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Zhurauliou A, Vasyukova O. Perianal Cutaneous Spindle Cell Squamous Cell Carcinoma With Myxoid Stroma: Case Report and Literature Review. Am J Dermatopathol 2023; 45:650-653. [PMID: 37506272 DOI: 10.1097/dad.0000000000002504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
ABSTRACT Spindle cell squamous cell carcinoma with myxoid stroma is a rare variant of squamous cell carcinoma with sarcomatoid morphology. We report a case of a 75-year-old woman with an ulcerated polypoid cutaneous mass in the perianal area. The patient had a history of clear cell renal cell carcinoma. Microscopy revealed an invasive myxoid spindle cell carcinoma without the classic squamous cell carcinoma component. The immunohistochemical study demonstrated diffuse positive reactions for p63, AE1/3, and CK5/6. The tumor cells were negative for desmin, smooth muscle actin, S100, and CD34. Fluorescent in situ hybridization was negative for EWSR1 gene rearrangement. Follow-up was remarkable for recurrence of tumor in 2 months after complete resection with negative surgical margin. This is the first case report of perianal spindle cell squamous cell carcinoma with myxoid stroma with a literature review of previous case reports from different locations.
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Affiliation(s)
| | - Olesya Vasyukova
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution (FSBSI) "Petrovsky National Research Centre of Surgery," Clinical Morphology Laboratory, Moscow, Russia
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Mudhar HS, Milman T, Zhang PJL, Shields CL, Eagle RC, Lally SE, Shields JA, Salvi SM, Rundle PA, Tan J, Rennie IG. Conjunctival 'mucoepidermoid carcinoma' revisited: a revision of terminology, based on morphologic, immunohistochemical and molecular findings of 14 cases, and the 2018 WHO Classification of Tumours of the Eye. Mod Pathol 2020; 33:1242-1255. [PMID: 31932683 DOI: 10.1038/s41379-020-0456-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/11/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
In 2018, the consensus meeting for the WHO Classification of Tumours of the Eye decided that conjunctival mucoepidermoid carcinoma should be reclassified as adenosquamous carcinoma, as this represented a better morphological fit. To examine the applicability of this terminology, we studied the clinical, histopathological, immunohistochemical and molecular pathology of 14 cases that were originally diagnosed as conjunctival mucoepidermoid carcinoma. There were 7 (50%) females and 7 (50%) males. The median age was 64 years. The left eye was affected in 8 and the right eye in 6 patients. In-situ carcinoma was present in 11/14 (79%) cases and comprised in-situ squamous cell carcinoma (SCC) and conjunctival intraepithelial neoplasia with mucinous differentiation (CIN-Muc). Invasive carcinoma was present in 11/14 (79%) cases. Group 1 (1/11 cases, 9%) comprised invasive SCC only. Group 2 (6/11 cases, 55%) comprised SCC with mucinous differentiation, manifesting as scattered intracellular mucin, occasionally together with intercellular mucin, with no evidence of true glandular differentiation. Group 3 (3/11 cases. 27%) comprised true adenosquamous carcinoma. Group 4 (1/11 cases, 9%) comprised pure adenocarcinoma. Thirteen of 14 cases (93%) underwent FISH for MAML2 translocation and none were rearranged. Two cases harboured high-risk HPV (type 16 and 18). The combined findings confirm that all lesions in our study were not mucoepidermoid carcinoma, but represented predominantly SCC with mucinous differentiation and adenosquamous carcinoma. We, therefore, recommend future revision of the WHO classification to include SCC with mucinous differentiation alongside adenosquamous carcinoma.
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Affiliation(s)
- Hardeep S Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, E-Floor, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK.
| | - Tatyana Milman
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul J L Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Carol L Shields
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Ralph C Eagle
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Sara E Lally
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerry A Shields
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Sachin M Salvi
- Sheffield Ocular Oncology Service, Department of Ophthalmology, A-Floor, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Paul A Rundle
- Sheffield Ocular Oncology Service, Department of Ophthalmology, A-Floor, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Jennifer Tan
- Oculoplastic Service, Department of Ophthalmology, A-Floor, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Ian G Rennie
- Sheffield Ocular Oncology Service, Department of Ophthalmology, A-Floor, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
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Cutaneous Metastasis of a Mucoepidermoid Carcinoma of the Pancreas: First Reported Case. Am J Dermatopathol 2017; 38:852-856. [PMID: 27043340 DOI: 10.1097/dad.0000000000000604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mucoepidermoid pancreatic cancer is a rare entity with only 8 cases reported in the literature. On review of the literature, the authors found that cutaneous metastases in pancreatic cancer are rare and have not been associated with the mucoepidermoid subtype. The authors present the first reported case of cutaneous metastasis in a patient with mucoepidermoid carcinoma of the pancreas. CASE PRESENTATION A 50-year old white male with a metastatic invasive poorly differentiated mucoepidermoid carcinoma of the pancreas was found to have a slow growing lesion in the skin over his left upper quadrant while undergoing active therapy. The lesion was biopsied and the pathology was consistent with pancreatic origin sharing similar morphologic features when compared with the primary pancreactectomy specimen. CONCLUSIONS Mucoepidermoid pancreatic cancer is an exceedingly rare subtype of pancreatic cancer, with very little information regarding its diagnosis, treatment, and patterns of metastases. Here, the authors present the first reported case of cutaneous metastases of mucoepidermoid pancreatic cancer.
