Nonmelanoma facial skin carcinomas: methods of treatment.

AIM: The objective was to present in this study the administered treatment, reconstruction, and outcomes for lesions excised according to a prediagnosis of facial tumor, whose pathological finding was reported as nonmelanoma skin tumor. METHODS: A total of 178 patients with full medical histories who were operated on for skin tumors in the Ear, Nose, and Throat Clinic of Ankara Oncology Education and Research Hospital between February 2010 and March 2012 were evaluated retrospectively. The test group was made up of 125 men (70%) and 53 women (30%), with a median age of 56 years (range, 29-89 years). RESULTS: Basal cell carcinoma was diagnosed in 112 patients (63%), 45 (40%) of whom underwent flap reconstruction procedures; squamous cell carcinoma (SCC) was diagnosed in 55 patients (31%), 25 (45%) of whom underwent flap reconstruction procedures; 5 patients (3%) were diagnosed with basosquamous carcinoma, 3 (60%) of whom underwent flap reconstruction, and metatypical carcinoma was found in 6 patients (3%), and 5 (80%) underwent flap reconstruction treatment. Recurrence occurred in 10 (18%) of the 55 SCC patients. Invasion depths in the patients with recurrence were between 7 and 30 mm. In 21 (46%) of the 45 patients without recurrence, invasion depths were between 4 and 30 mm, whereas the invasion depths in the other 24 patients (53.3%) were less than 4 mm. CONCLUSIONS: Metastatic lymph node involvement localized to the auricular, infra-auricular, and postauricular was present in the pathological specimens of all patients with lesions who had selective neck dissection I to IV included into their treatment. The depth of invasion of SCCs was found to be statistically significant in terms of recurrences.

BerEp4, cytokeratin 14, and cytokeratin 17 immunohistochemical staining aid in differentiation of basaloid squamous cell carcinoma from basal cell carcinoma with squamous metaplasia.

CONTEXT: Basaloid squamous cell carcinoma (bSCC) is an uncommon variant of squamous cell carcinoma, which may overlap histologically with basal cell carcinoma with squamous metaplasia (BCCm). OBJECTIVE: To aid in the differentiation of these neoplasms using immunohistochemical staining because of the worse prognosis associated with bSCC. DESIGN: Using immunohistochemical techniques, we investigated BerEp4, cytokeratin 17 (CK17), and cytokeratin 14 (CK14) protein expression in 25 cases of bSCC (8 cutaneous [32%], 12 aerodigestive tract [48%], and 5 lymph node metastases [20%]) and 43 cases of BCCm (39 cutaneous [91%], and 4 metastases [9%]). An immunoreactivity score was assigned using the percentage of tumor cells staining and the pattern of expression. Interobserver agreement for 2 independent pathologists was assessed using a κ coefficient. RESULTS: The mean percentage of staining was significantly higher in BCCm, compared with bSCC (BerEp4, P = .006; CK17, P < .001; CK14, P < .001; unpaired t test), with 58% of BCCm cases (25 of 43) displaying diffuse staining for all markers, and nearly all (98%; 42 of 43) displaying diffuse staining for CK17 and CK14. In contrast, no bSCC cases (0%) displayed diffuse staining for all 3 markers, and only 8% (2 of 25) displayed diffuse staining for CK17 and CK14. High interobserver agreement was determined. CONCLUSIONS: BerEp4 alone is unreliable for differentiation between BCCm and bSCC, and the addition of either CK14 or CK17 will augment the sensitivity and negative predictive value of BerEp4 staining in BCCm and bSCC diagnosis.

Giant temporalis muscle metastasis of esophageal carcinoma.

Temporalis muscle metastasis of a tumor is a rare condition. Basaloid squamous cell carcinoma is an uncommon variant of squamous cell carcinoma, which often occurs in the aerodigestive tract. To the best of our knowledge, there have been no previous reports dealing with temporalis muscle metastasis from esophageal carcinoma in the literature.

