Basaloid squamous cell carcinoma of the larynx and hypopharynx

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 of the hypopharynx: an analysis of 213 cases

PURPOSE

Basaloid squamous cell carcinoma (BSCC) is a rare aggressive variant of squamous cell carcinoma (SCC) with a poor prognosis. No large series of exclusively hypopharyngeal BSCC patients have been previously reported. Therefore, this retrospective population-based study aims to explain the patient demographics, clinicopathologic characteristics, incidence, and survival outcomes of hypopharyngeal BSCC and how it relates to conventional-type SCC.

METHODS

The National Cancer Institute's Surveillance, Epidemiology, and End Results database registry was queried for patients diagnosed with hypopharyngeal BSCC and conventional-type SCC between 2001 and 2016.

RESULTS

The incidence of hypopharyngeal BSCC from 2001 to 2016 was 0.0161 per 100,000 individuals. The BSCC group comprised 213 patients, and the SCC group 7958 patients. The majority of BSCCs were considered high grade (Grade III/IV, 89.58%). Most BSCC patients were diagnosed at an advanced stage (American Joint Committee on Cancer [AJCC] stage IV, 65.38%). The 1-, 5-, and 10-year disease-specific survival (DSS) rates for hypopharyngeal BSCC were 84.10%, 57.40%, and 46.20%, respectively. Multivariate analysis, after adjustment for sex, age, race, tumor location, grade, and AJCC stage, showed that patients with BSCC had significantly better DSS than those with conventional-type SCC. Surgery with radiation contributed to a favorable DSS for BSCC patients in comparison with other treatments.

CONCLUSION

This analysis of the largest hypopharyngeal BSCC series indicates a better prognosis for this pathologic type compared with conventional-type hypopharyngeal SCC. Multimodality treatment with surgery and radiation may result in a favorable prognosis for hypopharyngeal BSCC patients.

Constitutive Hedgehog/GLI2 signaling drives extracutaneous basaloid squamous cell carcinoma development and bone remodeling

Uncontrolled activation of the Hedgehog (Hh) signaling pathway, operating through GLI transcription factors, plays a central role in the pathogenesis of cutaneous basal cell carcinoma and contributes to the development of several malignancies arising in extracutaneous sites. We now report that K5-tTA;tetO-Gli2 bitransgenic mice develop distinctive epithelial tumors within their jaws. These tumors consist of large masses of highly proliferative, monomorphous, basaloid cells with scattered foci of keratinization and central necrosis, mimicking human basaloid squamous cell carcinoma (BSCC), an aggressive upper aerodigestive tract tumor. Like human BSCC, these tumors express epidermal basal keratins, and differentiation-specific keratins within squamous foci. Mouse BSCCs express high levels of Gli2 and Hh target genes, including Gli1 and Ptch1, which we show are also upregulated in a subset of human BSCCs. Mouse BSCCs appear to arise from distinct epithelial sites, including the gingival junctional epithelium and epithelial rests of Malassez, a proposed stem cell compartment. Although Gli2 transgene expression is restricted to epithelial cells, we also detect striking alterations in bone adjacent to BSCCs, with activated osteoblasts, osteoclasts, and osteal macrophages, indicative of active bone remodeling. Gli2 transgene inactivation resulted in rapid BSCC regression and reversal of the bone remodeling phenotype. This first-reported mouse model of BSCC supports the concept that uncontrolled Hh signaling plays a central role in the pathogenesis of a subset of human BSCCs, points to Hh/GLI2 signaling as a potential therapeutic target, and provides a powerful new tool for probing the mechanistic underpinnings of tumor-associated bone remodeling.

