Basaloid squamous cell carcinoma of the head and neck

Elective Neck Dissection in cT1-4 N0M0 Head and Neck Basaloid Carcinoma

OBJECTIVE

To investigate the survival benefit of elective neck dissection (END) over neck observation in surgically resected cT1-4 N0M0 head and neck basaloid carcinoma (HNBC).

STUDY DESIGN

Retrospective cohort study.

SETTING

The 2006 to 2017 hospital-based National Cancer Database.

METHODS

Patients with surgically resected cT1-4 N0M0 HNBC were selected. Linear, binary logistic, Kaplan-Meier, and Cox proportional hazards regression models were implemented.

RESULTS

Of 857 patients satisfying inclusion criteria, the majority were male (77.0%) and white (88.1%) with disease of the oral cavity (21.5%) or oropharynx (42.9%) classified as high grade (76.9%) and cT1-2 (72.9%). 389 (45.4%) patients underwent END. END utilization between 2006 and 2017 increased for cT1-2 disease (33.3% vs 56.9%, R2 = .699) but remained relatively constant for cT3-4 disease (66.7% vs 57.9%, R2 = .062). One-hundred and fifteen (29.6%) ENDs detected occult nodal metastases (ONMs). The 5-year overall survival (OS) of patients undergoing neck observation and END was 65.6% and 66.8%, respectively (P = .652). END was not associated with improved OS in survival analyses stratified by patient demographics, clinicopathologic features, and adjuvant therapy. Compared with surgery alone, adjuvant radiotherapy (adjusted hazard ratio: 0.74, 95% confidence interval [CI]: 0.57-0.97, P = .031) was associated with improved OS. END (hazard ratio [HR]: 0.96, 95% CI: 0.71-1.28, P = .770) and ONM (HR: 1.12, 95% CI: 0.78-1.61, P = .551) were not associated with OS.

CONCLUSION

END is performed in nearly half of patients with HNBC but is not associated with improved OS, even after stratifying survival analyses by patient demographics, clinicopathologic features, and adjuvant therapy. The rate of ONM approaching 30%, however, justifies inclusion of END in the surgical management of HNBC.

Basaloid squamous cell carcinoma in the mandibular alveolus: A rare case report with differential diagnosis

ABSTRACT

Basaloid squamous cell carcinoma (BSCC) is a distinct, high-grade variant of oral squamous cell carcinoma (OSCC) with a poor prognosis. In the head and neck region, the most common sites are the epiglottis, piriform sinus, and tongue base. Other less common sites include the floor of the mouth, oral mucosa, palate, tonsils, nasopharynx, and trachea. In the present report, the unusual case of a 69-year-old male is presented; the patient exhibited ulceroproliferative growth involving the lower alveolus. Incisional biopsy was done and the hematoxylin and eosin-stained sections revealed tumor islands with dysplastic oral epithelial cells invading the underlying connective tissue as islands, cords, and nests. The presence of palisading basaloid cells with a central area of comedo necrosis and keratin formation on the islands revealed the diagnosis of BSCC. Immunohistochemistry demonstrated positive staining for proliferative cell nuclear antigen (PCNA) and pan-cytokeratin. The patient is still under treatment and follow-up.

Case Report: Basaloid Squamous Cell Carcinoma of the Tongue: A Case Report

The upper aerodigestive tract is where basaloid squamous cell carcinoma (BSCC), a rare variation of conventional SCC, is most frequently found. The hypopharynx, tonsil, supraglottic larynx, tongue (base), and head-neck regions are particularly susceptible to BSCC. Clinically, the presentation of BSCC is similar to that of conventional SCC, but it has a poorer prognosis than conventional SCC. BSCC is distinguished histopathologically by a dimorphic pattern, a distinctive basal cell component paired with a squamous component, and a squamous component. However, its similar features to conventional SCC make it difficult to diagnose. Therefore, histopathology and immunohistochemistry play a crucial role in diagnosing such tumors. Here we present the case of a 70-year-old male diagnosed with BSCC involving the tongue.

Basaloid squamous cell carcinoma of the larynx: A rare case report

INTRODUCTION AND IMPORTANCE

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive subtype of squamous cell carcinoma. BSCC in the larynx is an extremely rare occurrence, with only a few cases reported in the medical literature. This case report aims to shed light on the clinical presentation, diagnostic challenges, histopathological features, and therapeutic considerations associated with this rare entity.

CASE PRESENTATION

This case report describes a 65-year-old male patient who presented with hoarseness and dyspnea. Laryngoscopy revealed a 2.5 cm pedunculated lesion on the left vocal cord. The patient underwent a laryngectomy, and the histopathological examination of the excised specimen confirmed the diagnosis of BSCC.

CLINICAL DISCUSSION

BSCC of the larynx is a rare malignancy comprising less than 1 % of laryngeal cancers. Clinical features often overlap those of squamous cell carcinoma, such as hoarseness, progressive breathing difficulties, and swallowing issues. Treatment approaches vary, with some opting for neo-adjuvant radiotherapy before surgery, like in this case, while others favor surgical excision as the primary treatment, supplemented by adjuvant chemo- or radiotherapy in certain cases.

CONCLUSION

Basaloid squamous cell carcinoma is a rare variant of squamous cell carcinoma. Clinicians and pathologists should be aware of the distinctive characteristics of BSCC and its potential clinical aggressiveness. While rare, early recognition and appropriate management are essential for achieving favorable outcomes in patients with this challenging condition.

Vulvar squamous cell carcinoma arising on human papillomavirus-independent precursors mimicking high-grade squamous intra-epithelial lesion: a distinct and highly recurrent subtype of vulvar cancer

AIMS

Each category of vulvar squamous cell carcinoma (VSCC), human papillomavirus (HPV)-associated and HPV-independent, arises on a specific intra-epithelial precursor: high-grade squamous intra-epithelial lesions (HSIL) and differentiated vulvar intra-epithelial neoplasia (dVIN), respectively. However, a subset of HPV-independent VSCC arises on an intra-epithelial precursor closely mimicking HSIL. We aimed to explore the clinicopathological features of the HPV-independent tumours with HSIL-like lesions and compare them with HPV-independent VSCC with dVIN and HPV-associated tumours with HSIL.