Basosquamous carcinoma with systemic metastasis in a miniature Pinscher.

Basosquamous carcinoma (BSCC) is a rare malignancy, primarily composed of basal cells with foci of squamous differentiation. It is considered to be histologically an intermediate type between basal cell carcinoma and squamous cell carcinoma, and is known to have aggressive behaviors. BSCC occurred in a 17-year-old female minipin with a history of surgical excision for a mammary tumor. The right upper hindlimb was severely enlarged to 8 x 5 cm. Cross-section showed a homogenous white to yellow-white mass compressing the surrounding muscular tissues. The tumor metastasized also to the lungs, heart, abdominal cavity, liver and salivary gland. Microscopically, basaloid cells were crowded into solid nests or lobules separated by well-developed fibrous tissues with occasional keratinizations. Since there was no skin lesions, the tumor is assumed to be originated from the formerly present tumor in mammary gland. To our literature review, this case is the first BSCC with systemic metastasis in a dog.

[Cutaneous basosquamous carcinoma]. / Carcinome basocellulaire métatypique.

INTRODUCTION: Basosquamous carcinoma is a rare entity that essentially affects the head and neck region in male patients. The authors present the clinical signs and progression as well as the therapeutic consequences of this disease through two observations. CASE REPORT 1: A 41-year-old man presented with basosquamous carcinoma of the right temporoparietal region treated initially with surgery alone. Five years later, he was operated on for a local and lymph node recurrence followed by radiation therapy, stabilizing the disease for 4 years; subsequently a second recurrence with metastasis to the chest area occurred. The patient died 10 years after the onset of his disease of diffuse pneumopathy with severe septicemia. CASE REPORT 2: A 71-year-old man presented retroauricular basosquamous carcinoma at first treated with wide resection, but the surgical limits were invaded. He developed local recurrences treated with surgical resection until total petrosectomy, but the surgical limits were always invaded. Radiotherapy was delivered. Seven years after the end of treatment, he developed a local recurrence invading the brain, which was deemed untreatable. DISCUSSION: Basosquamous carcinoma is characterized by its severe aggression and its tendency to recur. Treatment is essentially surgical. Radiotherapy is an adjuvant for the cases with high risk of recurrence. The role of chemotherapy is not yet proved.

Basaloid squamous cell carcinoma of the head and neck is a mixed variant that can be further resolved by HPV status.

Basaloid squamous cell carcinoma (BSCC) of the head and neck is set apart as a distinct subtype of squamous cell carcinoma on the basis of its basaloid appearance and aggressive behavior. The purpose of this study was to determine whether BSCC could be further subdivided on the basis of human papillomavirus 16 (HPV16) status. HPV16 in situ hybridization was performed on 53 BSCCs of the head and neck. Of the 53 BSCCs, 21 (40%) arose in the oropharynx and 32 (60%) arose in nonoropharyngeal sites. HPV16 was detected in 34% of BSCCs overall, but the frequency varied by site. HPV16 was detected in 16 of 21 (76%) BSCCs of the oropharynx, but in only 2 of 32 (6%) BSCCs from nonoropharyngeal sites (P<0.0001, Fisher exact). The absence of HPV16 was significantly associated with decreased overall survival (Hazard ratio=17.1; 95% confidence interval=7.2-40.3, log-rank P=0.0001), even though patients with HPV16-positive carcinomas were more likely to present with lymph nodes metastases (P=0.01, Fisher exact). Morphologic similarities aside, BSCCs are composed of a mixed group of tumors that can be separated on the basis of HPV16 status. The distinction is important. HPV16-positivity in squamous cell carcinomas of the head and neck is now recognized as a powerful indicator of improved patient survival. HPV16 detection thus permits resolution of a less aggressive component within a high-grade subtype of head and neck carcinoma.

Basaloid squamous cell carcinoma of the head and neck: a clinicopathological and follow-up study of 40 cases and review of the literature.

