Metaplastic breast carcinoma histologically mimicking cutaneous spindle cell squamous cell carcinoma

Squamous cell carcinoma is one of the most common primary cutaneous carcinomas but on rare occasion, metastatic squamous cell carcinoma from a distant site or solid organ can present as a cutaneous lesion. Most metastases occur as dermal nodules or involve the dermal lymphatics, but when they are intimately associated with the epidermis, distinguishing the lesion as primary or metastatic may be extremely difficult and usually requires a clinical history or high index of suspicion. A 71-year-old woman presented with multiple eruptive nodules over her chest, flank, and back. Histologically the lesions appeared to be arising from the surface epithelium and consisted of atypical, predominantly spindle cells, some of which streamed off of the epidermis. Following the initial evaluation, a history of breast carcinoma with subsequent radiation therapy and ultimate mastectomy was obtained, and the original breast biopsy and mastectomy material was reviewed. After performing additional studies, it became clear that the origin of the carcinomas was metastatic from an underlying metaplastic breast carcinoma.     

Systemic treatment of locally advanced nonmetastatic cutaneous squamous cell carcinoma: a review of the literature

Summary Background There is a small subset of locally advanced nonmetastatic cutaneous squamous cell carcinoma (cSCC) for which local therapy is not curative or feasible, making systemic therapy a possible treatment option. Objectives To calculate overall response rates (ORR), median time to response (TTR) and median duration of response (DOR) of locally advanced nonmetastatic cSCC to systemic therapy [targeted agents, biological response modifiers (BRM) and chemotherapy]. Patients and methods Medline and PubMed were searched for reports of nonmetastatic locally advanced cSCC treated with systemic therapy from 1970 to 2011. No limits were placed on study design. ORR, TTR and DOR were calculated for systemic therapy overall and for each treatment category. Results Twenty‐eight observational studies yielded 119 patients for analysis. The ORR for systemic therapy was 72% (TTR 9 weeks, DOR 42 weeks). Targeted therapy and BRM achieved ORR of 100% (TTR 12 weeks, DOR 20 weeks) and 86% (TTR 10 weeks, DOR 20 weeks), respectively, and oral chemotherapy, intravenous chemotherapy and intra‐arterial chemotherapy achieved ORR of 20% (TTR 10 weeks, DOR 24 weeks), 68% (TTR 3 weeks, DOR 44 weeks) and 100% (TTR 15 weeks, DOR 112 weeks), respectively. A limitation of this study was that no controlled data were identified and sample sizes were small. Conclusions Systemic treatment leads to objective responses in locally advanced cutaneous SCC that are not amenable to local cure.     

Primary cutaneous adenosquamous carcinoma: a case report and review of the literature

BACKGROUND: Adenosquamous carcinoma (ASC) of skin is a rare but distinctive neoplasm that usually exhibits an aggressive course. To date, 13 well-documented and undisputed cases of primary cutaneous ASC have been reported. This term has been used for tumors with better prognosis, such as mucoepidermoid carcinomas and acantolytic squamous cell carcinomas, originating confusion. We report a primary cutaneous ASC and review the literature. METHODS: In this report a woman with primary ASC of the skin was studied. Histopathological examination and immunohistochemical stains were performed. RESULTS: The tumor had two components: conventional squamous cell carcinoma merging with adenocarcinoma. After a local recurrence and lymph node metastases, the patient has no evidence of disease 8 months later. CONCLUSIONS: Pathologists should reserve the term ASC for tumors exhibiting the above mentioned appearance. In such circumstances, a metastatic origin must always be excluded.     

p63 is a useful marker for cutaneous spindle cell squamous cell carcinoma

BACKGROUND: Cutaneous spindle cell squamous cell carcinoma (SCSCC) is a rare variant of SCC. This lesion is sometimes difficult to diagnose based purely on morphologic features. p63 is a member of the p53 gene family that can be identified in epithelial malignancies. METHODS: Thirteen cases of spindle SCC were stained with p63, CK34betaE12, MNF116, vimentin, and S100. Control cases included desmoplastic melanoma (eight cases), atypical fibroxanthoma (AFX) (10 cases), dermatofibrosarcoma protuberans (eight cases), and cutaneous leiomyosarcoma (LMS) (four cases). RESULTS: p63 was expressed diffusely in the nuclei of 100% (13/13) of SCSCCs. Of controls, p63 showed focal labeling of two LMS and two AFX. MNF116 and CK34betaE12 were positive in 13/13 SCSCCs. Of controls, one LMS was focally positive for MNF116. All SCSCCs and all control cases were positive for vimentin. CONCLUSIONS: In the given differential diagnosis, p63 appears relatively specific to SCSCC and adds a useful nuclear marker to the available repertoire. The findings also suggest that cytokeratins MNF116 and CK34betaE12 may be more useful than standard cytokeratins in labeling SCSCC.     