METHODS AND RESULTS

We retrospectively identified 105 cases of surgically treated VSCC with adjacent intra-epithelial precursors. The cases were classified into three groups based on the HPV status and the adjacent precursor identified: (i) HPV-associated VSCC with HSIL (n = 26), (ii) HPV-independent VSCC with dVIN lesions (n = 54) and (iii) HPV-independent VSCC with HSIL-like lesions (n = 25). We analysed the histological and clinical features including the recurrence-free survival and disease-specific survival in the three groups. Patients with HPV-independent VSCC with HSIL-like lesions and with dVIN were older than patients with HPV-associated VSCC (76 and 77 versus 66 years, respectively, P < 0.001). HPV-independent VSCC with HSIL-like lesions recurred more frequently [hazard ratio (HR) = 3.87; P < 0.001] than HPV-independent VSCC with dVIN (HR = 2.27; P = 0.1) and HPV-associated VSCC (HR = 1). In the multivariate analysis, HPV-independent VSCC with HSIL-like lesions remained significant for recurrence. No differences in disease-specific survival were observed between the three groups.

CONCLUSIONS

Even though VSCC with HSIL-like lesions are not associated with higher mortality, they are more likely to recur and might benefit from more intensive treatment strategies and closer surveillance after treatment.

[Clinicopathological study in 28 cases of oral basaloid squamous cell carcinomas]

OBJECTIVE

To investigate the clinicopathologic features and prognostic factors in oral basaloid squamous cell carcinoma.

METHODS

Retrospective analysis of oral basaloid squamous cell carcinomas patients who underwent tumor resection during the period from January 2002 to December 2020 in the authors' hospital, especially the clinicopathologic characteristics of 28 cases with confirmed diagnosis and follow-up data. Immunohistochemistry was performed to define the helpful markers for differentiation diagnosis. The factors influencing the prognosis were evaluated based on Kaplan-Meier method.

RESULTS

The tongue and mouth floor (11 cases, 39.3%) were the most frequently involved sites, followed by gingiva (6 cases, 21.4%), buccal (5 cases, 17.9%), palate (4 cases, 14.3%), and oropharynx (2 cases, 7.1%). The majority of basaloid squamous cell carcinomas were in advanced stage, with 12 cases in stage Ⅱ and 16 cases in stages Ⅲ-Ⅳ. Twelve of 28 patients were identified to have cervical lymph node metastasis, which was confirmed by histopathological examination. The incidence rate of lymph node metastasis was 42.9% (12/28). Nine tumors recurred, with one metastasized to the lung. At the meantime, the 28 conventional squamous cell carcinomas were matched with the same stage, among which 13 cases were identified with cervical lymph node metastasis. The incidence rate of lymph node metastasis was 46.4% (13/28). Five cases recurred, with two cases that metastasized to the lung and one to the brain. The 5-year overall survival rates of the basaloid squamous cell carcinoma and conventional squamous cell carcinoma patients were 54.6% and 53.8%, respectively. Histopathologically, basaloid cells consisted of tumor islands without evident keratinization but frequently with comedo-like necrosis within the tumor islands. CK5/6 and P63 exhibited strongly positive in all the 28 cases, whereas neuroendocrine markers, CgA and Syn, were negative. Eight cases positively expressed P16; one case showed focal SOX10 positive but CK7 negative.

CONCLUSION

The majority of oral basaloid squamous cell carcinomas present in advanced stage with a high tendency to lymph node metastasis, but the overall survival rates are not significantly different from conventional squamous cell carcinomas matched with the same stage. The human papilloma virus (HPV), as HPV-positivity rate is high, correlates to good prognosis. In addition, CK7 & SOX10 immunohistochemistry could contribute to differential diagnosis for basaloid squamous cell carcinoma with solid adenoid cystic carcinoma.

The importance of adjuvant treatment and primary anatomical site in head and neck basaloid squamous cell carcinoma survival: an analysis of the National Cancer Database

PURPOSE

Basaloid squamous cell carcinoma (BSCC) of the head and neck is an aggressive and highly malignant variant of squamous cell carcinoma that accounts for 2% of head and neck cancers. Previous studies have not analyzed the significance of adjuvant chemoradiation and anatomical site within BSCC subtype and its impact on survival.

METHODS

A cohort of 1999 patients with BSCC of the head and neck was formed from the National Cancer Database and analyzed with descriptive studies, median survival and 5- and 10-year survival. A multivariable Cox hazard regression was performed to determine the prognostic significance of anatomical site and adjuvant therapy.

RESULTS

The most common primary anatomical site was the oropharynx (71.9%) followed by oral cavity (11.5%), larynx (10.1%), hypopharynx (3.5%), esophagus (1.9%), and nasopharynx (1.1%). The presence of metastasis increased the risk of mortality (HR = 2.14; 95% CI 1.40-3.26). Tumors localized to the oropharynx demonstrated better survival compared to all sites except nasopharynx, including the oral cavity (HR = 2.45; 95% CI 1.83-3.29), hypopharynx (HR = 2.58; 95% CI:1.64-4.05), and larynx (HR = 2.89; 95% CI:2.25-3.73). Adjuvant chemoradiation (HR = 0.36; 95% CI 0.23-0.58) and adjuvant radiation (HR = 0.38; 95% CI 0.23-0.64) had better survival outcomes compared to adjuvant chemotherapy. Patients with microscopic margins had better survival outcomes when compared to no surgery (HR = 0.38, 98% Cl 0.23-0.64) while there were no better survival outcomes of patients with macroscopic margins compared to no surgery.

