs of recurrence during follow-up as of 2 years after surgery.ConclusionsThe etiology of giant peripheral ossifying fibroma with squamous cell carcinoma is still not definite. Therefore, careful observation is necessary. It needs to be examined by accumulation of more cases in the future. We herein report the case of giant peripheral ossifying fibroma coincidental squamous cell carcinoma.

Squamous cell carcinoma mimicking a wart

Sir, Cutaneous squamous cell carcinoma, a malignant proliferation of the cutaneous epithelium, represents the second most common non-melanoma skin cancer after basal cell carcinoma [1]. Verrucous carcinoma (VC) is a rare, low-grade, well-differentiated squamous cell carcinoma most commonly seen in the mucosa, infrequently reported to occur in the skin, where it is a slow-growing and locally aggressive tumor. It is not uncommon for cutaneous verrucous carcinomas to be mistaken for the more frequent wart (verruca vulgaris) and treated accordingly [2]. The etiopathogenesis of VC is not completely known. One theory mentions the human papillomavirus (HPV) infection; with plantar lesions, the types involved are reported to be 16 and 11 [3]. Histopathological diagnosis is difficult and needs one or more broad and in-depth biopsies. Morbidity results from the local destruction of the skin and soft tissues and, occasionally, from a perineural, muscular, and even bony invasion. Metastasis to regional lymphatic ganglia is rare, found in 5% of cases [4]. VC bears a high risk of local relapse. No matter the treatment employed, the rate of recurrence varies from 30% to 50% and usually is not the result of incomplete surgical interventions. The treatment of choice is complete surgical excision with safety margins [5]. A forty-year-old female patient with no previous history presented herself with a hyperkeratotic lesion on the right foot persistent for two years, which she had been manipulating routinely, which had progressively been increasing in size for the previous year, and which, for the previous three months, had become painful and bleeding. An examination revealed a hyperkeratotic plaque with a hyperpigmented border, hard on palpation, adherent to the deep plane, and with an eroded surface (Fig. 1). Dermoscopy was able to find a papillomatous appearance surrounded by dotted vessels (Fig. 2). This dermoscopic aspect typical of vulgar warts was confusing. Indeed, dermoscopy of the foot wart shows red or black dots in the center of papillomatous structures, which are thrombosed vessels supplying the wart; hence the importance, in our opinion, of the clinical and pathological correlation. For this reason, we performed a skin biopsy; an anatomopathological study found a squamous cell carcinoma of the verrucous type.

Carcinoma Cuniculatum with Bone Invasion Mimicking a Viral Wart

Carcinoma cuniculatum is a rare variant of low-grade and well-differentiated squamous cell carcinoma. It is a locally invasive tumor, although it has low metastatic potential. It was originally described in the plantar region but may exceptionally appear in other locations. It predominates in middle-aged men and presents clinically as an exophytic, solitary, painful tumor, with insidious growth. Histologically, this tumor simulates a variety of benign dermatoses and may require several biopsies for the correct diagnosis. It is often misdiagnosed as a viral wart, due to the clinical similarity and the indolent course. The treatment of choice is surgical excision due to the high risk of recurrence and locally aggressive behavior. Amputation can be performed in cases of deep tissue invasion. We present a case of carcinoma cuniculatum in which the late diagnosis favored the invasion of the underlying bone, resulting in amputation of the affected finger.

53 A Rare Malignant Lesion of the Jaws

Abstract Introduction Primary intraosseous carcinoma (PIOC) of the jaw is an incredibly rare lesion with approximately 200 cases reported in the literature. PIOC are mostly asymptomatic incidental radiographic findings and present as poorly-defined, non-corticated radiolucencies often with root resorption and cortical perforation. Prognosis is considered poor and best predicted by histological grade. Case report A gentleman in his 50s presented to his dentist with a draining sinus from his LR6 tooth. A radiograph revealed a non-corticated radiolucency localised to the distal root of the LR6. 7 months later, he returned with pain and mobility of the LR7. Another radiograph revealed a non-corticated radiolucency from around the distal root of the LR6 extending to the LR8. Urgent biopsy of the mandibular bone was arranged by the oral and maxillofacial surgery team. Histopathology revealed the lesion was likely a benign squamous odontogenic tumour. However, it was not possible to exclude a well-differentiated squamous cell carcinoma. Correlation of clinical findings, imaging and multidisciplinary team discussion was recommended. Following the MDT meeting, excision of the bony lesion was undertaken. Histopathology this time returned as primary intraosseous carcinoma NOS T4N0M0, thought to have arisen from a radicular cyst associated with the LR6/7. The treatment was right segmental mandibulectomy, fibular free flap, selective neck dissection (I-III) and adjuvant radiotherapy. Conclusions This case highlights how subtle radiographic features can represent malignancy in lesions appearing cystic at first. Although rare, clinicians should be aware of PIOC as a differential diagnosis when presented with radiographic features which could represent malignancy.