Primary cutaneous adenoid cystic carcinoma: a case report and literature review

Primary cutaneous adenoid cystic carcinoma (ACC) is a rare tumor, with less than 50 cases reported to date. We report an additional case of primary cutaneous ACC arising on the scalp of a 57-year-old woman. The clinical presentation, histologic findings, and subsequent treatment are described. A brief review of the literature is provided.     

Primary cutaneous adenoid cystic carcinoma: a case report and review of the literature

Primary cutaneous adenoid cystic carcinoma is a rare cancer, with only 61 cases reported in the literature. We report an additional case and review the latest recommendations for workup and treatment.     

Desmoplastic squamous cell carcinoma: case presentation and literature review

BACKGROUND: Desmoplastic squamous cell carcinoma (DSCC) is a variant of squamous cell carcinoma (SCC) with aggressive histologic and clinical features. DSCC has a 6 to 10 times higher rate of both local recurrence and metastatic spread compared with well-differentiated SCC. Clinical estimation of tumor margins can grossly underestimate both the depth and the peripheral extent of the tumor. Surgery with intraoperative margin control has been recommended. In many cases, postoperative radiotherapy or prophylactic lymph node dissection may be required. CASE PRESENTATION: A 71-year-old man with a biopsy positive for DSCC involving the left postauricular area was treated with nine-stage Mohs micrographic surgery before the tumor margins were negative. CONCLUSION: There are minimal reports in the literature pertaining to the presentation and treatment of DSCC; therefore, definitive conclusions are difficult. The depth of tumor penetration and peripheral spread of the DSCC presented in this case, however, supports the need for aggressive surgical excision, preferably with intraoperative margin control. To maximize the chance of cure, physicians must be aware of the distinct clinical and histologic features of DSCC and the aggressive treatment required.     

Merkel细胞癌合并原位鳞状细胞癌一例并文献复习

Merkel细胞癌是一种罕见的、具有高度侵袭性的皮肤神经内分泌癌,好发于老年人的日光暴露部位,尤其是头颈部(41%～50%),其次是四肢(32%～38%)。Merkel细胞癌可与鳞状细胞癌、鲍温病、基底细胞癌等皮肤肿瘤合并发生。我们报道一例发生在非光暴露部位的Merkel细胞癌合并原位鳞状细胞癌,并对相关文献进行复习。     

Cutaneous squamous cell carcinoma: a comprehensive clinicopathologic classification--part two

Cutaneous squamous cell carcinoma (SCC) includes many subtypes with widely varying clinical behaviors, ranging from indolent to aggressive tumors with significant metastatic potential. However, the tendency for pathologists and clinicians alike is to refer to all squamoid neoplasms as generic SCC. No definitive, comprehensive clinicopathological system dividing cutaneous SCCs into categories based upon their aggressiveness has yet been promulgated. Therefore, we have proposed the following based upon the malignant potential of SCC variants, separating them into categories of low (< or = 2% metastatic rate), intermediate (3-10%), high (greater than 10%), and indeterminate behavior. Low-risk SCCs include SCC arising in actinic keratosis, HPV-associated SCC, tricholemmal carcinoma, and spindle cell SCC (unassociated with radiation). Intermediate-risk SCCs include adenoid (acantholytic) SCC, intraepidermal epithelioma with invasion, and lymphoepithelioma-like carcinoma of the skin. High-risk subtypes include de novo SCC, SCC arising in association with predisposing factors (radiation, burn scars, and immunosuppression), invasive Bowen's disease, adenosquamous carcinoma, and malignant proliferating pilar tumors. The indeterminate category includes signet ring cell SCC, follicular SCC, papillary SCC, SCC arising in adnexal cysts, squamoid eccrine ductal carcinoma, and clear-cell SCC. Subclassification of SCC into these risk-based categories, along with enumeration of other factors including tumor size, differentiation, depth of invasion, and perineural invasion will provide prognostically relevant information and facilitate the most optimal treatment for patients.     