CONCLUSION

This study illustrated that tumors in the oropharynx, lower age, adjuvant chemoradiation and radiation, and microscopic margins were associated with greater survival.

Basaloid squamous cell carcinoma: a 31-year retrospective study and analysis of 214 cases reported in the literature

PURPOSE

The aim of this study was to analyze the clinical features of BSCC in the oral cavity, diagnosed over 31 years of service in oral pathology, and make comparisons with the data reported in the literature.

METHODS

Data regarding gender, age, clinical presentation, anatomical location, symptoms, evolution time, size of lesion, and use of alcohol and tobacco from cases of BSCC were collected. Additionally, we conducted a review of BSCC studies from searches in three electronic databases.

RESULTS

Among 24,570 oral biopsies, 7 (0.03%) were BSCC and represented 0.8% of oral squamous cell carcinoma (n = 875). All cases occurred in males, and the prevalent affected age was the sixth decade (60%). Ulcers occurred in all cases, with the majority showing no symptoms (71.4%). The tongue (30.8%), alveolar ridge/gingiva (30.8%), and floor of the mouth (23.1%) were the anatomical locations affected. The literature review indicated a total of fifteen publications, reporting 214 cases of BSCC. Males (76.7%) in the seventh (53.3%) decade of life were most affected. According to the cases with adequate information, symptomatic (90.0%) ulcers (80.0%) in the floor of the mouth (42.1%), with a mean size of 2 cm and the mean evolution time of 1.5 to 18 months were the most seen. Association with tobacco and alcohol use, when noted, was 50.0%.

CONCLUSION

The features presented in this study are more similar than different when compared with the literature data.

Basaloid nasopharyngeal carcinoma: A population-based analysis of a rare tumor

OBJECTIVES

Basaloid nasopharyngeal carcinoma (BNPC) is an extremely rare malignancy with a paucity of cases reported in the literature. This analysis represents the largest cohort of BNPC to date.

STUDY DESIGN

Retrospective population-based analysis.

METHODS

The Surveillance, Epidemiology, and End Results registry from 2001 to 2015 was utilized to extract a total of 82 cases of BNPC. Data were analyzed for incidence trends, demographic, and tumor characteristics, as well as potential outcome prognosticators.

RESULTS

White male patients between the ages of 40 to 79 years were most commonly affected. The incidence was measured at 0.06 per 100 thousand people. The majority of tumors were considered high grade (grade III/IV; 92.2%). At presentation, patients were most commonly advanced stage (American Joint Committee on Cancer [AJCC] stage IV) at 29.3%, followed by AJCC stages II and III (20.7%, respectively). T2 tumors were most common at 28.8%. Cervical node involvement and distant metastasis were measured at 53.7% and 10.4%, respectively. One-year, 5-year, and 10-year disease-specific survival was 87.7%, 60.7%, and 29.8%, respectively. No prognostic factors were identified in this study.

CONCLUSION

Basaloid squamous cell carcinoma represents a histologic subtype of nasopharyngeal carcinoma with excellent short-term outcomes but poor survival at 10 years when compared to conventional squamous cell carcinomas.

LEVEL OF EVIDENCE

NA Laryngoscope, 129:2727-2732, 2019.

Cause-specific mortality prediction model for patients with basaloid squamous cell carcinomas of the head and neck: a competing risk analysis

Purpose: Basaloid squamous cell carcinoma (BSCC) is a rare, high-grade variant of squamous cell carcinoma (SCC). Most published studies based on population-based datasets focus on prognostic differences between SCC and BSCC. Competing risk analyses for this disease have not been performed. We used Surveillance Epidemiology and End Results (SEER) data to calculate and model the cumulative incidence of death for patients with head and neck BSCC (HNBSCC) with competing risk approaches, and built a model to predict probability of cause-specific death for these patients.

Methods: We analyzed data on 1163 patients who were diagnosed with primary lip and oral cavity, oropharynx, or hypopharynx and larynx BSCC and registered in the SEER program between 2004 and 2013. We calculated crude cumulative incidence function (CIF) for mortality after diagnosis of HNBSCC. We built a Fine and Gray's proportional sub-distribution hazard model and nomogram to predict their probability of cause-specific death. We calculated concordance indexes (c-index) and plotted calibration curves to evaluate model performance.

Results: Five-year cumulative incidence of cause-specific death after diagnosis of HNBSCC was 26.5% (95% CI: 23.4-29.8%); cumulative incidence of other causes of death was 11.8% (95% CI: 9.4-14.3%). Old age, large tumor size, hypopharynx and larynx sites, lymph node-positive, distant metastasis, and non-radiotherapy were significant factors for high probability of cause-specific death. The model was well calibrated. The bootstrap-corrected c-index for the model was 0.71.

Conclusions: We built the first competing risk nomogram for HNBSCC. The model performance was found to be good. This individualized prognostic predictive tool will aid physicians in clinical counseling, and will assist patients in planning for their future lives.

Epidemiological and Histopathological Aspects of Tongue Squamous Cell Carcinomas-Retrospective Study

Tongue squamous cell carcinoma is one of the most commonly diagnosed intraoral squamous cell carcinomas (25-40%), being considered an aggressive form of squamous cell carcinoma, as it is most commonly associated with lymph node metastases and the survival rate at five years is below 50%. In according with these data, we have proposed in this study to individualize an epidemiological and histopathological profile of the patients with such oral cancers, diagnosed and treated in the Oral and Maxillofacial Surgery Clinic and in the Otolaryngology Surgery Clinic of the Emergency Clinical County Hospital Craiova, between 2015-2017. The cases were histopathologically reassessed according to the latest WHO classification of head and neck tumors, the variables of interest being the age of the patients, the gender, the lesion topography, the histological subtype, the degree of tumor differentiation, the pTNM stage, the resection margin status and the Brandwein-Gensler prognostic score. Thus, we recorded an average age of 55.81±14.98 tongue cancer development, 65% of the casuistry being diagnosed during the 7th and 6th decades, with a slight prevalence in men, with development in two thirds of cases in the mobile portion of the tongue. Histopathologically, conventional forms of squamous cell carcinoma prevailed (53.7%), followed by varieties: acantholytic (26%), basaloid (13%), sarcomatoid (5.45%) and verrucous (1.85%). Moderate differentiated forms prevailed (44.44%), half of the cases falling within the moderate degree of Brandwein-Gensler's histological risk score and two thirds were diagnosed in pTNM stage II and III of the disease, and a quarter of the cases having the margins invaded.

