Squamous Cell Carcinoma arising in a Giant Epidermal Cyst: a Case Report

Epidermal cysts are commonly encountered in surgical practice. Malignant degeneration of epidermal sebaceous cyst is uncommon. The authors report the case of a 38-year Filipino woman presenting with a voluminous sebaceous cyst of the left buttock. Ultrasonography and computer tomography were made preoperatively without any hint of eventual malignant degeneration. Marginal excision was performed with direct closure of the skin. The histological examination revealed epidermal sebaceous cyst with squamous cell carcinoma in situ, which is a quite rare, but well known complication occurring in sebaceous cysts.     

Subungual Squamous Cell Carcinoma of the Toe: Report on Three Cases

Background. Primary subungual squamous cell carcinoma (SCC) of the toe is seldom reported in the literature, with most described cases occurring on the fingernails.
Objective. To describe the clinical, histopathologic, and laboratory findings of cases of invasive subungual SCC of the toe.
Methods. All cases of SCC of the toes retrieved from our database in the last 3 years were reviewed. A search for human papillomavirus (HPV) DNA from paraffin-embedded sections was performed with polymerase chain reaction.
Results. Three patients, all male, with a subungual SCC (two welldifferentiated and one poorly differentiated) of the toe were identified. Treatment consisted of surgical amputation in all cases. One patient with poorly differentiated SCC and lymph node metastases also underwent inguinal lymphadenectomy. Polymerase chain reaction search for HPV DNA was negative in all samples.
Conclusions. Unlike Bowen's disease and SCC of the fingernails, a causative role of HPV infection in the development of in situ and invasive subungual SCC of the toe seems unlikely.     

阴茎假血管瘤型鳞状细胞癌的临床病理观察及人乳头瘤病毒的检测

目的:提高对阴茎假血管瘤型鳞状细胞癌(PASCC)的认识。方法:报告1例阴茎PASCC患者的临床资料,结合相关文献复习讨论。患者男性,47岁。临床表现为包皮菜花状肿物5.0cm×5.0cm×4.0cm,表面糜烂、出血伴脓性恶臭分泌物,双侧腹股沟淋巴结肿大。CT检查未发现腹部、盆腔肿大淋巴结,胸片未见异常。结果:经活检病理诊断后,行阴茎部分切除、双侧腹股沟淋巴结清扫术(T2N2M0),辅以盆腔放疗。术后2个月,因阴茎皮瓣坏死(伴局部复发)行阴茎全部切除术。首次术后11个月,患者因盆腔、肺部广泛转移死亡。光镜下见棘细胞显著松解,肿瘤主要由排列呈血管样的腔隙状、网状结构的梭形细胞和局灶的鳞状细胞癌细胞组成,二者之间存在移行过渡。电镜下见肿瘤细胞胞质内存在张力原纤维和桥粒结构。腹股沟淋巴结仅见普通型高分化鳞状细胞癌细胞(左3/9,右2/10)。复发肿瘤的结构和形态与原发肿瘤相似。免疫组化染色示肿瘤细胞CK(AE1/AE3)、34βE12、Vimentin均为阳性,EMA呈灶性或片状(+);CD31、CD34、FⅧAg、HMB45、SMA、Desmin、CEA均为阴性。HPV分型原位杂交HPVpan、HPV6B/11、HPV16/18、HPV31/33均为阴性。结论:阴茎PASCC是一种罕见的特殊鳞状细胞癌,预后不良。确诊需依赖组织病理学、免疫组化和电镜检查。早就诊、早诊断和及时恰当的治疗是关键。     

Granulocyte-Colony Stimulating Factor (G-CSF)-Producing Esophageal Squamous Cell Carcinoma: A Case Report