Endoscopic features and associated histology of an basaloid squamous cell carcinoma of the esophagus at the very early stage

Background

Basaloid squamous cell carcinoma of the esophagus (BSCCE) is generally detected at advanced stage and the prognosis is poorer than advanced conventional esophageal squamous cell carcinoma. Therefore, early detection is a critical to improve patients’ survival. However, only a few cases of early BSCCE have been reported and the endoscopic features of early BSCCE are not well described. We herein report the endoscopic features and associated histology of an early BSCCE limited within the mucosal lamina propria (m2). To our knowledge, this is the earliest BSCCE reported to date.

Case presentation

A 62-year-old male patient was admitted to our hospital because of epigastric pain for 3 months. White light endoscopy revealed a flat lesion with mild sloping at the periphery. The lesion was covered with leukoplakia, and normal vascular network could not be seen in the lesion. Magnifying endoscopy with narrow-band imaging showed abnormal intra-papillary capillary loop categorized as type B1 according to the classification of the Japan Esophageal Society. Iodine staining revealed a less-stained lesion. The lesion was completely resected through endoscopic submucosal dissection. Histopathologically, tumor cells, which were limited within the mucosal lamina propria, formed solid nests and lobule structures, with ribbon-like arrangement of sparse cytoplasm and round to ovoid hyperchromatic nuclei. A final diagnosis of early BSCCE was established.

Conclusions

This is the earliest BSCCE reported to date. The prominent lesion with a gentle rising slope and less-staining or abnormal stain might be initial feature of early BSCCE.

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.

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.

Basaloid squamous cell carcinoma in the nasal cavity treated with proton beam therapy concurrent with cisplatin: a case report

INTRODUCTION

Basaloid squamous cell carcinoma is a rare and aggressive variant of squamous cell carcinoma. Basaloid squamous cell carcinoma is mostly seen in the upper aerodigestive tract and has a propensity for lymph node spread and systemic metastases. Various treatment modalities have been reported, including surgical excision supplemented with radiotherapy/adjuvant chemotherapy. To the best of our knowledge, treatment of nasal basaloid squamous cell carcinoma with proton beam therapy and cisplatin has not been described in the literature.

CASE PRESENTATION

We report the case of a 56-year-old Japanese man with locally invasive basaloid squamous cell carcinoma in his right nasal cavity with invasion of the orbit, paranasal sinus, and buccal subcutaneous tissue. He underwent proton beam therapy concurrent with cisplatin. Acute and late side effects did not exceed grade 3. At 24-month follow up, he remains in complete remission.

CONCLUSION

Proton beam therapy concurrent with cisplatin may be one choice for locally invasive basaloid squamous cell carcinoma.

Basaloid Squamous Cell Carcinoma of the Oropharynx

Objective

Basaloid squamous cell carcinoma (BSCC) is considered an aggressive squamous cell carcinoma (SCC) variant. However, we hypothesized that BSCC of the oropharynx may carry a similar prognosis to SCC. A series of exclusively oropharyngeal BSCC patients has not been previously reported. Our objective was to describe the clinical presentation and prognosis of BSCC in a large series of patients with BSCC of the oropharynx and to compare these with a series of patients with conventional-type oropharyngeal SCC.

Study Design

Retrospective analysis of population-based data.

Setting

Data reported by the Surveillance, Epidemiology, and End Results (SEER) program are based on medical records of patients who are treated at academic medical centers, community and county hospitals, and health maintenance organizations.

Subjects and Methods

Clinicopathologic data and disease-specific survival (DSS) were compared between 650 patients with oropharyngeal BSCC and 19,484 with SCC.

Results

High-grade tumors and nodal metastasis were more common in the BSCC group ( P < .02). On multivariable analysis controlling for disease stage, BSCC patients had improved DSS ( P < .001). More BSCC patients received multimodality treatment ( P < .001). Disease-specific survival was similar in BSCC and SCC patients who were treated with primary surgery; however, among patients who received radiotherapy, DSS was better for those with BSCC ( P < .04).

Conclusion

Analysis of the largest oropharyngeal BSCC series to date demonstrates that BSCC of the oropharynx carries a more favorable prognosis than conventional-type oropharyngeal SCC.