Basaloid squamous cell carcinoma - A rare and aggressive variant of squamous cell carcinoma: A case report and review of literature

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of oral squamous cell carcinoma with a predilection for the tongue and in other locations, such as floor of the mouth, palate, retromolar trigone, and gingival mucosa. Here, we present a case of BSCC of oropharynx in a 60-year-old male patient.

Basaloid squamous cell carcinoma: Report of two rare cases and review of literature

Basaloid squamous cell carcinoma (BSCC) is a histologically distinct variant of SCC in the head-and-neck region it occurs most commonly in older men with a history of heavy smoking and alcohol abuse and usually presents as a high stage disease with widespread metastases and hence poor prognosis. BSCC is believed to arise from a totipotential primitive cell in the basal layer of the surface epithelium or from the salivary duct lining epithelium. BSCC is an uncommon tumor with a predilection for the upper aerodigestive tract, is a distinct variant of squamous carcinoma, due to its unique histological features and ominous clinical behavior. In the oral cavity, BSCC has a predilection for the tongue, followed by the floor of the mouth, palate, buccal mucosa, retromolar trigone and gingiva. In the oral cavity, retromolar trigone/gingiva is very rare sites and only a few cases have been reported in the literature. This paper reports an additional two cases of BSCC, one reported in the retromolar region and other reported on the gingiva.

Aggressiveness pattern and second primary tumor risk associated with basaloid squamous cell carcinoma of the larynx

Basaloid squamous cell carcinoma (BSCC) is a rare, aggressive and distinct variant of squamous cell carcinoma (SCC) of the upper respiratory and digestive tract. We have evaluated disease specific survival (DSS) and overall survival (OS) through Kaplan-Meier method and mortality risk through univariate statistical analysis of Cox in 42 cases of BSCC and other 42 of laryngeal SCC (LSCC) matched for both age and sex. We demonstrated that laryngeal BSCC is a more aggressive tumor than LSCC as is associated to higher nodal recurrence of pathology (5 vs 2 patients, overall risk, OR 2.7), a reduced survival (median survival 34 vs 40 months, OR 3.2 for mortality); in addition, basaloid patients have a higher risk to be affected by second primary tumors (13 vs 3 patients, OR 5.8) and a higher probability to die for this second tumor (Hazard Risk, HR 4.4). The analysis of survival shows an increased mortality risk concurrent with the parameters assessed by univariate analyses that assume a predictive and statistical significance in second tumor and grading in basaloid LSSC.

How phenotype guides management of non-conventional squamous cell carcinomas of the larynx?

Although the majority of laryngeal malignancies are the conventional squamous cell carcinomas (SCC), a wide variety of malignant epithelial tumors can affect the larynx. Current treatment guidelines are designed to guide clinicians in management of conventional laryngeal SCC. Less is known about the biological behavior and responsiveness to therapy and overall outcomes of other malignant epithelial lesions. Because a spectrum of disease biology is represented by these rare phenotypes, an understanding of the basic biology can help direct management to optimize clinical outcome in this group of patients. This review provides a critical analysis of literature relating to the diagnosis, management, and outcome of patients with non-conventional squamous malignant epithelial neoplasms of the larynx. Particular attention is paid to features which are at variance with the conventional SCC and how these impact on management of these rare tumors.

Basaloid squamous cell carcinoma arising in an inverted papilloma in the nasal cavity: A case report and review

Basaloid squamous cell carcinoma (BSCC) is a histologically distinctive variant of squamous cell carcinoma comprising basal cell carcinoma and squamous cell carcinoma. BSCC is aggressive and shows a poor prognosis because of frequent lymph node invasion and distant metastases. BSCC preferentially occurs in the cervix, thymus, and esophagus and is uncommonly found in the head and neck region. BSCC in the nasal cavity or paranasal sinus is particularly rare. Inverted papilloma is an uncommon, benign tumor with a propensity to be associated with malignancy; however, BSCC arising in an inverted papilloma has never been reported. Here we report a case of a 56-year-old woman with BSCC arising in an inverted papilloma in the nasal cavity. The woman was referred to our hospital for epistaxis, nasal congestion, and dysphagia. A tumor was observed to completely occupy the left nasal cavity. The biopsy specimen was histologically diagnosed as papilloma. Computed tomography demonstrated a tumor with heterogeneous contrast effect occupying the left nasal cavity; however, extra-nasal tract extension was not observed. We performed endoscopic excision of the tumor. Microscopic findings confirmed the diagnosis of BSCC arising from an inverted papilloma. No tumor recurrence has been observed for 13 months after surgery.

Basaloid squamous cell carcinoma of the maxilla

Basaloid squamous cell carcinoma (BSCC) is a distinctive aggressive variant of squamous cell carcinoma. We present a case of a 60-year-old man with tender swelling in the right cheek region for 6 months and continuous unilateral nasal discharge for 2 months. Extraoral examination revealed an ovoid, well-defined swelling from the right infraorbital rim to the angle of the mouth superoinferiorly and the right lateral wall of the nose to preauricular region anteroposteriorly. Intraorally, an ulceroproliferative growth from right upper gingivobuccal sulcus to mid palatine raphe with bicortical expansion was evident. CT revealed a hypodense mass obliterating the right maxillary sinus. Histopathology showed closely packed basaloid cells, with hyperchromatic palisading nuclei, arranged in a solid pattern with a lobular configuration. Prominent areas of comedo necrosis and keratin pearl formation were seen. These features suggested BSCC. The patient underwent surgical excision with adjuvant radiation but was lost to follow-up after 6 months of radiation therapy.