Local surgical treatment of cutaneous squamous cell carcinoma: deficits and controversies in the literature

The prognostic impact of primary excision in the treatment of cutaneous squamous cell carcinoma depends on certain tumor characteristics (risk factors), the surgical approach chosen and the subsequent histological examination. For the development of the AWMF (Association of Scientific Medical Societies in Germany) guidelines for squamous cell carcinoma, the most conclusive guidelines available were evaluated using the DELBI tool (German Instrument for the Methodological Appraisal of Guidelines). These were the Scottish and Canadian guidelines as well as the joint guidelines published by EDF, EADO and EORTC. The primary literature on the aforementioned topics that was used for these guidelines included 49 studies and 9 reviews. None of the studies had a prospective, randomized design; 19 studies contained prospective data; 30 studies provided retrospective data. Overall, the results were heterogeneous. Not only were there discrepancies in terms of the validity of the various risk factors for locoregional disease progression – such as dedifferentiation, desmoplasia and perineural invasion – but also with respect to tumor thickness and surgical consequences. Differences were also found regarding the histological processing method used. In general, there are two such methods: conventional histology (bread loaf technique) and complete histological assessment of excision margins. The latter was found to be associated both with low recurrence rates and low metastatic rates, possibly due to the fact that patients treated with the latter method had lower‐risk tumors. Publications on bread loaf histology lacked precise information as to how the tissue was actually processed. Likewise, there was a lack of usable data in terms of the surgical margins used in the primary excision. Conclusion : The current literature is inconsistent and insufficient with regard to the various prognostic factors and the surgical approach to cutaneous squamous cell carcinoma.     

Prognostic variables in high‐risk cutaneous squamous cell carcinoma: a review

Cutaneous squamous cell carcinoma (SCC) is a growing public health problem in the United States. A subset of high‐risk SCC exhibits a more aggressive clinical trajectory including increased local recurrence and lymph node metastasis. However, there are no universally accepted criteria to help define and manage these patients. This review provides an overview of the high‐risk features of cutaneous SCC, prognostic stratification of various staging systems and treatment options. It further examines the prognostic factors influencing the staging of cutaneous head and neck SCC.     

Acitretin suppression of squamous cell carcinoma: case report and literature review

Retinoids have been used for the treatment and suppression of cutaneous malignancies in patients with basal cell nevus syndrome, xeroderma pigmentosum, and in patients with recurrent skin cancers as a result of immunosuppression for renal transplantation. We report a 40-year-old male who began to develop multiple squamous cell carcinomas of the skin after treatment with PUVA for severe psoriasis. The numbers of squamous cell carcinomas increased when acitretin was discontinued and decreased when he was taking the drug at a dose of 25 mg daily. Acitretin should be considered as a maintenance therapy for psoriasis patients developing squamous cell carcinomas as a result of PUVA therapy.     

The utility of cytokeratin 5/6 in the recognition of cutaneous spindle cell squamous cell carcinoma

BACKGROUND: Cutaneous spindle cell squamous cell carcinoma (SSCC) is a challenging diagnosis since it may be difficult to distinguish from spindle cell melanoma, leiomyosarcoma and atypical fibroxanthoma. Furthermore, it may be difficult to demonstrate epithelial differentiation by a traditional immunohistochemical panel. We performed an expanded immunohistochemical evaluation of ultrastructurally documented SSCC to assess its utility in diagnosing this entity. METHODS: We identified 16 cases of SSCC that were composed predominantly of spindle-shaped cells and with ultrastructural evidence of epithelial differentiation (i.e. at least rudimentary cell junctions). Immunohistochemical analysis using antibodies to a variety of cytokeratins (AE1/3, K903, CK5/6) and S-100 protein was performed. The extent of immunostaining was graded on a scale of 0 to 4+ (0: no staining; 1+: < or =25%; 2+: 26-50%; 3+: 51-75%; 4+: >75%). RESULTS: Of the 16 cases, 6 expressed AE1/3 (38%), 8 expressed K903 (50%) and 11 (69%) expressed CK5/6. Six cases were positive for all three CK markers and two cases were positive for both K903 and CK5/6 but negative for AE1/3. Three cases (19%) stained for CK5/6 without any staining for AE1/3 or K903. Five cases (31%) were negative for all epithelial markers. The extent of CK5/6 staining was either similar to or greater than K903 staining in 7 of 8 cases that stained with both markers. All 16 cases were negative for S-100 protein. CONCLUSIONS: Including CK5/6 in the initial battery of immunostains performed on a cutaneous spindle cell neoplasm can help demonstrate epithelial differentiation in SSCC, even in the absence of AE1/3 or K903 staining. However, some cases of cutaneous SSCC can only be confirmed ultrastructurally, as up to one-third may not show evidence of epithelial differentiation using an expanded immunohistochemical panel.     