There are very few reports of esophageal G-CSF-producing cancer. This report describes a case of G-CSF-producing esophageal squamous cell carcinoma we recently encountered. A 70-year-old male patient had Stage III esophageal squamous cell carcinoma. The patient received preoperative chemotherapy, and therapeutic response for the primary lesion was rated as complete response and that of the lymph node metastasis as stable disease. A radical operation was then performed. A relapse to neutrophilia occurred as liver metastasis recurred postoperation, and serum G-CSF level was high. Immunohistochemical staining of the resected specimen with anti-G-CSF antibody was positive. The patient died about 1 year after the operation. According to our search of the literature, there are 22 cases of esophageal G-CSF-producing cancer. Carcinosarcoma was more frequent as compared to esophageal non-G-CSF-producing cancer. The prognosis was graver in those cases of G-CSF-producing squamous cell carcinoma, relative to cases of non-G-CSF-producing esophageal squamous cell carcinoma.Key words: Granulocyte colony-stimulating factor, Esophageal cancer, Squamous cell carcinomaThe number of papers reporting cases of granulocyte colony-stimulating factor (G-CSF)-producing tumors has been increasing in recent years, but there are very few reports of G-CSF-producing esophageal tumor.¹⁻⁶ This report describes a case of G-CSF-producing esophageal squamous cell carcinoma that we recently encountered.     

包皮环切术后发生阴茎鳞状细胞癌17例报道

目的:分析包皮环切术后发生的阴茎癌的诊治。方法:回顾性分析我院1997年1月~2004年12月行包皮环切术后1个月~16年发生阴茎癌17例患者的临床资料。结果:本组患者中术后1~12个月发现阴茎癌者11例,术后3~16年发现者6例;16例行阴茎部分切除术+腹股沟淋巴结活检术,1例行扩大包皮环切术后复发相继行阴茎部分切除、全切术。复发的1例死亡,其余16例存活至今。结论:成年人行包皮环切术后仍有发生阴茎癌可能,对伴有包皮炎症、溃疡等病变的患者行包皮环切术应常规行病理检查,术后需密切随访,阴茎部分切除术是治疗早期阴茎鳞状细胞癌有效的方法,术中有必要行前哨淋巴结活检。     

Squamous Cell Carcinoma Presenting as Peri-Implantitis: A Case Report

Dental implants have proved to be a useful adjunct in the rehabilitation of oral cancer patients. We describe the case of a 62-year-old woman who presented with a white patch in the oral cavity, diagnosed to be a squamous cell carcinoma. She underwent extensive surgery including microvascular reconstruction, followed by implant rehabilitation. Unfortunately, she suffered from multiple episodes of peri-implantitis and later on went on to develop oral squamous cell carcinoma around two of the dental implants. Here, we highlight the importance of regular follow-up and maintaining a high index of suspicion in high-risk patients.     

Partial Penectomy for Patients With Squamous Cell Carcinoma of the Penis: The Memorial Sloan-Kettering Experience

Background To present our institution’s experience with squamous cell carcinoma (SCC) of the penis, with analysis of oncologic efficacy and survival. Methods Between 1989 and 2005, we identified 32 consecutive patients (median age, 61 years) with SCC of the penis managed with partial penectomy. Clinicopathologic variables were examined, and overall and disease-specific survival were determined. Results Pathologic stage of the primary tumor was pTis in 1 patient (3%), pT1 in 11 (34%), pT2 in 16 (50%), and pT3 in 4 (13%). Pathologic grade was well differentiated in 9 patients (28%), moderately differentiated in 20 (63%), and poorly differentiated in 2 (6%). Twenty-five patients (78%) underwent inguinal lymph node dissection, with 15 (60%) demonstrating nodal metastases. Twenty-two patients (69%) underwent pelvic lymph node dissection; 21 were negative for pelvic nodal metastases, and 1 had grossly positive nodes. One patient developed local recurrence. After a mean follow-up of 34 months, overall survival was 56%. Numbers of patients alive and disease-free were 9 and 11 in the low-stage and advanced-stage groups, and 8 and 12 in the well and moderately differentiated groups, respectively. Both patients with poorly differentiated disease died of disease within 12 months from presentation. Conclusions Partial penectomy for SCC of the penis provides excellent local control, with low recurrence rate, and acceptable maintenance of urinary and sexual function. Outcomes are generally poor, however, for patients with regional metastases, even in moderately differentiated disease. Future studies are needed to identify a reliable method of predicting regional metastases.     