Basaloid squamous cell carcinoma of the nasal septum presenting as a primary cutaneous lesion

BACKGROUND

Basaloid squamous cell carcinoma is a rare aggressive variant of squamous cell carcinoma, with a predilection for the head and neck region. There are only two case reports in the literature documenting a nasal cavity squamous cell carcinoma presenting as a primary cutaneous lesion.

OBJECTIVE

We report a rare case of nasal cavity basaloid squamous cell carcinoma presenting initially as a nasal bridge mass. Two initial biopsies revealed features consistent with basal cell carcinoma and basosquamous cell carcinoma, respectively.

RESULT

Final surgical pathology showed extensive invasive squamous cell carcinoma with basaloid differentiation arising from the nasal septal mucosa with extension to the overlying skin. The clinicopathologic features were interpreted as basaloid squamous cell carcinoma.

CONCLUSION

We discuss the difficulties in pathologic diagnosis of this condition given its varied phenotypical expression. As well, this case emphasizes the necessity for diagnostic vigilance when assessing a primary cutaneous lesion as it may be a rare presentation of an underlying malignancy extending to the skin.

Basaloid squamous cell carcinoma of the head and neck: report of 18 cases

Objective:

To evaluate the clinical course and pathological characteristics of basaloid head and neck squamous cell carcinoma.

Method:

Retrospective study of 18 cases of basaloid head and neck squamous cell carcinoma. Epidemiological, clinical and histological data were analysed and the Kaplan–Meier test used to estimate survival rates.

Results:

The majority of lesions were at an advanced stage. These lesions were primarily localised in the larynx, hypopharynx and oropharynx. Routine pre-therapeutic assessment of squamous cell carcinoma was performed. Pathological diagnosis was difficult, although immunostaining was extremely useful. Positive staining for KL1, MNF 116 and 34βE12 and negative immunostaining for chromogranin and synaptophysin were also important factors in obtaining a definitive diagnosis. In the majority of cases, treatment involved surgery and radiotherapy. The five-year survival rate was 5 per cent.

Conclusion:

Basaloid squamous cell carcinoma is an uncommon head and neck lesion, with a challenging histological diagnosis. These lesions must be carefully monitored due to their aggressive course, and require multimodality treatment.

Cytology of head and neck squamous cell carcinoma variants

The most common diagnosis rendered with head and neck fine needle aspiration (FNA) biopsy is metastatic squamous cell carcinoma (SCC). While most cases of metastatic SCC pose little diagnostic difficulty, the diagnosis of metastatic histologic variants of SCC, often coupled with less common etiologies, can be more problematic. This manuscript reviews the clinicopathologic features of the histologic variants of upper aerodigestive tract SCC (verrucous, papillary, spindle cell, undifferentiated, acantholytic, and basaloid) and uncommon etiologies of head and neck SCC (human papillomavirus, Epstein-Barr Virus, and NUT midline carcinomas). Particular attention is paid to the cytologic features of these lesions. Differential diagnoses and the use of ancillary testing are discussed.

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.

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.

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.

Course and prognosis of basaloid squamous cell carcinoma of the head and neck: a case-control study of 62 patients

OBJECTIVE

To describe the natural history and evaluate the prognosis of basaloid squamous cell carcinoma (BSCC) of the upper aero-digestive tract as compared to the usual squamous cell carcinoma (SCC).

MATERIALS AND METHODS

Sixty-two patients with BSCC and 62 patients with SCC were matched with regards to TNM classification, localisation and therapeutic modalities. Histological criteria, follow-up and 5-year survival were compared among the two groups.

RESULTS

Survival rates were significantly higher in patients with SCC as compared to patients with BSCC. The rate of distant metastasis was six times higher in cases of BSCC, which was the major cause of mortality.