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Penile Analogue of Stratified Mucin-Producing Intraepithelial Lesion of the Cervix: The First Described Case. A Diagnostic Pitfall. Am J Dermatopathol 2017; 38:e64-7. [PMID: 27097242 DOI: 10.1097/dad.0000000000000462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors report a case where undifferentiated (classic) penile intraepithelial neoplasia was associated with the presence of goblet cells throughout the full epithelial thickness and which later progressed into an invasive carcinoma. The lesion evolved in three consecutive biopsies from only surface epithelium occupying numerous goblet cells in the first to variably sized solid nodules in the dermis composed of atypical squamous and/or basaloid cells intermixed with numerous goblet cells in the third biopsy. Both cellular components expressed CK7 and p16 protein. Human Papillomavirus (HPV) genotyping revealed high risk HPV type 16. To the best of our knowledge, this is the first description of such a lesion occurring on the penis, which can be considered the penile analogue of cervical stratified mucin-producing intraepithelial lesion (SMILE). The correct diagnosis was rendered retrospectively, after recognition of the existence of a vulvar lesion resembling cervical SMILE. The initial biopsy was misinterpreted as extramammary Paget disease, which also constitutes the main pitfall in the differential diagnosis. Another important differential diagnosis is penile/vulvar mucinous metaplasia. The finding of atypical squamous epithelial cells positive for p16 associated with mucinous cells present throughout the full epithelial thickness is a clue to the diagnosis of penile SMILE.
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Wang NR, Wang MM, Zhou L, Liu ZL, Chen NP, Hu JP, Deng YJ, Qi XQ, Huang XF, Su Y, Zhang SY, Tong F, Zhang Y, Lu Q, Zhu ZY, Deng H. Cutaneous clear cell/signet-ring cell squamous cell carcinoma arising in the right thigh of a patient with type 2 diabetes: combined morphologic, immunohistochemical, and etiologic analysis. Diagn Pathol 2016; 11:36. [PMID: 27066782 PMCID: PMC4827219 DOI: 10.1186/s13000-016-0487-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/02/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The clear cell/signet-ring cell variant of cutaneous squamous cell carcinoma (cSCC) is extremely rare. Its carcinogenesis has consistently been linked to ultraviolet radiation and HPV in the literature. However, there is little definite information about the contribution of diabetes mellitus (DM) to cSCC. CASE PRESENTATION A 78-year-old Chinese woman with type 2 DM presented with a mushroom-like lump in her right thigh. Histological findings revealed that the lesion was mainly composed of clear cells and signet-ring cells. The septa of vacuoles in cytoplasm displayed positivity for periodic acid schiff (PAS) and cytokeratins such as AE1/AE3, CK5/6, CK14, and CK19. Malignant cells did not express CK7, CK8, CK18, CK20, p16, p53, or c-erbB-2, and the Ki-67 index was less than 5 %. We further explored the etiology of clear cell/signet-ring cell cSCC using human papillomavirus (HPV) type-specific PCR and genotyping and confirmed that the patient was not infected with HPV. Nucleus positivity for p63 indicated the involvement of the p53 family in the lesion. Meanwhile, the expression of fibroblast growth factor receptor-2 (FGFR2), a downstream effector of p63, was upregulated in tumor cells. CONCLUSIONS This study provides the first report on the clear cell/signet-ring cell variant of cSCC found in the right thigh of a patient with type 2 DM. Metabolic imbalance in addition to conventional pathogens such as UV and HPV may contribute to the development of the lesion via p63/FGFR2 axis.