Prognostic Significance of Vascular Endothelial Growth Factor in Squamous Cell Carcinomas of the Tonsil in Relation to Human Papillomavirus Status and Epidermal Growth Factor Receptor

Background

Angiogenesis markers, vascular endothelial growth factor (VEGF) and microvessel density (MVD) have been associated with prognosis in squamous cell carcinomas (SCCs) of the head and neck. Other prognostic variables such as human papillomavirus (HPV) and epidermal growth factor (EGFR) may also be involved in tumour angiogenesis. This study determined relationships between VEGF, MVD, EGFR, HPV, response to radiotherapy and clinical outcome in 85 tonsillar SCCs.

Methods

HPV status was determined by an HPV multiplex real-time polymerase chain reaction (PCR) assay/p16 immunohistochemistry. Expression of VEGF, CD31 (as marker of MVD) and EGFR was assessed by semiquantitative immunohistochemistry.

Results

Strong VEGF expressers were significantly more likely to have higher MVD than were weak expressers. There were no associations between VEGF or MVD and gender, patient age, TNM stage, EGFR expression or HPV status. Tumours with MVD of >15 per high-power field were significantly more likely to be poorly differentiated. There was a significant inverse relationship between EGFR and HPV status. HPV was a strong independent marker of loco-regional recurrence and death. VEGF and EGFR were risk factors for local recurrence and disease-specific death on univariate analysis but the associations weakened after adjustment for HPV. Among patients treated with radiotherapy, VEGF was associated with disease-specific death after adjusting for HPV and TMN stage. High-VEGF-expressing tumours positive for EGFR had a worse prognosis than all other groups combined after adjusting for HPV and TNM stage.

Conclusions

HPV is a stronger prognostic marker than VEGF or EGFR in tonsillar SCCs. VEGF correlates with MVD in these tumours.     

Outcomes of Initial Surveillance of Invasive Squamous Cell Carcinoma of the Penis and Negative Nodes

Purpose

We determined factors predictive of inguinal nodal relapse in patients with stages T1 to 3N0M0 squamous cell penile cancer treated initially with surveillance of inguinal nodes.

Materials and Methods

Between 1980 and 1994, in 42 patients with stages T1 to 3N0M0 squamous cell penile cancer of 60 with invasive disease seen at our center the inguinal nodes were surveyed after definitive treatment of the primary tumor. Clinical inguinal nodal recurrences were treated with inguinal lymphadenectomy.

Results

A total of 26 patients (62 percent) had inguinal nodal recurrences during followup, with 50 percent occurring within 1.4 years and 75 percent within 2.8 years of resection of the primary tumor. The only factor predicting nodal relapse was grade of the primary tumor at initial treatment. Patients with grade 1 tumors had a 45 percent long-term actuarial relapse-free survival rate. All other groups had a 100 percent actuarial nodal relapse rate. Of the patients 10 percent had metastatic disease without nodal recurrence.

Conclusions

Invasive penile cancer may be associated with inguinal lymph node and hematogenous metastasis. A strong case for prophylactic bilateral inguinal lymphadenectomy can be made in patients with primary tumors other than grade 1, since surveillance of these patients will not spare them eventual lymphadenectomy and may potentially compromise survival by delaying surgery. Patients with grade 1 tumors may be offered either careful surveillance or prophylactic bilateral inguinal lymphadenectomy depending on the clinical circumstances and patient preference.     