CONCLUSION

This study reveals that BSCC has distinct histo-pathologic features and an aggressive clinical course, justifying its consideration as a separate entity with poor prognosis. The authors propose to systematically perform a chest CT-scan and FDG-PET to rule out early distant metastasis and to include adjuvant chemotherapy in treatment protocols.

Is there an epidemiological link between human papillomavirus DNA and basaloid squamous cell carcinoma of the pharynx?

The epidemiological link between human papillomavirus (HPV) DNA and basaloid squamous cell carcinoma (BSCC) of the pharynx was studied. The expression of p53 protein was evaluated by immunohistochemical analysis. The presence of HPV DNA was evaluated by polymerase chain reaction amplification and "in situ" hybridization. The tobacco and alcohol consumption and the clinical outcomes of nine patients with BSCC of the pharynx are compared with site and stage matched 109 conventional squamous cell carcinoma (SCC) patients. The BSCC specimens were analyzed for the presence of HPV DNA and p53 expression. We did not find any significant differences in tobacco and alcohol consumption between patients with BSCC and patients with SCC. No HPV DNA was detected in BSCC, and p53 overexpression was found in five (55%) of the cases. Our results do not support an etiological link between HPV DNA and BSCC.

Basaloid squamous cell carcinoma of the maxillary sinus: a report of two cases

Basaloid squamous cell carcinoma (BSCC) is a highly aggressive neoplasm and a histologically distinctive variant of squamous cell carcinoma. Since the first description by Wain et al. in 1986, only 18 cases with BSCC in the nasal cavity or in the paranasal cavity have been reported in the English literature. We report herein two cases of BSCC of the maxillary sinus. Case 1 was 78-year-old man, who received preoperative radiotherapy and operation. He was alive without disease for 25 months after the operation. Case 2 was a 60-year-old man who received radiotherapy without operation. He died of lung metastasis 6 months after the initial diagnosis. We reviewed the clinical features of BSCC from the literature.

Basaloid squamous carcinoma of the larynx. A potential diagnostic pitfall

Basaloid squamous carcinoma is a rare variant of squamous cell carcinoma. It is frequently diagnosed at an advanced stage with metastases. Histologically, it is identical to basaloid carcinoma at other anatomical sites. Some authors suggest that it may be associated with second primary tumors. Others implicate the Epstein-Barr and human papilloma viruses. All reports but one warn of its aggressive biological behavior. Our case concerns a 52-year-old man who had a small lesion in his right cord. Biopsy of the lesion was performed twice, and conventional squamous cell carcinoma was diagnosed; the patient returned 2 months later with progressed metastatic disease. The patient underwent a laryngectomy and a complete clinical and immunohistochemical investigation. Basaloid squamous carcinoma is a totipotential neoplasm with a grave prognosis. It can be misdiagnosed; therefore, the authors would like to emphasize the significance of this condition in comparison to conventional squamous cell carcinoma, and we provide a review of the relevant recent literature.

Prognostic value of p27Kip1 expression in Basaloid Squamous Cell Carcinoma of the larynx

Background

Very few reports have investigated the role of cell cycle regulators as biomarkers in Basaloid Squamous Cell Carcinoma (BSCC) of the larynx, a definite morphologic, uncommon, very aggressive variant of squamous cell carcinoma. Lower expression of Ki67/Mib-1, a proliferation marker highly expressed in the majority of tumours, and p53, a tumour suppressor protein that can induce an arrest of the G1-S transition, was related to a better prognosis in laryngeal BSCC. In the head and neck, p27^kip1, a member of the Cip1/Kip1 family of cyclin-dependent kinase inhibitors, has emerged as an independent prognostic factor, able to identify low-expressing tumours with unfavourable course. Up to date the role of this protein was never studied in BSCC. Aim of our study was to investigate the potential prognostic value of p27^kip1 levels and their correlation with Ki67/Mib-1 and p53 expression in BSCC of the larynx.