Potential impact of human papilloma virus on survival of basaloid squamous carcinoma of the head and neck

OBJECTIVES

Basaloid-squamous-carcinomas (BSCC) have been considered as aggressive variants of common squamous-cell-carcinomas (HNSCC). Recent studies demonstrated a different clinical course depending on the tumour site. The aim of the study is to analyze the histopathologic/clinical features of BSCC/HNSCC resolved by the HPV-status.

METHODS

We analysed the histopathologic/clinical features of BSCC (n=59) and HNSCC (n=981), subdivided due to the HPV status. Differences were analysed using Chi square, Fisher exact, and student's t-test. Survival rates were calculated by Kaplan-Meier and log-rank test. Prognostic variables were subsequently evaluated by Cox regression.

RESULTS

Our cohort was congruent with the literature regarding sex, age, metastases, and a predilection in the oropharynx. HNSCC/BSCC did not show a different disease-specific-survival. After UICC matching, univariate analysis revealed a better survival of UICC stage IVa BSCC compared to HNSCC (69% vs. 42%, p=0.022) that was associated with a better response to radio-chemotherapy (p = 0.009). These results referred to the high prevalence of HPV+ (86%) oropharyngeal BSCC. Subgroup analysis demonstrated a better survival of HPV+ oropharyngeal BSCC than HPV- BSCC (p=0.017).

CONCLUSION

The clinical outcome in BSCC depends on the tumour site and HPV-status. Prospective studies have to evaluate the beneficial application of postoperative radio-chemotherapy in HPV+ BSCC.

The basaloid variant of squamous cell carcinoma of the larynx

Introduction

Basaloid squamous cell carcinoma (BSCC) is a rare subtype of squamous cell carcinoma (SCC). Because of its rarity, both clinical and prognostic features of this variant are not well known.

Objective

In this study, we aimed to determine the frequency of BSCC and other SCC variants among all laryngeal SCC cases, and to determine clinical and prognostic features of BSCC variant. Study design: retrospective cohort study. Evidence level: Level 2b.

Material and methods

Records of the patients who had laryngeal SCC surgically treated at our institute between 2007 and 2013 were retrospectively reviewed.

Results

Among 198 subjects who had laryngeal SCC surgically treated, the frequency of the variants of SCC other than classical variant was 10.1% (20/198). The most common SCC variant was BSCC (6.6%). Eleven (84.6%) patients with BSCC were at an advanced stage at the presentation (p > 0.05). The 3-year overall survival and disease-free survival rates were 63% and 53% respectively.

Conclusion

BSCC variant may be more common than previously reported. Since almost the half of patients experiences disease recurrence in the early period, multimodal treatment strategies should be employed at initial treatment, and a close follow-up is strongly recommended for this aggressive SCC variant.

Squamous cell carcinoma variants of the upper aerodigestive tract: a comprehensive review with a focus on genetic alterations

CONTEXT

Squamous cell carcinoma of the upper aerodigestive tract is a heterogenous entity. Although conventional squamous cell carcinomas are easily recognized, the morphologic variants of squamous cell carcinoma can present a diagnostic challenge. Familiarity with these variants is necessary because many are associated with unique risk factors and are characterized by specific molecular alterations (eg, nuclear protein in testis midline carcinomas). Perhaps the most important distinction is in identifying viral-related from nonviral-related carcinomas. The accurate diagnosis of these variants is necessary for prognostic and therapeutic reasons.

OBJECTIVES

To provide a clinicopathologic overview and summary of the molecular alterations of the common squamous cell carcinoma variants, including verrucous, spindle cell, acantholytic, adenosquamous, basaloid, and papillary squamous cell carcinoma, as well as nuclear protein in testis midline carcinoma, and to discuss the distinguishing features of human papillomavirus- and Epstein-Barr virus-related squamous cell carcinomas.

DATA SOURCES

Published peer-reviewed literature.

CONCLUSIONS

Familiarity with squamous cell carcinoma variants is essential for proper diagnosis and to guide appropriate clinical management. Further insight into the molecular alterations underlying those variants may lead to alterations in existing treatment approaches and to evolution of novel treatment modalities.

Expression of E-cadherin and β-catenin in basaloid and conventional squamous cell carcinoma of the oral cavity: are potential prognostic markers?

Background

Basaloid squamous cell carcinoma presents with a preference for the head and neck region, and shows a distinct aggressive behavior, with frequent local recurrences, regional and distant metastasis. The alterations in the cadherin-catenin complex are fundamental requirements for the metastasis process, and this is the first study to evaluate the immunostaining of E-cadherin and β-catenin in oral basaloid squamous cell carcinoma.

Methods

Seventeen cases of this tumor located exclusively in the mouth were compared to 26 cases of poorly differentiated squamous cell carcinoma and 28 cases of well to moderately differentiated squamous cell carcinoma matched by stage and tumor site. The immunostaining of E-cadherin and β-catenin were evaluated in the three groups and compared to their clinicopathological features and prognosis.

Results

For groups poorly differentiated squamous cell carcinoma and basaloid squamous cell carcinoma, reduction or absence of E-cadherin staining was observed in more than 80.0% of carcinomas, and it was statistically significant compared to well to moderately differentiated squamous cell carcinoma (p = .019). A strong expression of β-catenin was observed in 26.9% and 20.8% of well to moderately differentiated squamous cell carcinoma and poorly differentiated squamous cell carcinoma, respectively, and in 41.2% of basaloid squamous cell carcinoma. The 5-year and 10-year overall and disease-free survival rates demonstrated no significant differences among all three groups.

