Basosquamous carcinoma: florid lesion in a Nigerian

Basosquamous carcinoma (BSC) is a rare malignancy with features of both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) with a potential for infiltration and destruction. This is a report of a florid scalp lesion of BSC with erosion of the skull. A preoperative diagnosis of BCC was made following a biopsy. However, further evaluation of the excised lesion revealed BSC. Timely diagnosis of this potentially aggressive neoplasm, which could be enhanced by multiple biopsies, is essential for proper treatment.     

Synchronous primary lung cancers: a multidisciplinary approach in diagnosis

BACKGROUND. For patients with two or more primary cancers a correct diagnosis is critically important because prognosis and treatment vary considerably between multiple primary cancers and metastatic disease. CASE REPORT: Two bilateral synchronous primary lung malignancies of different histological types were diagnosed and immunohistochemically confirmed in a 60-year-old woman. In biopsy specimens of the right lung pure squamous cell carcinoma was detected (stage IIIa). The tumor expressed AE1/AE3, cytokeratin 5 and 34βE12. In biopsy specimens of the left lung small cell carcinoma was detected (stage IIIa). The small cells expressed synaptophysin, chromogranin A and CD56. DNA was extracted from paraffin-embedded tissue of both tumors. Exons 5-9 of the TP53 gene were examined for genetic mutations by polymerase chain reaction and DNA sequencing analysis. Direct sequencing of DNA isolated from the small cell carcinoma revealed a TGC to TTC mutation at codon 404 of TP53 exon 5. In DNA isolated from the squamous cell carcinoma no TP53 mutation was found. The tumors' different response to chemotherapy also suggested that they belonged to different histological types. The patient lived 24 months after the diagnosis, which is more typical for stage III than for stage IV lung carcinoma. CONCLUSION: Discrimination of synchronous primary lung cancers from intrapulmonary metastases based only on clinical findings can be very difficult. Multidisciplinary diagnostic evaluation is therefore very helpful in cases like this, because a correct diagnosis will determine the best treatment for the patient and consequently a better prognosis.     

Scalp lesion: a presenting feature of squamous cell carcinoma of lung

We describe a 45-year-old man, heavy smoker, presenting with 6.5 x 5.3 cm painless solitary growth over right temporal region. Chest radiograph showed opacity over left lung abutting mediastinum. Computed tomogram revealed homogenous ill-defined opacity indicative of bronchogenic carcinoma with metastases to right lung, liver and adrenal glands. The carina was involved with tumor along with partial obliteration of the left main bronchus over bronchoscopy; the biopsy confirmed squamous cell carcinoma. The biopsy from scalp lesion and cervical lymph node also established metastatic squamous cell carcinoma. Although cutaneous metastasis with primary lung cancer has been reported, the scalp lesion as a sole presenting feature of underlying quiescent squamous cell lung cancer, which is described here, has not been reported frequently.     

A case of adenoid squamous cell carcinoma of the breast skin

We report a case of a 45-year-old Japanese woman with adenoid squamous cell carcinoma (ASCC) of the left breast skin. The patient had showed a large mass in the left breast region with axillary swelling about 1 year before admission. Grossly, the tumor was an extensively ulcerated and elevated lesion measuring 15X16X5 cm. Based on the tumor biopsy and cytologic examination of the axillary lymph nodes, squamous cell carcinoma (SCC) was diagnosed. No evidence of distant metastasis was identified. A modified radical mastectomy with left axillary node dissection was performed. Microscopically, the resected tumor showed an invasive proliferation of atypical squamous cells with marked keratinization. At the periphery of the tumor, an adenoid growth pattern was frequently seen with a transitional area showing squamous cell carcinoma and adenoid growth components. ASCC was diagnosed. A transition between the overlying squamous cell epithelium and squamous cell carcinoma component was also seen, thus the tumor was thought to have originated from the breast skin. The patient died of respiratory failure due to multiple lung metastasis about 1 month after the mastectomy. Tumor rarely originates at the breast region to include both the mammary glands and breast skin. The pathogenesis and management of ASCC are discussed following the presentation of this case.     

A case report of synchronous small cell lung cancer and gastric cancer successfully treated with carboplatin

A 53-year-old man complained of anorexia and abdominal distention of one month's duration. The chest X-ray demonstrated a mass in the left lung with hilar and mediastinal adenopathy and a lytic lesion in the right fourth rib. A transbronchoscopic biopsy of the mass revealed oat cell carcinoma (WHO classification). The endoscopic evaluation also revealed a gastric lesion (IIc type). Biopsy of this lesion indicated signet ring cell gastric cancer. An abdominal CT scan demonstrated multiple liver metastases. Based on these findings, the patient was diagnosed as having synchronous lung and gastric primaries, with liver and bone metastasis from lung cancer. Carboplatin (CBDCA) was administered by intravenous drip infusion of 450 mg/m2. After a second treatment with CBDCA about 3 weeks later, the patient achieved a partial response at the primary site of lung cancer as well as at the liver and bone metastases. In addition, repeat endoscopy of the stomach demonstrated a complete regression. A biopsy specimen taken by gastroscopy was negative for cancer cells. Subsequent chemotherapy for small cell lung cancer was administered with cyclophosphamide, adriamycin, and vincristine, and to date there is no evidence of recurrence. Further studies on CBDCA treatment of small cell lung cancer and gastric cancer are needed to establish the efficacy of this drug against these two histologically different cancers.     