Methods

The retrospective study group consisted of 15 male and 1 female patients, affected by laryngeal BSCC, ranging in age from 44 to 69 years (mean 58). The tumour originated from the supraglottis in thirtheen cases and from the glottis in the remaining three. Ten patients had metastatic cervical lymph nodes at presentation and were classified as N+. Post surgical stage was IV in four patients, III in nine, II in two cases and I in the remaining one. Follow-up ranged from a minimum of 5 months up to 9 years. Paraffin-embedded tissue sections of each laryngeal tumour were analyzed for p27^kip, Ki67/Mib-1 and p53 expression by immunohistochemistry.

Results

The immunohistochemical study showed p27^kip1 expression in 40% of the patients with no evidence of disease (NED) and in none (0%) of the patients dead of disease (DOD), whilst p53 was expressed in 60% of patients in NED status and in 90% of patients in DOD status. Ki67/Mib-1 was positive in 80% of NED patients and in 100% of DOD patients. At multivariate analysis, performed by means of Discriminant analysis, low levels of p27^kip1 expression significantly correlated with poor prognosis (P < 0.05).

Conclusion

p27^kip1 protein has been shown to be a significant independent prognostic factor in laryngeal SCC. In our series of laryngeal BSCC the resulting data seem to confirm the clinical prognostic relevance of p27^kip1 low expression, which directly correlated with biological aggressiveness and consequent shortened survival.

Basaloid squamous cell carcinoma of the larynx

Basaloid squamous cell carcinoma (BSCC) is a rare tumor with distinct morphological and biological features that differentiate it from the common form of squamous cell carcinoma (SCC) in the head and neck region. It is mostly seen in the supraglottic larynx, hypopharynx and a base of the tongue. We present two cases of BSCC of the larynx; both being transglottic tumors. Both of the patients underwent primary surgery including bilateral neck dissections. None of the patients had cervical metastases at histopathological examination. Both patients received radiotherapy after surgery. They were alive and free of disease at 24 and 27 months, respectively.

High nuclear expression of the apoptosis inhibitor protein survivin is associated with disease recurrence and poor prognosis in laryngeal basaloid squamous cell carcinoma

CONCLUSION

Nuclear expression of survivin should be studied as a promising marker of higher-risk laryngeal basaloid squamous cell carcinomas (BSCCs), which can then be treated more aggressively and followed more closely.

OBJECTIVE

BSCC is an uncommon bimorphic variant of SCC. The hypothesized greater aggressiveness and poorer prognosis of head and neck BSCC compared to SCC are still under debate. The regulation of apoptotic cell death has a profound effect on the pathogenesis and progression of malignancies. Survivin is the smallest member of the inhibitor of apoptosis gene family. The aim of this study was to investigate for the first time the expression of the inhibitor of apoptosis protein survivin in laryngeal BSCCs and their neck lymph node metastases and to compare the results with those obtained with conventional SCCs.

MATERIAL AND METHODS

Immunoreactivity to survivin was determined in nine laryngeal BSCCs and nine site- and stage-matched SCCs.

RESULTS

A nuclear subcellular localization of survivin dominated in both primary laryngeal BSCCs and SCCs and in their lymph node metastases. There was no significant difference in mean survivin expression between primary laryngeal BSCCs (25.1%) and SCCs (25.6%) (p=0.86). Nuclear survivin expression was significantly higher in BSCCs associated with disease recurrence and poor prognosis (p=0.02).

Basaloid squamous carcinoma of the hypopharynx with an extensive spindle cell component exhibiting a pedunculated polypoid mass

We report a case of basaloid squamous carcinoma of the hypopharynx with an extensive spindle cell component in an 82-year-old man. The tumor (4.0 x 2.5 x 2.2 cm) was a pedunculated polypoid mass that was attached to the left pyriform sinus. Histologically, most (70%) of the tumor was composed of malignant spindle cell proliferation, and the rest (30%) was basaloid squamous carcinoma. Some of the spindle cells were positive for cytokeratins. The preoperative histologic diagnosis was difficult because the endoscopic biopsy specimens showed only spindle cell proliferation. This is an unusual presentation of basaloid squamous carcinoma of the head and neck.