Conclusions

The clinical and biological behavior of three groups of the oral cavity tumors evaluated are similar. E-cadherin and β-catenin immunostaining showed no prognostic value for basaloid and conventional squamous cell carcinomas.

A literature review on oral basaloid squamous cell carcinomas, with special emphasis on etiology

In the recent years, basaloid squamous cell carcinomas (BSCCs) have gained attention because of (1) observation of a relative increase in the number of tumors arising particularly in head and neck sites, (2) identification of human papillomavirus (HPV) in BSCCs arising predominantly in the oropharynx, and (3) controversies that exist regarding the biological aggressiveness of the tumor. The objective of the present review was to address the issues mentioned above by focusing primarily on oral BSCCs, using literature that has been published in the English language up to 2013. According to the literature review, oral BSCCs were found to be relatively more common in elderly patients with a mean age of 64 years. A male predominance with a male/female ratio of 3:1 was observed. The predominant site was the tongue, with almost half of the reported cases occurring at this site, followed by the floor of the mouth and palate. With reference to habit history, majority were found to be tobacco and alcohol users. However, only 3 studies revealed data on HPV status of purely oral BSCC, and according to the results of these studies, of the 17 tumors tested, 4 had harbored high-risk HPV. Furthermore, most oral BSCCs were in an advanced clinical stage, namely, stage III or IV with T3 or T4 lesions and cervical lymph node metastasis at initial presentation, whereas 41% of patients had presented with local recurrences and 45% had died of the disease. In conclusion, although, the present literature review found enough evidence to consider tobacco and alcohol as risk factors for the development of oral BSCC, steps should be taken to fill the gap in our knowledge that exist with reference to contribution of oncoviruses, particularly HPV in the etiology of oral BSCC.

Moderately differentiated neuroendocrine carcinoma (atypical carcinoid) of the parotid gland: report of three cases with contemporary review of salivary neuroendocrine carcinomas

Primary neuroendocrine carcinomas (NECs) of the salivary glands are rare. Most reported NECs in that region are small cell carcinomas with few cases of large cell undifferentiated carcinoma and typical carcinoid tumors. Only two moderately differentiated NECs (atypical carcinoid tumors) have been previously reported. In the current series, the authors report three additional moderately differentiated NECs (atypical carcinoid tumors) of the parotid gland; two occurred in women and one in a man. All patients were initially treated with parotidectomy, with selective lymph node excision in one, and radiation therapy in another. Follow-up was available for two cases (18 and 79 months). One patient had two local recurrences, developing lymph node and liver metastases requiring further surgery and chemotherapy. Currently, she is alive with disease, on supportive care. The second patient is alive with no signs of recurrence. Patients' work-up excluded the possibility of metastatic NECs to the salivary glands in all cases. Histologically, the tumors demonstrated infiltrating nests, cords and trabeculae of round, oval to spindle shaped cells with moderate to focally abundant eosinophilic cytoplasm, small to prominent nucleoli and chromatin stippling. Scattered rosette-like structures were prominent in one tumor. The highest mitotic counts for the three tumors ranged from 5 to 8 mitotic figures/10 hpfs. Necrosis, focal but distinct, was noted in two tumors, vascular invasion in two tumors and perineural invasion in one tumor. Immunohistochemical staining was diagnostic of neuroendocrine carcinoma, showing uniform positive labeling with broad-spectrum cytokeratin (with a paranuclear punctuate pattern in one case), chromogranin and synaptophysin antibodies. CK20 was negative in two tumors and stained rare cells (<1%) in the third.

Sinonasal squamous cell carcinomas: clinical outcomes and predictive factors

This was a retrospective study of 33 patients treated for sinonasal squamous cell carcinoma between 1995 and 2008. Epidemiological, clinical, histological, and therapeutic aspects of this series of patients were analysed, and their impacts on overall survival and disease-free survival established using the Kaplan-Meier method. A search for prognostic factors was made using a log-rank test. There were 27 men. The average age at diagnosis was 64.7 years. Tobacco-smoking was found to be a risk factor in 24 patients (72.7%). The median follow-up was 66 months (range 0-99 months). Tumours were classified as T1 in 18.3%, T2 in 27.3%, T3 in 6%, and T4 in 48.5% of cases. Disease-free survival rates at 1 and 5 years were 58.5% and 46.1%, respectively, and overall survival rates were 70.3% and 40%, respectively. Overall survival was correlated to tumour status (TNM, American Joint Committee on Cancer) (P = 0.010) and involvement of key structures (skull base, dura mater, brain, orbit, cavernous sinus, infratemporal fossa, skin) (P = 0.049). Surgery followed by radiotherapy improved overall survival (P = 0.005) and disease-free survival (P = 0.028) when compared to other treatment modalities. When compared to surgery alone, it improved disease-free survival (P = 0.049) regardless of tumour stage.

Basaloid squamous cell carcinoma of the maxillary sinus: Report of two cases in association with cathepsin K expression

Basaloid squamous cell carcinoma (BSCC) is a rare variant of squamous cell carcinoma. The occurrence of BSCC in the nasal cavity is extremely rare. In the present study, two cases of BSCC occurring in the maxillary sinus are reported and the clinicopathological features and immunohistochemical characteristics of this rare tumor are discussed. Two patients, aged 85 (case 1) and 60 years (case 2), presented with nasal tumors and persistent nasal obstruction. In each case, the biopsy or resected specimen of the maxillary sinus tumor revealed an infiltrative proliferation of solid epithelial nests composed of basaloid cells exhibiting hyperchromatic nuclei without conspicuous nucleoli and scant cytoplasm. Mitotic figures were frequently observed and spherical hyalinized materials were present within the tumor nests. Immunohistochemically, the tumor cells exhibited diffuse positive immunoreactivity for p63 and perinuclear dot-like positivity for vimentin, leading to a final diagnosis of BSCC of the maxillary sinus. Furthermore, it was demonstrated for the first time in the two cases that cathepsin K, a cysteine protease with marked collagenolytic and elastolytic activities, was expressed in a diffuse manner. One patient (case 2) succumbed to multiple metastases, while the other (case 1) remains alive with the disease. In conclusion, it was demonstrated that cathepsin K was immunopositive in two cases of BSCC of the maxillary sinus and that it may be involved in tumor invasion by this highly aggressive carcinoma.