A case of elderly advanced squamous cell lung carcinoma successfully treated with nedaplatin and S-1 combination chemotherapy

A 7 4-year-old male was referred to our hospital for an abnormal chest shadow pointed out by a medical examination. A chest computed tomography revealed a tumor shadow 39 X 32mm in size in his left upper lobe in January, 2010. Pathological examination of biopsy specimens showed squamous cell carcinoma of the lung. Although there was no distant metastasis, multiple metastases to mediastinal lymph nodes was noted. He was diagnosed as Stage III A(cT2aN2M0). Considering his age and the histology of the disease, systemic chemotherapy with nedaplatin and S-1 was performed. The diameter of the primary lesion was decreased from 39mm to 18mm after 4 courses of chemotherapy, and was considered as partial response (PR)according to the RECIST criteria. The adverse events were grade 2 appetite loss, grade 3 neutropenia, and grade 2 thrombocytopenia. Recently, various new agents for treating non-squamous cell lung carcinoma have been developed, but there has been little progress in the treatment of squamous cell lung carcinoma. We experienced a patient with advanced squamous cell lung carcinoma who responded with CDGP/S-1 combination chemotherapy. We are now conducting a phase I / II clinical study to verify the usefulness of this regimen against advanced squamous cell lung carcinoma.     

A case of superficial squamous cell carcinoma of the esophagus showing multicentric development

A 43-year-old male was admitted to the hospital with a complaint of mild dysphagia. A barium esophagogram showed an annular narrowing in the lower esophagus. Further, an endoscopic examination revealed erosive mucosa of the esophagus about 35 cm anal to the incisor. Lugol staining also revealed a geographical unstained lesion. The histologic diagnosis of a biopsy specimen indicated a squamous cell carcinoma and a total resection of the esophagus was performed. The operated material macroscopically showed a tumor of a superficially mixed type (IIa + IIc + IIb). The resected specimen histologically consisted of 18 squamous carcinomas that were separated with the normal squamous epithelium from each other. The major part of these lesions were limited to the epithelium, and only a few specimens microscopically showed an invasion of cancer nests in the propria mucosae. Great permeation of cancer cells into lymph vessels and the metastasis of one regional lymph node also were noted. Taken together, these findings indicated that the squamous cell carcinomas of this case seemed to have multicentrically developed from the normal esophageal mucosa.     

Endobronchial ultrasound for diagnosis of synchronous primary lung cancers

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has recently been shown to be accurate in diagnosis and staging of mediastinal lymph node metastases. We report a case of squamous cell carcinoma diagnosed by endobronchial biopsy with concomitant contralateral hilar lymph node metastasis from small cell carcinoma being confirmed by EBUS-TBNA. The diagnosis of synchronous primary lung cancers in this case, which altered the treatment strategy, would not be made if pathological staging of intrathoracic lymph node was not pursued. The unique role of EBUS-TBNA in diagnosis of hilar lymphadenopathy was underscored. The potential pitfall of missing synchronous lung tumour if the diagnosis is based either on sampling from intrathoracic lymph node or from endobronchial lesion alone is discussed.     

Molecular-pathological Analysis of a Patient with Three Synchronous Squamous Cell Carcinomas in the Aerodigestive Tract

A case of synchronous squamous cell carcinomas in the soft palate,larynx and esophagus is reported, along with findings of molecular-pathologicalanalysis. A biopsy sample from the aryngeal carcinoma revealedwell differentiated squamous cell carcinoma harboring two pointmutations at codons 144 and 148 of the p53 gene but not at codon299, and more than 50% of the cancer cells showed accumulationof p53 protein immunohistochemically. The esophageal tumor,which was moderately differentiated squamous cell carcinoma,showed immunoreactivity for p53 within the nuclei of 25–50%of cancer cells with a missense mutation at codon 299 but notat codon 144 or 148. This cancer also showed immunoreactivityfor transforming growth factor alpha. On the other hand, thepoorly differentiated squamous cell carcinoma in the soft palateshowed negative immunoreactivity for p53 and no point mutationin exons 5 to 8 of the gene. These results suggest that thethree synchronous squamous cell carcinomas arose as independentevents.     