Evolution et pronostic du carcinome basaloïde squameux des voies aéro-digestives supérieures

INTRODUCTION

The course and prognosis of basaloid squamous cell carcinoma (BSCC) are not well known.

OBJECTIVES

To study the course and prognosis in a population of BSCC patients.

MATERIALS AND METHODS

We analyzed a retrospective cohort of 49 patients with BSCC in comparison with a cross-matched population of 49 patients treated for well- to moderately differentiated squamous cell carcinoma (SCC).

RESULTS

The statistical analysis showed that survival in BSCC group was lower than in the SCC group. Local recurrence in the BSCC group was not higher than in the SCC group, but mortality by distant metastasis was six times higher than in the SCC population.

CONCLUSIONS

We consider BSCC patients as a high-risk population and we complete diagnosis explorations including a FDG-PET before curative treatment. We also recommend post-operative or exclusive radiotherapy which may be associated with concomitant chemotherapy.

Immunoexpression of p53, Ki-67 and E-cadherin in basaloid squamous cell carcinoma of the larynx

INTRODUCTION

Basaloid is a rare and poorly-differentiated variant of squamous cell carcinoma of the larynx, with an invasive solid growth of cells in a lobular configuration. Different molecular markers, such as p53, Ki-67 and E-cadherin, have been shown to be prognostic factors in head and neck cancer.

OBJECTIVE

To evaluate the relationship between the immunoexpression of p53, Ki-67 and E-cadherin in relation to prognosis in basaloid squamous cell carcinoma of the larynx (BSCCL).

PATIENTS AND METHODS

We retrospectively studied 11 cases of BSCCL, all male with a mean age of 62.4 years. Immunohistochemical analyses were performed on paraffin-embedded tissues using p53 (DO- 7), Ki-67 (MIB-1) and E-cadherin (36B5) antibodies. Quantitative assessments of the expression and descriptive statistical analyses were performed.

RESULTS

In 72.7% of the cases, clinically advanced stages III-IV were diagnosed. Average survival time was 56.09 months, and 72.7% of patients died as a consequence of the tumour. Immunoreactivity of p53 (>10% of cells) was detected in the 81.8% of the cases. The 72.7% of the cases showed overexpression of Ki-67 (>50% of cells). The cases with low immunoexpression of Ki-67 and p53 had the best clinicopathological data. All cases showed a decreased expression of E-cadherin.

CONCLUSIONS

BSCCL is an aggressive variant of the squamous cell carcinoma and has a high expression of p53 and Ki-67 with a low expression of Ecadherin. These results could be related to the aggressiveness of the disease and its poor prognosis.

Basaloid Squamous Cell Carcinoma of the Larynx: A Report of Four New Cases

OBJECTIVES

This study is designed to report the clinical and pathologic features and outcome of cases of basaloid squamous cell carcinoma (BSCC) of the larynx treated in our clinic.

STUDY DESIGN

A retrospective review of the medical records of these patients.

METHODS

Four cases of BSCC of the larynx were treated in our department. Histopathologic slides were reevaluated to confirm the diagnosis. Immunohistochemical studies were performed, and file records were reviewed. Follow-up was available for all patients and ranged between 11 and 72 (mean 37) months.

RESULTS

All patients were male (mean 57), with supraglottic or transglottic larynx tumors. Two patients presented with stage-II disease and the other 2 with stage-IV disease. Initial diagnosis was invasive squamous cell carcinoma in 3 patients and BSCC in one patient. Two patients who had stage-II disease underwent partial laryngectomy and bilateral neck dissections; total laryngectomy and bilateral neck dissections were performed in stage-IV patients. Three patients received adjuvant postoperative radiotherapy, and 2 of them also received additional chemotherapy. Patients with stage-IV disease were found to have 4 and 27 metastatic lymph nodes on histopathologic examination and died because of distant metastases at 11 and 14 months, respectively. Patients with stage-II disease did not have cervical metastasis on histopathologic examination and were alive and free of disease at 52 and 72 months respectively.