Basaloid squamous cell carcinoma of the tonsil: report of a case and review of the literature

The most common type of malignancy affecting the upper aerodigestive tract is squamous cell carcinoma. Basaloid squamous cell carcinoma (BSCC) is a rarely seen, high-grade, bimorphic variant of squamous cell carcinoma, which displays distinct histological features. This entity was first described by Wain et al. in 1986. Since then, approximately 170 cases of head and neck basaloid squamous cell carcinoma have been reported. Tonsils are an uncommon site of occurrence of basaloid cell carcinoma. Only 10 cases of basaloid squamous cell carcinoma arising in the tonsils have been described in current English literature. Histopathologically, these carcinomas are characterised by the presence of a basaloid component in close association with squamous cell carcinoma. In this article, a case of BSCC of the tonsil is reported. The clinical and histopathological features of this tumour are discussed. Relevant literature has been reviewed and differential diagnosis of this tumour is discussed.

Expression of PTEN in basaloid squamous cell carcinoma and its clinicopathological significance

There are a few ideal predictors that are used to evaluate the prognosis of basaloid squamous cell carcinoma (BSCC). This study was designed to investigate the expression of PTEN (phosphates and tensin homolog deleted on chromosome ten) and its association with clinicopathological and available follow-up data. PTEN protein was examined by using immunohistochemical SABC staining method in eight cases of BSCC. Loss of PTEN expression was noted in five (62.5%) of the eight studied BSCC cases. Statistically, there was a significant relationship between PTEN expression and studied BSCC groups depending upon the basaloid component level, lymph node involvement, and the clinical stage of the disease. Of the five patients whose tumors were PTEN negative, three (80%) had recurrence or death at follow-up, whereas none of the three patients whose tumors were PTEN positive had recurrence or death. It was concluded that the PTEN positive expression may be useful for predicting the prognosis of BSCC.

Human papillomavirus-positive basaloid squamous cell carcinomas of the upper aerodigestive tract: a distinct clinicopathologic and molecular subtype of basaloid squamous cell carcinoma

Basaloid squamous cell carcinoma of the upper aerodigestive tract is a rare, morphologically distinct variant of squamous cell carcinoma that is thought to be clinically aggressive. The histologic features are distinct from, but often confused with, those of human papillomavirus-related oropharyngeal nonkeratinizing squamous cell carcinoma. The role of human papillomavirus as an etiologic agent in true basaloid squamous cell carcinoma is controversial. The purpose of this study was to determine human papillomavirus prevalence and its clinicopathologic significance in upper aerodigestive tract tumors with true basaloid squamous cell carcinoma histology. Twenty-eight cases were identified, 12 in the oropharynx and 16 in the larynx and/or hypopharynx. High-risk human papillomavirus in situ hybridization and immunohistochemistry for p16 and p53 were performed. Nine (75%) of the oropharyngeal and none of the larynx/hypopharynx tumors were human papillomavirus positive. Human papillomavirus-positive tumors affected younger patients. No significant statistical differences in patients' sex, tumor stage, treatment modality, or length of follow-up were observed between the 2 groups. Viral status showed a strong, positive correlation with p16 (P < .001) and a strong, negative correlation with p53 (P < .0001) immunoreactivity. Overall survival was better for human papillomavirus-positive basaloid squamous cell carcinomas (P < .05), with 86% of patients alive at 3 years compared with 35.3% of patients with human papillomavirus-negative tumors. These findings suggest that a subset of basaloid squamous cell carcinomas is virally driven. These tumors occur almost exclusively in the oropharynx, are molecularly distinct from their human papillomavirus-negative counterparts, and have a more favorable clinical outcome.

Basaloid squamous cell carcinoma in nasal cavity

Basaloid squamous cell carcinoma (BSCC) is often founded in the head and neck region. However, BSCC in the sinonasal tract is rare. We report here on the case of a 58-yr-old woman who presented with nasal obstruction and epistaxis. Computed tomography and examination of the nasal cavity revealed a tumor mass that originated from the right inferior turbinate with erosion of the nasal floor. The tumor that was attached to the inferior turbinate, the lateral nasal wall and the eroded right side hard palate, and so all this was resected. Histopathologic examination of the excised tumor confirmed BSCC in the nasal cavity. We report here on a nasal cavity BSCC that was treated with partial maxillectomy only.

Thymic basaloid carcinoma: a clinicopathologic study of 12 cases, with a general discussion of basaloid carcinoma and its relationship with adenoid cystic carcinoma

Thymic carcinoma (primary carcinoma of the thymic epithelium; type C thymoma) is a rare malignancy. It usually presents in middle-aged to elderly patients and can exhibit a wide variety of morphologic appearances. Thymic basaloid carcinoma (thymic BC) is a particularly rare subtype, with less than 20 cases published in the English literature, mostly in the form of individual case reports. In this study, we present the clinicopathologic and immunohistochemical features of 12 new cases of thymic BC. There were 10 (83%) men and 2 (17%) women. Ages at the time of initial diagnosis ranged from 34 to 77 years (mean 55 y). The 2 most common manners of presentation were dyspnea on exertion (3 patients) and as an incidental finding on radiographic imaging (2 patients). Tumors ranged in size from 4.4 to 17 cm (mean 10.1 cm). One of 12 cases (8.3%) was associated with a multilocular thymic cyst. Immunohistochemistry was performed in 8 cases. Pan-cytokeratin was positive in all cases. CD117 (c-kit) was positive in 6 of 8 cases (75%), p63 was positive in 7 of 8 cases (88%), p53 was positive in 7 of 8 cases (88%), ranging from <10% to 90%, CD5 was focally positive in 3 of 8 cases (38%), collagen type IV was positive in 4 of 8 cases (50%), and proliferative index, as estimated by Ki67, ranged from <1% to approximately 15%. In 1 of 2 cases with sarcomatoid differentiation, Ki67 was greater than 80% in the sarcomatoid area. Cases were negative for thyroid transcription factor-1 (0 of 8), S-100 (0 of 7), and synaptophysin (0 of 7). Long-term data was available in 8 patients with an average follow-up of 30 months. Five patients died of their disease at an average of 34 months from the time of diagnosis. Of the remaining 3 patients, 1 had a stable recurrence and died at 4 years from unrelated causes, and 2 were alive without the evidence of disease at 12 and 7 months, respectively. Thymic BC, although previously regarded as a low-grade neoplasm, has shown that it is capable of aggressive behavior and significant mortality. In this paper, we review the pertinent literature and discuss the possible relationship of thymic BC with thymic adenoid cystic carcinoma, as well as BCs and adenoid cystic carcinomas at other sites.

