Neuroendocrine small cell carcinoma of the breast: report of a case

A rare case of neuroendocrine small cell carcinoma (SmCC) of the breast is reported. A 51-year-old postmenopausal woman noticed a nodule approximately 3 cm in diameter in her right upper breast. Histologically, the tumor consisted of small ovoid to pleomorphic cells with hyperchromatic nuclei, and a large central area was occupied by acellular amorphous tissue. Extensive lymphatic permeation was seen around the tumor. Invasive and in situ ductal carcinoma foci were not observed in and surrounding the tumor. Immunohistochemically, estrogen and progesterone receptors and HER2/neu were all negative in the tumor cells. Synaptophysin and chromogranin A were diffusely positive in the tumor cells. Cytokeratin 8 was only positive in a few tumor cells. The labeling indices of Ki-67 and p53 were high in the tumor. Postoperatively, systemic studies including positron emission tomography were performed but failed to reveal any other possible primary sites, including lung. Based on these findings, the tumor was diagnosed as neuroendocrine primary SmCC of the breast. Postoperatively, the patient received a course of weekly paclitaxel. However, pelvic bone metastasis was identified on a bone scintigram 1 year after surgery. Mammary SmCC showing high Ki-67 and p53 index should be treated carefully because of their aggressive clinical behavior.     

Ghost cell odontogenic carcinoma arising in dentinogenic ghost cell tumor,peripheral: A case report

Ghost cell odontogenic carcinoma (GCOC) is an extremely rare intraosseous malignant odontogenic tumor with prominent ghost cell keratinization and dentinoid formation. Here, we present the first case of GCOC arising in dentinogenic ghost cell tumor (DGCT), peripheral. The patient was a man in his 60s with an exophytic mass in the anterior part of lower gingiva. The resected tumor measured 4.5 cm in maximum diameter. Histologically, the nonencapsulated tumor proliferated in the gingiva without bone invasion. It was predominantly composed of ameloblastoma-like nests and islands of basaloid cells with ghost cells and dentinoid in the mature connective tissue, suggesting DGCT, peripheral. As minor components, sheets of atypical basaloid cells and ameloblastic carcinoma-like nests with pleomorphism and high proliferative activity (Ki-67 labeling index up to 40%) consistent with malignancy were identified. CTNNB1 mutation and β-catenin nuclear translocation were observed in both benign and malignant components. Final diagnosis was GCOC arising in DGCT, peripheral. GCOC shows similar histological features to DGCT. In this unique case without invasion, the cytological atypia and high proliferative activity supports the diagnosis of malignant transformation from DGCT.     

Squamous cell carcinoma arising in a hepatic forgut cyst

We report the second case of squamous cell carcinoma arising in a hepatic foregut cyst (CHFC) in a 40-year-old woman. Microscopically, the lining of the cyst was composed of ciliated columnar epithelium, gastric and squamous epithelium. The squamous epithelium showed areas with dysplastic changes and other areas with carcinomatous transformation. In this congenital lesion, it was not surprising to find squamous and gastric mucosa because oesophagus, stomach, and tracheobronchic tree derive from the embryologic foregut. Squamous carcinoma might develop in a context of inflammation as in biliary cyst. In agreement with the first case described in the literature, this report also suggests that a large-sized symptomatic hepatic cyst should be excised.     

Squamous cell carcinoma arising in a ciliated hepatic foregut cyst: Case report and literature review

We report a case of squamous cell carcinoma arising in a ciliated hepatic foregut cyst (CHFC) in the left lobe of the liver in a 60-year-old woman. Gross examination revealed an irregular, partially encapsulated, smooth tumor mass with multiple cystic areas, 3–5 mm in size. Microscopically, the lining of the microcysts was composed of ciliated columnar epithelium with scattered goblet cells. Multiple foci of squamous metaplasia of the columnar epithelium were observed, which showed areas with dysplastic changes and other areas with carcinomatous transformation. Our case also showed an inconspicuous or absent smooth muscle layer. This case suggests that CHFC deserves careful clinical follow-up and differential diagnosis to exclude malignant transformation. Total surgical excision of the cyst is recommended.     

Squamous cell carcinoma of the small bowel manifesting as a jejunal perforation: a case report

Squamous cell carcinoma arising from the small intestine is rare and difficult to identify as a primary or metastatic feature. We report a case of small intestinal squamous cell carcinoma manifesting as subacute peritonitis due to perforation. An 80-year-old man was admitted to our hospital with intermittent postprandial abdominal pain. He was diagnosed with acute peritonitis due to gastrointestinal perforation. During explorative laparotomy, a perforation site was detected in the jejunum and segmental resection to correct the perforation was performed including the perforation site located at the 70 cm inside the jejunum from the Treitz ligament. The pathology results revealed squamous cell carcinoma in the resected segment of the jejunum with two perforation sites.     