CONCLUSION

In contrast with the literature reporting the tendency of more aggressive clinical behavior of the BSCC, we can say that BSCC has a behavior similar to conventional squamous cell carcinoma based on our 4 cases.

Basaloid squamous cell carcinoma of the head and neck

PURPOSE OF REVIEW

Basaloid squamous cell carcinoma is an uncommon variant of squamous cell carcinoma and was first described as a distinct entity in 1986. Basaloid squamous cell carcinoma seems to have a poorer survival rate than classical squamous cell carcinoma. On the basis of a critical literature survey, we attempt to evaluate if basaloid squamous cell carcinoma is really more aggressive and presents a poorer outcome than squamous cell carcinoma.

RECENT FINDINGS

All papers are retrospective, and most include small numbers of cases, which are further diminished when subdivided according to specific sites. Only in three studies was basaloid squamous cell carcinoma of the head and neck region compared with matched squamous cell carcinoma controls. These studies did not show a uniform tendency regarding the aggressiveness and outcome of basaloid squamous cell carcinoma. In addition, several recent papers confirmed the presumed greater aggressiveness and worse outcome, and other recent papers questioned these characteristics.

SUMMARY

The presented literature survey does not permit conclusions regarding the aggressiveness and outcome of basaloid squamous cell carcinoma compared with squamous cell carcinoma. Greater numbers of basaloid squamous cell carcinoma should be studied and compared with site-matched, stage-matched, and age-matched controls of conventional squamous cell carcinoma.

[Therapeutic and histological features of basaloid squamous cell carcinoma]

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 carcinoma of the larynx

BACKGROUND

Basaloid squamous cell carcinoma (BSCC) is a distinct variant of squamous cell carcinoma that was first described by Wain et al in 1986. Since then, about 160 cases have been reported in the literature. Only 40 cases have been described in the larynx.

METHODS

Four cases of BSCC of the larynx treated in our department between 1986 and 2000 are presented. The clinical features, biological behavior, and histopathological and immunohistochemical characteristics of this uncommon tumor are described, and the relevant literature is reviewed.

RESULTS

The main clinical presentation did not differ from other histological types of laryngeal carcinoma. The clinical course, however, was much more aggressive. All the patients received aggressive therapy including radical surgery and radiation. Two patients received chemotherapy. Two of the 4 patients presented died of distant metastasis shortly after diagnosis and treatment.

CONCLUSIONS

The finding of this study with a limited number of patients supports previous reports suggesting that BSCC is a highly aggressive tumor that presents in older population with male predominance. The frequency of associated regional as well as distant metastases suggests that aggressive treatment is indicated and that systemic chemotherapy should be contemplated.

Basaloid Squamous Cell Carcinoma of the Larynx: Report of a Case

Basaloid squamous cell carcinoma is a variant of squamous cell carcinoma. This malignancy has a predilection for the upper aerodigestive tract, although it has been found in multiple other sites. The tumor is highly aggressive biologically, and the overall prognosis is poor despite intensive treatment. We describe a case of basaloid squamous cell carcinoma of the larynx that metastasized to the spine.