Tetraspanin 151 and its role in carcinogenesis

CD151, a member of the tetraspanin protein family, is a transmembrane protein involved in a number of physiological processes such as maintaining cell integrity, intercellular transport, wound healing, and more. It is not the main participant in these functions, but rather acts as a mediator molecule, interacting with other tetraspanins, integrins, adhesion receptors, signaling receptors and matrix metalloproteases. It is commonly expressed in endothelial cells and platelets, and its overexpression is associated with processes of progression and metastasis in neoplastic diseases. CD151, associated with laminin and laminin-binding integrins, is involved in the regulation of carcinogenesis. CD151 has been shown to play a significant role in the de novo carcinogenesis and progression of squamous cell carcinoma of the skin, influencing transcription factors related to the processes of cell proliferation and apoptosis. There are reports in the scientific literature of the association of impaired regulation of various tetraspanins with malignancies in humans. A number of authors have also reported that CD151 overexpression has been associated with a poor prognosis in cancers of the lung, colon, esophagus, pancreas and endometrium. In prostate cancer, overall survival rates were found to be significantly higher with low CD151 expression than with high expression. This tendency is particularly pronounced in highly and moderately differentiated tumors. Significant heterogeneity of CD151 expression in different tumor tissues was observed. The intensity of staining is noticeably lower in well-differentiated squamous cell carcinoma of the oral cavity. The expression gradient of CD151 is particularly noticeable at the front of tumor growth. Large-scale prospective and retrospective studies on various types of malignant tumors have established CD151 as a prognostic marker for tumor therapy with minimal side effects on normal cells.

Relevance of mast cell infiltration in well-differentiated oral squamous cell carcinoma in biopsy specimen

Oral cancer is very common worldwide. More than 90% of all oral cancers are squamous cell carcinoma (SCC). The molecular biological markers of oral SCC have been extensively studied to aid in prevention and prognosis. However, no marker has been universally accepted so far. Mast cells are important component of cancer stromal interaction. Their early recruitment in tumor microenvironment and multifarious function make them a burning topic of interest in the field of research. So mast cell may act as a new target for the adjuvant treatment of oral SCC. Therefore, the aim of the study was to assess the number of mast cell infiltrations in well differentiated oral SCC. In this cross-sectional study the sample size was 66. After routine tissue processing and staining with Hematoxylin & Eosin (H/E) stains slides of all cases were grouped as well differentiated oral SCC. Identification of mast cell was done by Toluidine blue stain. Distribution of mast cells was observed and number of mast cells was counted. The data was tabulated and statistical analysis was performed. The number of mast cell was highly increased in all cases of oral SCC than normal. The mean ± SD number of mast cells was 3.28 ± 1.21 in oral SCC, whereas in control oral tissue it was 0.44 ± 0.19. The p-value was found to be highly significant (p<0.001). So, in our observation mast cell is a good cellular indicator of tumorigenesis. Mediscope 2021;8(2): 67-74

Debulking followed by intralesional 5-fluorouracil for the treatment of cutaneous squamous cell carcinoma and keratoacanthoma: A retrospective analysis.

Debulking followed by intralesional 5-fluorouracil (deb-IL5FU) is a nonsurgical modality which has been used to treat skin cancer anecdotally for many years. There are few in depth studies examining this technique and success rate of intralesional 5-fluorouracil (IL5FU) for the treatment of cutaneous squamous cell carcinoma (cSCC). To evaluate the response rate of deb-IL5FU for the treatment of cSCC and to determine which patient factors were associated with tumor clearance or treatment failure. A retrospective chart analysis of patients with the diagnosis of cSCC or keratoacanthoma (KA) and subsequent deb-IL5FU treatment. Sixty-one patients with a total of 315 tumors (cSCC and KA), were treated using deb-IL5FU. The overall tumor clearance rate was 89%. This was highest for well-differentiated SCC, SCC, KA-type SCC, and KA. Tumors on the trunk and extremities showed high clearance rates while tumors on the scalp/face/neck/ears showed lower clearance rates. Immunocompetent patients cleared more tumors compared to immunocompromised patients. Limitations included the retrospective nature of this analysis as well as a small sample size. Treatment of cSCC and KA with deb-IL5FU demonstrated high tumor clearance rates. Lower rates of clearance were seen in males, immunosuppressed patients, tumors located on the scalp and face/neck/ears.

Immunohistochemical evaluation of D2-40, Galectin-3, Maspin and MCM7 expression in palate squamous cell carcinomas.