Squamous Cell Carcinoma of the Esophagus: Multimodal Therapy in Locally Advanced Disease

The aim of this prospective study is to report our experience in the multimodal management of locally advanced esophageal squamous cell carcinoma (LAESC; stage III cTNM), focusing on the results of chemoradiotherapy followed by surgery. These findings were compared to the results of a standard group of patients with locally advanced esophageal carcinoma (LAEC; stage III pTNM) treated in our center with surgery alone. Sixty-one patients with LAESC underwent preoperative chemoradiotherapy (5-fluorouracil + cisplatin) with concomitant 45 Gray radiotherapy in a 5-week course. Transthoracic esophagectomy was performed 4 to 5 weeks after the end of the neoadjuvant therapy. Thirty-eight patients underwent surgery, and 37 of them had resections (resectability: 97% in the multimodal group; 84% in the standard surgical series; p = 0.07). The R0 (complete) resection rate was 78% compared to 56% in the standard surgical group (p <0.03). Eleven patients had no residual tumor in the resected specimen (pathologic complete response: pCR: 30%). The operative mortality rate was 19% compared with 8.8% in the standard series. The overall median survival of the resected patients was 21 months, with a 5-year survival rate of 11% (14% in the surgical group; NS). The 3-year and 5-year survival rates were 34% for the pCR group and respectively 5% and 0% for the group with pathologic incomplete response (pIR; p <0.05). The median survival was 28 months for the pCR patients and 19 months for the pIR group. In this non-randomized trial, preoperative chemoradiotherapy in LAESC seems to increase the resectability and R0 resection rates, to allow a higher pCR rate and a longer survival only in the pCR group, at the expense of an inadequate increase in operative mortality. This multimodal treatment cannot be proposed as a standard procedure unless less toxic regimens are developed, increasing the benefits with better local and distant failure control and decreasing operative mortality.     

Thyroid Papillary Carcinoma Recurring as Squamous Cell Carcinoma: Report of a Case

We report a case of local squamous cell carcinoma recurrence of thyroid papillary carcinoma, 4 years after subtotal thyroidectomy, in an 82-year-old woman. The papillary cancer of the right thyroid was histopathologically classified as T2a, N0, M0, Ex1; pT2a, pN1b, pEx1; Stage III. Fine-needle aspiration cytology of the recurrent tumor revealed atypical squamous epithelium-like cells with keratinization. The tumor was judged cytologically to be class III, defined as a suspicious malignancy and, after reoperation, it was diagnosed histopathologically as papillary carcinoma recurrence with extensive squamous metaplasia. The recurrent papillary carcinoma was thought to have changed to a squamous cell carcinoma because most of the tumor was occupied by atypical squamous cells, with a small amount of glandular tissue. The primary tumor was histologically diagnosed as a well-differentiated papillary carcinoma at the initial operation. It contained numerous tall neoplastic cells with eosinophilic granules and pseudostratified nuclei, indicating that it could potentially transform into squamous cell carcinoma. We report this case as an example of how squamous cell carcinoma of the thyroid can develop.     

Predictors of Cancer-specific Mortality After Disease Recurrence in Patients with Squamous Cell Carcinoma of the Penis

Disease recurrence occurs frequently after surgical treatment for squamous cell carcinoma of the penis (SCCp). We sought to determine prognostic factors that influence cancer-specific mortality (CSM) after disease recurrence in patients with SCCp. We performed a retrospective analysis of 314 patients who experienced disease recurrence after surgical treatment for SCCp between 1949 and 2012. Competing risk regression analysis addressed factors associated with CSM after SCCp recurrence. Median time from surgery to disease recurrence was 10.5 mo (interquartile range [IQR]: 5.9–21.3). Of the recurrences, 165 (53%), 118 (38%), and 31 (9.9%) were local, regional, or distant, respectively. Within a median follow-up of 4.5 yr (IQR: 2.0–6.5), 108 patients died of SCCp and 41 patients died of causes other than SCCp. Shorter time to disease recurrence was found to be significantly associated with a higher risk of CSM (p = 0.0006). Lymph node metastasis at the time of initial treatment (subdistribution hazard ratio [SHR]: 1.96; 95% confidence interval [CI] 1.23– 3.11; p = 0.005) and regional recurrence (SHR: 4.14; 95% CI, 2.16–7.93; p < 0.0001) or distant recurrence (SHR: 5.75; 95% CI, 2.59–12.73; p < 0.0001) were associated with increased risk of CSM after disease recurrence. Inclusion of time to recurrence into risk stratification may help patient counseling and treatment planning.     