Ber-EP4, CK1, CK7 and CK14 are useful markers for basaloid squamous carcinoma: a study of 45 cases

Diagnosis of basaloid squamous carcinoma (BSCC) currently relies mainly on histological criteria, with variable immunohistochemical results reported in small series. We explored the use of a battery of immunohistochemical stains to elucidate this diagnosis on 45 cases of BSCC. To further elucidate the immunohistochemical profile of BSCC, to explore potential genetic pathways of malignant transformation using proliferation markers, and to investigate a possible link with Human Papillomavirus (HPV). Forty-five cases of BSCC and 34 site-matched cases of squamous cell carcinoma (SCC) were obtained from the archives of the pathology department at our institution. Extensive literature review was undertaken utilizing Medline. Ber-EP4 is a useful diagnostic marker for BSCC, positive in 82% (37/45) of the cases and in 68% (23/34) of SCC. An alternative is the combination of cytokeratins CK14 and CK7, known to be negative, and CK1, known to be positive, which achieves an accuracy of 73% (33/45) in BSCC and 88% (30/34) in SCC. The two diagnostic approaches were in agreement in 66% of the cases; both methods were equally accurate in the divergent cases. Increased expression of the proliferation markers supports the concept that BSCC is a rapidly growing tumor. Results of p16 stains support an etiological link between BSCC and HPV; interestingly, HPV was present significantly more in BSCC (71% (32/45)), than in SCC (59% (20/34)) in this study (P=0.02).

Expression of PCNA and Bcl-2 in Basaloid Squamous Cell Carcinoma of the Larynx: A Controlled Study

We investigated the difference in the biologic nature of typical squamous cell carcinoma (SCC) and basaloid SCC (BSCC) of the larynx by studying proliferation and antiapoptotic markers. We performed an immunohistochemical analysis of the expression of proliferating cell nuclear antigen (PCNA) and bcl-2 protein in 15 patients with laryngeal BSCC and 15 stage-and site-matched controls with typical laryngeal SCC. We found no significant difference between the two groups in the PCNA index or the frequency of bcl-2 overexpression, nor did we find any significant difference in survival. Our findings indicate that the biologic nature of typical laryngeal SCC and laryngeal BSCC is similar. In addition, our follow-up data suggest that the clinical course of laryngeal BSCC is no worse than that of typical laryngeal SCC.

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.

Outcomes after radiotherapy for basaloid squamous cell carcinoma of the head and neck: a case-control study

BACKGROUND

Basaloid squamous cell carcinoma (BSCC) is an uncommon, high-grade variant of squamous cell carcinoma (SCC) of the head and neck. Its poorer prognosis compared with common SCC remains controversial. The authors investigated the outcomes of patients with BSCC who received radiotherapy and compared them with the outcomes of patients with SCC.

METHODS

From 1994 to 2004, 1007 patients received radiotherapy for head and neck carcinoma with lymph node involvement. The histologic types consisted of 51 BSCC, 431 poorly differentiated SCC (PSCC), and 525 well or moderately differentiated SCC (WMSCC). A case-control analysis was performed with BSCC matched against both PSCC and WMSCC to compare disease-control and survival rates.

RESULTS

Patients with BSCC received treatment modalities similar to those received by patients with SCC: They received induction chemotherapy (12%) or concurrent chemotherapy (33%), and a median radiation dose of 70 Gray. Posttreatment viable tumor was present in 44%, 13%, and 28% of neck dissection specimens from patients with BSCC, PSCC, and WMSCC, respectively. The 5-year disease-free survival rates (63%, 77%, and 76%, respectively) and overall survival rates (85%, 70%, and 71%, respectively) demonstrated no statistically significant differences for BSCC, PSCC, or WMSCC, respectively.

CONCLUSIONS

In this study, a poorer prognosis could not be demonstrated for irradiated patients with BSCC compared with either PSCC or WMSCC. All patients in this study had positive lymph node status, and the majority of patients (84%) had oropharyngeal cancer. The BSCC cohort did have a relatively high rate of viable tumor in their posttreatment neck dissections, and they had a relatively high rate of distant disease. On the basis of the high rate of lung metastases and the possibility of efficient salvage, the authors recommend obtaining a chest computed tomography scan during initial staging and follow-up.

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).

Basaloid squamous cell carcinoma of the soft palate: case report

Basaloid squamous cell carcinoma (BSCC) is a histologically distinct variant of squamous cell carcinoma. It occurs in various sites of the head and neck region and is believed to carry a dismal prognosis. The palate is a very rare site of BSCC development and only three cases have been reported in the international literature. In this report, we present a case of basaloid squamous cell carcinoma of the soft palate. The therapeutic strategy and histological findings are described in detail, including immunohistochemistry with the use of involucrin, an agent used for the first time for BSCC diagnosis. In addition, a brief review of the literature is presented.