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MESH Headings
- Aged
- Biomarkers, Tumor/analysis
- Biopsy
- Carcinoma, Signet Ring Cell/chemistry
- Carcinoma, Signet Ring Cell/etiology
- Carcinoma, Signet Ring Cell/pathology
- Carcinoma, Signet Ring Cell/surgery
- Carcinoma, Squamous Cell/chemistry
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Female
- Humans
- Immunohistochemistry
- Predictive Value of Tests
- Risk Factors
- Skin Neoplasms/chemistry
- Skin Neoplasms/complications
- Skin Neoplasms/pathology
- Skin Neoplasms/surgery
- Thigh
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Affiliation(s)
- Nong-Rong Wang
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meng-Meng Wang
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lv Zhou
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Ze-Lin Liu
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
- />Department of Endocrinology, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Nan-Ping Chen
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jin-Ping Hu
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Yan-Juan Deng
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Xiao-Qing Qi
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Xiao-Feng Huang
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Yue Su
- />Medical College, Nanchang University, Nanchang, China
| | - Si-Yao Zhang
- />Medical College, Nanchang University, Nanchang, China
| | - Fei Tong
- />Medical College, Nanchang University, Nanchang, China
| | - Yu Zhang
- />Medical College, Nanchang University, Nanchang, China
| | - Qi Lu
- />Medical College, Nanchang University, Nanchang, China
| | - Zi-Yu Zhu
- />Medical College, Nanchang University, Nanchang, China
| | - Huan Deng
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
- />Renmin Institute of Forensic Medicine, Nanchang, China
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Histopathologic Variants of Cutaneous Squamous Cell Carcinoma In Situ With Analysis of Multicentric Subtypes. Am J Dermatopathol 2015; 37:680-5. [DOI: 10.1097/dad.0000000000000354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Low rate of detection of mucosal high-risk-type human papillomavirus in Korean patients with extragenital Bowen's disease and squamous cell carcinoma, especially in digital cases. BIOMED RESEARCH INTERNATIONAL 2013; 2013:421205. [PMID: 24024191 PMCID: PMC3760177 DOI: 10.1155/2013/421205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 07/23/2013] [Indexed: 11/21/2022]
Abstract
Human papillomavirus (HPV) infection has been demonstrated in some of the nonmelanoma skin cancers as well as in precancerous lesions. Multiple infections of mucosal high-risk HPV may contribute to the onset of digital Bowen's disease through, if any, digital-genital transmission. We screened for the presence of the mucosal HPV DNA in patients with extragenital Bowen's disease (n = 30), squamous cell carcinoma (n = 11), bowenoid papulosis (n = 9), verrucous carcinoma (n = 1), actinic keratosis (n = 5), and basal cell carcinoma (n = 5). We used a PANArray HPV Genotyping Chip for high-risk and low-risk mucosal types. Genotyping data was confirmed using a conventional direct DNA sequencing method. Two cases of extragenital Bowen's disease were positive for types 16 and 33 of mucosal HPV, respectively. None of the squamous cell carcinoma cases were positive. Neither patients with digital Bowen's disease (n = 5) nor those with squamous cell carcinoma (n = 3) showed any mucosal high-risk HPV. Mucosal high-risk HPV DNA was confirmed in 5 (55.6%) of the 9 patients with bowenoid papulosis. HPV 16 was most prevalent (n = 3), while the DNA of HPVs 35 and 67 was detected in one sample for each of the two types. Our study demonstrated that two (6.7%) of the patients with 30 extragenital Bowen's disease were positive for types 16 and 33 of mucosal HPV, respectively. HPVs belonging to the mucosal high-risk group may participate in the development of extragenital Bowen's disease. However, we could not find any relationship between the mucosal high-risk HPV and Bowen's disease or squamous cell carcinoma in the fingers.
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Böer-Auer A, August C, Falk TM, Jung JE, Kohl K, Metze D. Benign mucinous metaplasia of the genital mucosa: histomorphological and immunohistochemical features and criteria for differentiation from extramammary Paget disease. Br J Dermatol 2011; 165:1263-72. [PMID: 21824128 DOI: 10.1111/j.1365-2133.2011.10567.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Benign mucinous metaplasia of the genitalia (BMM) is a rare condition typified by cells with foamy mucinous cytoplasm. Differential diagnoses include extramammary Paget disease (PD) and human papillomavirus (HPV)-induced vulval intraepithelial neoplasia (VIN) with mucinous differentiation. OBJECTIVES To characterize histopathological and immunohistochemical features of BMM and to forge criteria for differentiation from PD and VIN with mucinous differentiation. METHODS Eight biopsy specimens of BMM were stained with haematoxylin and eosin, periodic acid-Schiff and alcian blue, and for cytokeratin (CK) 7, CK10, CK14, CK20, carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), S100, gross cystic disease fluid protein-15 (GCDFP-15), lysozyme and Ki67 and compared with PD. Polymerase chain reaction was performed in order to identify HPV-specific DNA. RESULTS BMM showed mucin deposition in superficial epithelial layers ranging from numerous large goblet cells to subtle deposits. The epithelium often showed polygonal (squamoid) or cuboidal differentiation while columnar differentiation was an inconsistent feature. A band-like inflammatory infiltrate was consistently present. Metaplastic epithelium consistently expressed CK7, CEA and EMA either in the entire epithelium or in a superficial band, while CK14, CK10, GCDFP-15 and lysozyme were largely not expressed, and staining for CK20 and S100 was negative. Comparison with PD demonstrated similar staining characteristics, but in a scattered pattern of mucinous cells within preserved squamous epithelium and not in a band-like pattern as in BMM. Nuclear pleomorphism and Ki67-positive mucinous cells in superficial epithelial layers were seen only in PD; GCDFP-15 and/or lysozyme were expressed in the majority of cases of PD. No evidence of HPV-specific DNA was found in BMM. CONCLUSIONS The spectrum of changes in BMM is distinctive, and BMM can be differentiated with surety from both PD and VIN with mucinous differentiation.
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Affiliation(s)
- A Böer-Auer
- Department of Dermatopathology, Dermatologikum Hamburg, Drehbahn 1-3, 20354 Hamburg, Germany.
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