An unusual variant of squamous cell carcinoma (inverted verrucous carcinoma) arising in a pilonidal sinus

A case of squamous cell carcinoma arising in a chronic pilonidal sinus in a 59-year-old man is described. Twenty-seven instances of malignant change in a pilonidal sinus have been previously documented, none of which showed the pattern seen in this case. The possibility of malignant change in longstanding pilonidal sinus is emphasized.     

Primary squamous cell carcinoma of the stomach: a case report and literature review

Primary squamous cell carcinoma (SCC) of the stomach is rare. Its pathogenesis is also unclear and there are conflicting reports about it in the past. Only about 100 cases have been reported so far in the literature. The current study discusses a new case of gastric squamous cell carcinoma, from a 50-year-old Chinese male patient diagnosed via subtotal gastrectomy with Roux-en-Y reconstruction and D2 lymphadenectomy. In the stomach, an ulcerated mass in the antrum, measuring 12×8×6 cm, was observed. Further, pathological examination of the resected specimen revealed a well-differentiated SCC. Observations indicated tumor cell invasion into the serosa, and encroachment into perigastric regional lymph node. A follow-up abdominal CT scan three months later revealed tumor invasion into the ascending colon. We assume that this invaded mass was transferred from the gastric squamous cell carcinoma. Interestingly, the patient is still alive.     

Spindle cell carcinoma of the breast: A case report and an immunohistochemical study including p53 and Ki-67 expression

A rare case of spindle cell carcinoma (SpCC) of the breast occurring In a 51-yearold Japanese woman Is reported. A firm and well-circumscribed tumor, measuring 9times8.5times8.5 cm, was located on the upper lateral region of the right breast. Microscopically, the tumor consisted of sheets of both malignant spindle cells and poorly differentiated ductal carcinoma containing squamold islands with gradual transition to the spindle cell component. The Immunocyto chemical expression of epithelial markers was recognized in the spindle cells, as well as in the carcinomatous cells. Moreover, the spindle cell component expressed vimentin, α-smooth muscle actln and S-100 protein. Ultrastructurally, in addition to the features of adenocarcinoma, squamous or rnyoeptthelial differentiation was confirmed in the spindle cell component. These findings thus suggest an epithelial origin with squamous differentiations and myoepithellal participation In the genesis of SpCC. In a comparative study, the expression of p53 protein and KI-67 as a proliferation marker In each component of this tumor was also Investigated. The mean p53 labeling index (LI) in both the carcinomatous and spindle cell area was similar, however the mean MIB-1 LI in the spindle cell area was significantly higher than that in the carcinomatous area. The results indicate that p53 over-expression is Involved In the tumorigenesis of both components in the SpCC, and the spindle cell component shows a higher degree of proliferative activity than the carcinomatous component.     

Squamous cell carcinoma of the larynx in a Pekingese dog

This is a report of an unusual multicentric squamous cell carcinoma in the larynx of a Pekingese dog. A 5-year-old female Pekingese dog with a 1-month history of unexplained pain localized to an asymmetrical swelling of the neck together with lethargy and poor appetite was referred to the Veterinary Clinic of Shiraz University. Plain radiographs of the neck revealed ventral displacement of the trachea, with the space between the trachea and spine occupied by a soft tissue mass. Histopathology of the mass affirmed squamous cell carcinoma that affected the larynx. According to the history, clinical signs, radiology, necropsy findings, and histopathological examination, the case was diagnosed as laryngeal squamous cell carcinoma.     

Intestinal metastases in a squamous cell carcinoma arising in mature cystic teratoma of the ovary: a case report

Metastatic spread to the intestines by squamous cell carcinoma (SCC) arising in mature cystic teratoma (MCT) or dermoid cyst is a very rare event. A case of a 40-year-old cachectic woman is presented with an MCT of the left ovary found at autopsy. Focal mural thickening of the cyst wall harbored a moderately differentiated SCC with single cell keratinization. Intramural metastases were noted in the jejunum, ileum, colon transversum, and left colonic flexure. In addition, liver metastases were detected. The tumor was staged as FIGO IV. The peritoneum was covered diffusely by fibrinous and suppurative exudate. In this unusual case, metastasizing SCC of the ovary arising in an MCT led to suppurative peritonitis and consequently to death of the patient. Follow-up procedures regarding intestinal spread could be useful in patients with SCC in MCT.     