Squamous cell carcinoma (SCC) is the most frequent cancer in oral cavity and its prognosis has exhibited little improvement in the last decades. Although much less common palate SCCs manifests a higher local aggression invading very quickly the adjacent muscles and jawbones, thus being able frequently to lead to dysfunctions in chewing, swallowing, and speech. To elucidate what underlies such local aggression, we investigated the immunohistochemical expression in palate SCCs of Podoplanin (D2-40), Galectin-3 (Gal-3), mammary serine protease inhibitor (Maspin) and minichromosome maintenance complex component 7 (MCM7), markers that are known to be involved in tumor invasiveness. We found a progressive increase in reactivity for D2-40 and MCM7 from the normal epithelium toward dysplastic epithelium and respectively to SCC, which suggests the intervention of these markers in the early stages of squamous cell carcinogenesis in the palate. The highest D2-40, Gal-3 and MCM7 reactivity was observed in basaloid and in poorly differentiated (G3) palate SCCs, while for Maspin the well-differentiated (G1) palate SCCs were the most reactive. The first three markers mentioned above were most intensely expressed at the invasion front, while the Maspin reactivity was low or absent at this level. Statistically, we found significant stratification on localization, grading, muscle invasion, and survival for all investigated markers, but with very high direct correlations between D2-40, Gal-3, and MCM7 immunoreactive score (IRS) values, while between the Maspin and each of the previous markers there were very high inverse correlations. Overall, all these investigate markers proved to be responsible for the local invasiveness and regional lymph node metastasis, thus allowing a prognostic and therapeutic stratification of patients with palate SCCs.

S2208 Primary Squamous Cell Carcinoma as a Long-Term Complication of Percutaneous Endoscopic Gastrostomy Placement

Introduction: Common complications associated with percutaneous endoscopic gastrostomy (PEG) placement include aspiration, bleeding, leakage, irritation, abdominal pain, and infection. Previous case reports have described the PEG site as a location for metastatic malignancy, especially in the setting of head and neck cancers (often an indication for PEG placement). We present a rare case of primary squamous cell carcinoma (SCC) which developed in the setting of long-term PEG placement. Case Description/Methods: Patient is a 51-year-old woman with developmental delay and dystonia secondary to DYT1 gene mutation. Given her developmental delay, a PEG was placed for nutritional support and had been in place for thirty-two years. She presented with a 2-cm abscess at her PEG site and was discharged with oral antibiotics following incision and drainage (I+D). She noted persistent leakage of bloody and foul-smelling drainage from her PEG tube (figure 1). She returned with worsening irritation surrounding the PEG site and was noted to have a 5x7 cm area of erythema with overlying fluctuant abscess. Again, she underwent I+D and was started on IV antibiotics. Cross sectional imaging demonstrated irregular soft tissue thickening involving the greater curvature of the stomach, adjacent to the PEG site, extending into the gastrostomy tube tract. A biopsy of the skin surrounding the PEG tube was performed and demonstrated well-differentiated and invasive SCC. A subsequent PET scan showed locally invasive disease with PEG site involvement extending into the abdominal wall. There were no additional areas concerning for malignancy (no indications of an alternative primary site). Given the burden of locally invasive disease, surgical resection was deferred and she was offered palliative radiation. Discussion: The development of SCC at the PEG site is an uncommon occurrence and previous case reports typically describe these events as metastasis from a head/neck primary site. There has been at least one additional documented case of primary SCC at the PEG site but this occurred in an immunosuppressed patient. Chronic irritation of the skin, which is a known complication of PEG placement, possibly contributed to the development of SCC in this patient. Aggressive wound care and close monitoring for suspicious mucosal changes should be considered in patients with long-term PEG placement.Figure 1.: Squamous Cell Carcinoma along the PEG site.

Esophageal papillomatosis presenting with complete esophageal obstruction and high positron emission tomography avidity

A 70-year-old man weighing 100 pounds presented with dysphagia to solids and liquids. He had a history of esophageal human papillomavirus (HPV) infection, and a PEG tube was in place to provide nutrition and hydration. Biopsy at an outside hospital revealed esophageal papillomatosis. On EGD at our center, he was found to have a confluent mass of circumferential papillomatous lesions beginning 25 cm from the incisors (A, B). The lumen of the esophagus was almost completely obliterated. The upper endoscope could not be advanced to the stomach. Repeated biopsies, obtained to rule out malignancy, were interpreted as showing an atypical squamoproliferative lesion with parakeratosis consistent with papillomatosis. Although no clear malignancy was seen, this was thought to possibly be a manifestation of well-differentiated or verrucous squamous cell carcinoma (SCC). Positron emission tomography/CT revealed an exceptionally avid lesion occupying the esophagus (C, D). The patient was referred to surgery for consideration of esophagectomy but was thought to be a poor candidate for surgical intervention or chemoradiation therapy.