Case Report: Primary Squamous Cell Carcinoma of a Tarsal Bone

We describe a rare case of primary squamous cell carcinoma of the cuneiform bone of the foot in a 57-year-old man. In the appendicular skeleton, epithelial carcinomas of bone are usually metastatic deposits, primary squamous cell carcinomas of bone being found more frequently in the skull. A review of the English literature revealed only two other reported cases of primary squamous cell carcinoma outside the skull—one in the ilium and one in the tibia. In our patient, extensive metastatic workup and monitoring during more than 2 years showed no primary focus, supporting the rare presentation of a primary squamous cell carcinoma of bone in the appendicular skeleton.     

Protein Expression of Epidermal Growth Factor Receptor in Laryngeal Squamous Cell Carcinoma Index Tumors Correlates with Diagnosis of Second Primary Tumors of the Upper Aero-Digestive Tract

Background  

Field cancerization is a feature of HNSCCs. No biological marker in the index tumor has correlated with second primary tumor (SPTs) development. Changes in MDM-2 and epidermal growth factor receptor (EGFR) expression are known to be early neoplastic changes in HNSCC. EGFR expression is correlated with clinical outcomes. This study has assessed the predictive correlation of MDM-2 and EGFR protein expression with clinicopathological parameters and occurrence of SPTs in HNSCC.     

Salvage Lymphadenectomy of the Right Recurrent Nerve Node with Tracheal Involvement After Definitive Chemoradiation Therapy for Esophageal Squamous Cell Carcinoma: Report of Two Cases

Thoracic esophageal cancers frequently metastasize to the right recurrent nerve nodes (RRNNs). In fact, huge RRNNs invading the trachea sometimes remain after definitive chemoradiation therapy (CRT), despite complete remission of the primary lesion. We performed salvage lymphadenectomy of a large RRNN combined with partial resection of the trachea in two patients. Using an anterior approach, we removed part of the sternum, clavicle, and the first and second costal cartilage; then, we removed the RRNNs with combined resection of the lateral quarter circumference of the trachea, the esophageal wall, and the recurrent nerve. Reconstruction was done with a musculocutaneous patch of major pectoral muscle to cover the tracheal defect. The only minor complication was venous thrombosis in one patient. Thus, combined removal of the RRNN and trachea was performed safely as a salvage operation after definitive CRT for esophageal squamous cell carcinoma.     

Primary Small Cell Carcinoma of the Bladder: A Report of 25 Cases

Primary small cell carcinoma of the bladder is a rare condition with approximately 100 cases reported to date. An incidence of 0.7 percent small cell carcinoma was found in a total series of bladder tumors diagnosed in Western Sweden during a 2-year period. We describe 22 patients with primary small cell carcinoma followed to death or for at least 6 years. Three additional cases were diagnosed at autopsy. Of 18 patients with stages T2M0 to T4M0 cancer treated with locoregional therapy 5 (28 percent) had no evidence of disease after a median observation of 10 years (range 6 to 18) and 13 died of disease after 0.5 to 19 months (median 7.3). Two patients with metastatic disease were treated with systemic chemotherapy but died within 15 months. Two patients died shortly after the diagnostic biopsy. Our study and a review of the literature indicate that primary small cell carcinoma of the bladder is less aggressive than its pulmonary counterpart and that some patients can be cured by transurethral resection, or partial or radical cystectomy combined with radiotherapy.