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of cancer that mainly arises in the upper aerodigestive tract. This study reviews the clinico-pathological features and follow-up of a series of cases occurring in the head and neck. During a 32-year period (1974-2005), a total of 40 BSCCs have been diagnosed in the head and neck in our Institution. Males predominated in the series (35M/5F). The average age was 60.2 years (range, 40-85). Tobacco and alcohol consumption was found in more than 80% of the cases. Topographic distribution was as follows: larynx and hypopharynx, 22 cases (55%); oropharynx, 12 cases (30%); and oral cavity 6 cases (15%). The basaloid component predominated in 29 cases (72.5%). Vasculo-lymphatic invasion was detected in 5 cases (12.5%). Lymph node metastases were seen in 25 cases (62.5%, levels II and III in the neck dissection). Local recurrences appeared in 11 cases (27.5%) and distant metastases in 6 (15%). In 7 cases (17.5%) a second primary tumour was detected. The 2002 TNM staging was as follows: Stage I, 5 cases (12.5%); Stage II, 7 cases (17.5%); Stage III, 8 cases (20%), and Stage IV, 20 cases (50%). On follow-up, 21 cases (52.5%) are alive and 19 (47.5%) died of disease. Three- and 5-year overall survival was 50% and 38.5%, respectively. A significant shorter survival was detected in node positive patients (P<0.05).

Rapid and unusual spread of basaloid squamous cell carcinoma of the maxillary sinus.

Basaloid squamous cell carcinoma is a variant of epidermoid carcinoma with a morphology consisting of both basaloid and squamous cell components. It is a high-grade tumour with a propensity for nodal and systemic metastases. In this report, we present the aggressive course of a basaloid squamous cell carcinoma of the maxillary sinus in a 28-year-old patient who died only four months after the initial diagnosis. We describe the unusual spread of the disease to the scalp, pancreas, kidney, adrenal gland, ovaries, lungs and bone marrow.

Periocular metatypical cell carcinoma: clinicopathologic correlation, management, and follow-up in 35 patients.

BACKGROUND: To present the clinical characteristics and treatment outcomes in a relatively large series of patients with periocular metatypical cell carcinoma. METHODS: This is a retrospective study of 35 patients with periocular metatypical cell carcinoma, who were seen between January 2000 and December 2004 in Izmir Ataturk Research and Training Hospital, Turkey. The patients were histologically confirmed metatypical cell carcinoma with radiologic evidence of periocular region. The main outcome measures were patients' demographics, duration of tumour, clinical presentation, tumour site, treatment modalities, recurrence rate and tumour-related exenteration. Statistical comparisons between the nonrecurring group and recurring group were completed using the Cox regression analysis and the log rank test. Significance was determined for all statistical tests as pé 0.05. RESULTS: The median age of patients at time of diagnosis was 61 years. The most common site for metatypical cell carcinoma was medial canthus and lower eyelid region. The median follow-up for all patients was 18 months. The average length of time until recurrence was 13 months. Five of the 35 patients received adjuvant therapy to the primary tumour site after excision. Signs suggestive of orbital involvement included bone fixation of the mass, limitation of ocular motility and globe displacement. The early lack of diagnostic criteria for metatypical cell carcinoma created considerable debate and confusion regarding its diagnosis. We believe that once this diagnosis is made, the treatment modality should be individualized and chosen with consideration of the extent of orbital involvement, visual function, and the patient's general health.

Cutaneous basosquamous carcinoma infiltrating cerebral tissue.

Basosquamous carcinoma of the skin is a rare malignancy with specific histopathological features of both basal cell carcinoma and squamous cell carcinoma. Some authors believe that basosquamous carcinoma is a variant of basal cell carcinoma, while others suggest that this tumour may behave more aggressively. We present a 44-year-old female patient who was diagnosed with a basosquamous carcinoma histopathologically. She had extensive ulcero-vegetative lesions, involving the anterior half of the scalp, the left orbit and the left side of the face. With this case we aim to emphasize the aggressive nature of basosquamous carcinoma and review the literature.