Basaloid squamous cell carcinoma of the oral mucosa: a new case and review of 45 cases in the literature

Basaloid squamous cell carcinoma (BSCC) of the oral mucosa other than the tongue is uncommon. We report a case of a 67-year-old man who diagnosed with Stage I BSCC in the floor of the mouth. This early stage presentation carries a considerably better prognosis. Clinical summary of 46 cases of oral BSCC indicated that the tongue base was the most preferred site (61%). The patients were 19 males and 15 females with the mean age of 61 years (n=34). Most presented with Stage III or IV disease (62%). Even at the initial presentation, 47% had cervical lymph node metastases. Its aggressive clinical behaviour was characterized by a high incidence of local recurrence (32%), regional lymph node metastases (52%), and mortality rate (38%). Because of the advanced stage at presentation, oral BSCC is prognostically worse.

Basaloid squamous cell carcinoma of the head and neck

OBJECTIVE/HYPOTHESIS

Basaloid squamous cell carcinoma (BSCC), an uncommon tumor with predilection for the upper aerodigestive tract, is a distinct variant of squamous carcinoma, because of its unique histological features and ominous clinical behavior. This study reviews the experience in treating BSCC from two institutions.

STUDY DESIGN

Retrospective.

METHODS

H&E-stained sections from 20 patients with BSCC of the head and neck were reviewed and clinical follow-up was obtained for all patients.

RESULTS

The study group consisted of 14 male and 6 female patients. Their ages ranged from 43 to 85 years, with a mean age of 62 years. Sites of origin included the larynx (4), tongue (3), pyriform sinus (3), nose (2), floor of mouth (2), mastoid (1), tonsil (1), epiglottis (1), nasopharynx (1), trachea (1), and palate (1). Pain was the most common presenting symptom (5 cases), followed by hoarseness and bleeding (3 cases each). Tobacco and alcohol abuse was noted in 17 patients. Treatment modalities included surgery with or without chemotherapy or radiotherapy in 13 patients, chemotherapy with irradiation in 2, chemotherapy alone in 2, and radiotherapy alone in 3. Clinical follow-up revealed no evidence of disease in 11 patients. Four were alive with disease at the time of writing and five died of disease.

CONCLUSION

BSCC is a highly aggressive malignant tumor that presents in elderly patients who have a history of abuse of tobacco or alcohol, or both. Greater number of patients must be studied and compared with age-matched and stage-matched controls of conventional squamous cell carcinoma to determine whether the poor clinical outcome is related more to high-stage presentation or to the tumor's high-grade malignant cytological features.

Basaloid squamous cell carcinoma occurring in the urinary bladder

Basaloid squamous cell carcinoma is a recently described, distinct variant of squamous cell carcinoma that arises predominantly in the upper aerodigestive tract. Herein we report a case of basaloid squamous cell carcinoma arising in the urinary bladder. The patient was a 60-year-old woman who experienced intractable urinary tract infections following multiple corrective surgical procedures for incontinence. Biopsies of cystoscopically evident flat lesions were performed, and the patient subsequently underwent a radical cystectomy. Histologically, the lesions consisted of nests of basaloid cells with brisk mitotic activity, areas of squamous differentiation along with areas of squamous metaplasia, and squamous cell carcinoma in situ. These features are similar to those of basaloid squamous cell carcinoma described elsewhere in the body. To our knowledge, this is the first reported case of basaloid squamous cell carcinoma in the urinary bladder.

Management of the clinically negative cervical lymph nodes in patients with non-conventional squamous carcinoma of the larynx

This paper discusses the indications for neck dissection in those patients with laryngeal tumours which prove to be, on pathologic examination, not conventional squamous carcinomas but rather fall into the category either of one of the uncommon histological subtypes of carcinoma, or another type of unusual histological variant of laryngeal malignancy, a mesenchymal tumour. It appears as though these unusual laryngeal malignancies may manifest both biological behaviours and propensities to metastasize to regional lymph nodes that differ from those of the more commonly encountered conventional squamous carcinomas of the larynx. This heterogeneous group of tumours accounts for about 10 per cent of all malignant tumours of the larynx.

Impact of phenotype on treatment and prognosis of laryngeal malignancies

An overview of the impact of the phenotype on treatment and prognosis of different laryngeal malignancies is presented.