Immunohistochemical distinction of cutaneous spindle cell carcinoma

Cutaneous spindle cell squamous carcinoma is an uncommon variant of squamous cell carcinoma in which keratinocytes infiltrate the dermis as single cells with elongated nuclei rather than as cohesive nests or islands, and signs of keratinization of conventional squamous cell carcinoma are insubstantial or nonexistent. Spindle cell carcinoma must be distinguished from spindle cell/desmoplastic melanoma, cutaneous leiomyosarcoma, atypical fibroxanthoma (AFX), and scar. In instances when there is no definitive evidence of squamous differentiation, immunohistochemical studies may confer diagnostic discrimination. Twenty-four cases consisting of 12 spindle cell squamous cell carcinomas, 3 AFXs, 3 leiomyosarcomas, 3 desmoplastic melanomas, and 3 scars were evaluated with a battery of immunohistochemical stains, with the specificity and sensitivity of each marker calculated. The immunohistochemical battery consisted of S-100, desmin, CD68, and smooth muscle actin and cytokeratins P KER (keratins predominantly of molecular weight 56 and 69 kd) and low-molecular weight keratin (CAM 5.2), AE1/AE3, p63, and 34 beta E12 (CK903). Spindle cell squamous carcinomas were negative for S-100, CD68, smooth muscle actin, and desmin with the exception of 2 cases with weak staining for smooth muscle actin. 34 beta E12 provided positive results for each spindle cell squamous carcinoma. The other cytokeratin stains were less sensitive for spindle cell squamous carcinoma than 34 beta E12. The final immunohistochemical results were as follows: 34 beta E12 (12/12, 100%), p63 (10/12, 80%), AE1/AE3 (8/12, 67%), low-molecular weight keratin (7/12, 58%), and P KER (4/12, 33%). The 3 AFXs were positive for CD68 and negative for all other stains, whereas the 3 leiomyosarcomas stained positively for desmin and smooth muscle actin and negatively for all other stains. The 3 melanomas stained positively for S-100 and negatively for all other immunohistochemistry. The scars were negative for all stains. In conclusion, our study of 34 beta E12 proved most promising in distinguishing spindle cell squamous carcinoma from the histologic mimickers, AFX, spindle cell melanoma, scar, and leiomyosarcoma.     

Primary localized cutaneous amyloidosis: a clinicopathologic study from Saudi Arabia

Background Primary localized cutaneous amyloidosis (PLCA) refers to deposition of amyloid in apparently previously normal skin with no evidence of deposits in internal organs. Certain ethnic groups are particularly predisposed. The objective of this study was to investigate the occurrence of PLCA in a hospital-based set-up and to review the clinicopathologic findings of histologically confirmed cases. Methods Methods included a retrospective evaluation of the records and paraffin sections of skin biopsies of all patients, diagnosed clinically as cutaneous amyloidosis in a tertiary care teaching hospital during the period 1987–95. Results Twenty-one out of 42 suspected cases were histologically confirmed as PLCA; the total number of biopsied patients during the whole period was 920. Eleven were cases of lichen amyloidosis (LA) and 10 were of macular amyloidosis (MA). All were adults, and women dominated in MA. The mean duration of symptoms was shorter for the latter subtype. Histologically epidermal changes were the main differentiating feature between LA and MA. Conclusions PLCA is a rare chronic progressive skin disorder affecting adults, with a prevalence of 0.15 among patients attending the dermatology clinic in a tertiary care teaching hospital in Saudi Arabia. There were few differences in demographic profile or histochemical characteristics between LA and MA. Meticulous histologic examination of sections and even sequential biopsies may be needed to confirm the diagnosis in clinically suspected cases.     

E-钙黏蛋白与皮肤鳞状细胞癌

E-钙黏着蛋白是介导上皮细胞间粘连的最重要的一种钙依赖性的细胞黏附分子.近年来研究发现E-钙黏着蛋白异常表达与多种上皮恶性肿瘤的分化、浸润生长、转移和预后有着密切的关系.研究E-钙黏着蛋白的结构功能、在肿瘤侵袭转移中的作用机制、与皮肤鳞状细胞癌的相关性及临床意义,以期对皮肤鳞状细胞癌的早期诊断、治疗选择和预后预测提供一定依据.