[Therapeutic and histological features of basaloid squamous cell carcinoma]. / Therapeutische und histologische Besonderheiten des basaloiden Plattenepithelkarzinoms.

BACKGROUND AND OBJECTIVE: Basaloid squamous cell carcinoma s a rare, highly malignant carcinoma variant typically situated in the tongue base, supraglottis and pyriform sinus. It is usually only diagnosed at a very advanced stage due to its tendency towards submucosal growth, deep infiltration and early local and distant metastases. PATIENTS/METHODS: The case described involves a 39-year-old man with the clinical and histopathological findings typical for this neoplasm. RESULTS: In contrast to simple squamous cell carcinomas, the basaloid variant with its very poor prognosis calls for therapeutic decisions that give particular consideration to quality of life. It should be stressed that highly invasive surgery is justified only in exceptional cases because of the high local recurrence rate and early distant metastases. CONCLUSIONS: The case presented shows that radio- and chemotherapeutic approaches are just as important as surgery.

Basaloid squamous cell carcinoma of the vagina metastasizing to the lung. A case report.

BACKGROUND: While observed on the vulva, basaloid squamous cell carcinoma (BC) of the vagina is extremely rare, with no reported cases. CASE: A 54-year-old, African American woman presented with carcinoma metastatic to both lungs, morphologically similar to her BC of the vagina four years previously. She was treated initially in 1995 with local excision. Reexcision and radiation therapy were given for a recurrence in 1996. CONCLUSION: BC of the vagina is an extremely rare and aggressive tumor, which can recur and metastasize.

Basaloid squamous carcinoma in the liver.

This report concerns a 46-year-old female who presented with 3 months of abdominal pain and underwent a right hemi-hepatectomy for a 27 x 25 x 15 cm, centrally necrotic tumor that showed histological, immunohistochemical and ultrastructural features typical of a basaloid squamous carcinoma (BSC). A primary tumor at another site was not diagnosed and she died of disease 2 years later after several intra-abdominal recurrences. The entity of BSC was first described in 1986 and is a rare, poorly differentiated variant of squamous cell carcinoma occurring in various sites including the upper aerodigestive tract, esophagus, lung, anus, cervix and thymus. It has never been reported arising in the liver. It has characteristic histological, immunohistochemical and ultrastructural features and is associated with a poor prognosis. Whilst no other primary tumor was diagnosed, it is not possible to substantiate that this is a primary hepatic tumor in the absence of an autopsy examination to exclude an occult malignancy in another site.

Basosquamous carcinoma: analysis of prognostic factors influencing recurrence.

BACKGROUND: Basosquamous carcinoma is a rare malignancy, with features of both basal cell carcinoma and squamous cell carcinoma. Some authors believe that basosquamous carcinoma merely is a variant of basal cell carcinoma, whereas others have suggested that basosquamous carcinoma may behave more aggressively. To the authors' knowledge the largest published series to date, comprised of 35 cases, was reported >20 years ago. The authors reviewed their recent experience with basosquamous carcinoma to identify prognostic factors influencing recurrence. METHODS: The medical records of all patients with the diagnosis of basosquamous carcinoma treated at the University of Louisville-affiliated hospitals between 1985-1988 were reviewed by a senior pathologist. Prognostic factors were analyzed using Cox regression analysis and the log rank test. RESULTS: Thirty-one cases of basosquamous carcinoma were identified in 28 patients. The median age at diagnosis was 68 years (range, 10-94 years). The median follow-up was 60 months (range, 12-312 months). Seventy-five percent of cases were located on the face, neck, and scalp. One patient had regional lymph node metastasis synchronous with the primary tumor. Patterns of recurrence were: local recurrence only (five patients), local recurrence plus regional lymph nodes (three patients), and pulmonary plus regional lymph nodes (one patient). One patient died of pulmonary metastasis. Significant factors predictive of recurrence (P<0.01) were male gender, positive surgical resection margin, lymphatic invasion, and perineural invasion. Although tumor size was not a statistically significant factor overall (P = 0.076), the 3 patients with lymph node metastases had large tumors (measuring 2 cm, 5 cm, and 5 cm, respectively). CONCLUSIONS: Basosquamous carcinoma is an aggressive epithelial neoplasm with a propensity for local recurrence and potential for distant metastatic spread. This behavior differs substantially from basal cell carcinoma. Complete resection with negative surgical margins is essential. Long term follow-up for the detection of local recurrence and distant metastatic spread is recommended.