Squamous cell carcinoma in a duplicate large intestine

Summary A case report of a squamous cell carcinoma arising in a closed duplication of the large intestine is presented. The aetiology of squamous cell carcinoma in this site is discussed. It is quite possible the epithelial changes described in this case are similar to those associated with squamous cell carcinoma in other anatomical sites. The unusual environment within the lumen of a closed duplication may be carcinogenic.     

Squamous cell carcinoma and osteosarcoma arising from a dermoid cyst-a case report and review of literature

A rare case of multiple malignant tumors (poorly differentiated squamous cell carcinoma and high grade osteosarcoma) arising in an ovarian dermoid cyst of a 55 year old female is reported. To the best of our knowledge, this is the first well documented example of such an unusual combination of tumors arising in a dermoid cyst. The osteosarcoma and squamous cell carcinoma appear to arise in the background of benign teratomatous environment of a dermoid cyst rather than from “pure” mixed mesodermal tumors of the ovary. The tumors did not appear to have well demarcated boundaries with a junction or close intermingling of both cell types, features less favorable for collision tumor or carcinosarcoma. Despite extensive surgery with negative surgical margins and combination chemotherapy, the patient had recurrence of the tumor within four months and she died secondary to septicemia to chemotherapy and bilateral pulmonary emboli shortly after.     

Acinar cell carcinoma arising in the stomach: a case report with literature review

Acinar cell carcinomas (ACCs) are uncommon malignant tumors of the exocrine pancreas, constituting 1% to 2% of all nonendocrine pancreatic neoplasms. Cases of acinar cell carcinoma developing in heterotopic pancreatic tissue are extremely rare. To the best of our knowledge, no cases of primary ACC developing in the stomach have been reported in the literature. We report the first case of a primary ACC arising in the stomach in an 86-year-old female who presented with a 5-cm gastric submucosal mass with superficial ulceration and a history of anemia. The neoplasm exhibited typical acinar morphology. Immunohistochemical studies demonstrated strong positive reactivity for antitrypsin and antichymotrypsin, and electron microscopy confirmed the presence of zymogen granules. A complete metastatic workup failed to identify any primary pancreatic tumor or other nonpancreatic tumor.     

Squamous cell carcinoma variants of the head and neck

Variants of squamous cell carcinoma (SCC) frequently arise within the mucosa of the upper aerodigestive tract, accounting for up to 15% of SCCs in these areas. The most common variants include verrucous, exophytic or papillary, spindle-cell (sarcomatoid), basaloid and adenosquamous carcinoma. Each of these variants has a unique histomorphologic appearance, which raises a number of different differential diagnostic considerations, with the attendant clinically relevant management decision.Verrucous squamous cell carcinoma has a broad border of pushing infiltration of a non-dysplastic squamous epithelium, essentially devoid of mitotic figures, displaying hyperkeratosis on elongated rete pegs. Papillary and exophytic SCC have a papillary or exophytic architecture, but have malignant cytologic features within the epithelium. Spindle-cell (sarcomatoid) carcinoma is an SCC blended with a spindle-cell morphology, frequently mimicking other mesenchymal tumours. Epithelial markers are often negative. Basaloid SCC is a high-grade SCC variant with small cells arranged in a palisaded architecture, with hyperchromatic nuclei and only focal areas of squamous differentiation. Adenosquamous carcinoma is a rare variant, which is a composite of adenocarcinoma and squamous cell carcinoma, often with areas of transition. The cytomorphologic features are described in detail in an attempt to allow the general surgical pathologist to separate these variants of SCC in order to achieve appropriate clinical management.     

Papillary and verrucous lesions of the oral mucosa

A wide variety of papillary and verrucous lesions can affect the oral mucosa. Benign and reactive lesions (e.g. squamous papilloma, verruciform xanthoma) usually present little diagnostic difficulty. However, premalignant and malignant verrucous and papillary lesions pose a much greater diagnostic challenge, not helped by often confusing terminology. For example, papillary hyperplasia is a reactive inflammatory condition, whereas the term “verrucous hyperplasia” is often used to describe a potentially malignant lesion, which is probably part of the spectrum of verrucous carcinoma. A classical verrucous carcinoma, with an exo-/endophytic growth pattern and a “pushing” invasive front is easily identified, but many exophytic verrucous proliferations can also show endophytic growth. These can reasonably also be considered as verrucous carcinoma and managed accordingly. The distinction becomes academic in the face of conventional invasion, when squamous cell carcinoma is the appropriate diagnosis. This review aims to summarise and highlight the key features seen in these lesions, and to provide a practical approach for tackling these entities in routine diagnostic practice.