Basaloid squamous carcinoma: a clinical comparison of two histologic types with poorly differentiated squamous cell carcinoma.

Basaloid squamous carcinoma (BSC) of the head and neck has been shown to have a poor prognosis when compared with conventional squamous cell carcinoma (SCC). Pathologically, specimens determined to be BSC can have nearly pure basaloid features (group 1) or a mixture of basaloid and squamous features (group 2). The clinical behavior in these 2 subgroups has not been compared previously. BSC is also commonly confused histologically with poorly differentiated SCC (PDSCC). A retrospective comparison of disease stage at presentation, rate of distant metastasis, rate of local recurrence in those offered surgical resection, and rate of survival is made to compare outcomes of the 2 BSC groups and the PDSCC group. The presence of particular histologic features may be associated with poorer outcomes. Patients with BSC have advanced disease at presentation. Survival in the BSC group was less than half that in the PDSCC groups. Statistical analysis shows the 2 groups to be well matched with regard to stage and site of disease. Presence of neck nodal disease on presentation predicts poor survival. In this study distant metastases occurred in 52% of patients with BSC and in 13% of patients in the PDSCC group. The local recurrence rate is comparable for BSC and conventional SCC, with even early tumors in the BSC group recurring distantly rather than locally or regionally. Considering the high distant metastatic rate of BSC and poorer overall survival rate, a more extensive metastatic survey is indicated in these patients before surgery is recommended. We recommend that patients with a diagnosis of BSC not be included with conventional SCC groups in prospective randomized cancer protocols.

Fine-needle aspiration of basaloid squamous carcinoma: a case report with review of differential diagnostic considerations.

Basaloid squamous carcinoma is a distinct variant of squamous carcinoma with a particularly poor prognosis. To our knowledge, there are only two papers in the cytopathology literature which describe this entity. We report the fine-needle aspiration findings of an additional case of metastatic basaloid squamous carcinoma in a cervical lymph node and compare its cytomorphologic features to those observed on touch imprints of the subsequent surgical specimen. Smears of the aspirate showed a mixed lymphoid background with interspersed cohesive clusters of small cells roughly 3 times the size of small mature lymphocytes. Some cells were angulated and others exhibited irregular nuclear contours. The cells were generally hyperchromatic with evenly staining dense chromatin or irregularly distributed coarse chromatin. Focally there was evidence of nuclear molding. On Diff-Quik staining, irregular globules of magenta-stained extracellular dense material were noted within or adherent to the periphery of some clusters or as somewhat linear formations with small epithelial cells clinging to the edges. Abundant mitotic figures and clumps of necrotic tumor were more apparent on touch preps of the subsequent surgical specimen. The differential diagnosis by fine-needle aspiration includes adenoid cystic carcinoma, basal-cell adenocarcinoma, adenosquamous carcinoma, and small-cell carcinoma. If a fine-needle aspirate of a cervical lymph node shows the features described above and the primary tumor is unknown, suggesting the possibility of metastatic basaloid squamous carcinoma may aid clinicians in the search for a primary site, as basaloid squamous carcinoma occurs most frequently at the base of the tongue, hypopharynx, and supraglottic larynx.