Centrally Located Squamous Cell Carcinoma of the Lung Mimicking Endobronchial Tuberculosis

Here we report a case of centrally located squamous cell carcinoma of the lung mimicking endobronchial tuberculosis. On the basis of the white light bronchoscopic (WLB) findings, bronchial tuberculosis was initially suspected. But transbronchial biopsy of the lesion revealed squamous cell carcinoma. Autofluorescence imaging bronchovideoscopy (AFI) showed the lesion area as magenta. After four cycles of chemotherapy, the magenta area was markedly shrunk on AFI. Performance of AFI might be useful for differentiating centrally located lung cancer from endobronchial tuberculosis.     

Serial histologic evaluation of multiple primary squamous cell carcinomas of the esophagus

A review of data on 205 patients with esophageal squamous cell carcinoma who underwent subtotal esophagectomy revealed 30 cases (14.6%) and 32 lesions with multiple primary squamous cell carcinomas. The incidence of this multiplicity was 11.7% and 25.6% in those with and without preoperative irradiation treatment, respectively. Among the 32 second lesions, there were 17 intraepithelial carcinomas, eight restricted to the mucosa, five invading the submucosa, one invading down to the proper muscular layer, and one involving the entire thickness of the esophageal wall. These second lesions were in the relatively early stage. Moreover, incidence of the coexistence of intraepithelial carcinoma contiguous to the main lesion was 42.1% and 100.0% in those with multiple cancers, with and without preoperative irradiation, respectively. The values were 7.6% and 53.1% in patients with a solitary carcinoma, respectively. These findings show the close relationship between multiplicity and intraepithelial carcinoma contiguous to the main lesion, and support the concept of multicentric or field carcinogenesis of esophageal squamous cell carcinoma.     

A case of coexisting malignant mesothelioma and squamous cell carcinoma of the lung

We experienced a case of malignant mesothelioma with squamous cell carcinoma of the lung concurrently. A 40-year-old man presented with dyspnea. A massive pleural effusion was found by X-ray in the right side of his chest. Transcutaneous pleural biopsy yielded a diagnosis of malignant mesothelioma(IMIG cT4N0M0, Stage IV ). At the same time, his chest CT revealed tumor in the right hilar lesion. Transbronchial lung biopsy yielded a diagnosis of squamous cell carcinoma of the lung (cT3N0M0, Stage III B). Our diagnosis was double cancer, malignant mesothelioma and lung cancer. Chemotherapy with carboplatin, gemcitabine and radiation therapy was performed, but the patient died from deterioration of his systemic condition. We encountered a rare case of double cancer. More attention must be paid in making a diagnosis of malignant mesothelioma and lung cancer.     

Synchronous cancers of the esophagus and the ampulla of vater after distal gastrectomy: Successful removal of the esophagus,gastric remnant,duodenum, and pancreatic head

A case of synchronous squamous cell carcinoma of the esophagus and adenocarcinoma of the ampulla of Vater after previous gastrectomy is presented. The coexistence of these two lesions has never been reported in the English literature. We performed a subtotal esophagectomy, total residual gastrectomy, and pancreaticoduodenectomy with lymph node dissection in a one-stage procedure. An operation of this magnitude could be safely performed with attention to meticulous surgical technique and intensive postoperative care. Histologic examination of the ampulla lesion showed adenocarcinoma with Paneth-cell differentiation. This is a rare lesion, and a review of the literature revealed only one other case. Neoplastic Paneth cells were also found in a lymph node metastasis that originated from the ampulla tumor. This case confirms that cells with Paneth-cell differentiation can be a significant component in invasive carcinoma. © 1995 Wiley-Liss, Inc.     

Two autopsy cases associated with a latent superficial carcinoma of esophagus

To clarify the histogenesis of squamous cell carcinoma of esophagus, 307 esophagus resected from autopsied cases have been thoroughly examined. These specimens were dyed with Lugol solution and entirely blocked to study subserial sections. Among these specimens, two subclinically superficial squamous cell carcinomas were found. First case uncovered was that of a woman who had died of a carcinoma of uterus. Microscopic examination revealed a small carcinoma in situ, located in the cervical portion of the esophagus, though this lesion showed no associated dysplasia. The other case was that of an old man who had died of a massive hemorrhage from a gastric ulcer, associated with carcinomas of the lip, liver, and prostate. The esophageal lesion was an intramucosal carcinoma located in the mid esophagus that was encountered with moderate dysplasia. These examples are not only quite rare as being multiple primary carcinomas but they also suggest two possible types of cancer development of the esophagus: one that progresses from normal mucosa, and the other from dysplastic mucosa.     

Primary squamous cell carcinoma with its spindle cell variant in the endometrium. A case report and review of literature

A case of squamous cell carcinoma of the endometrium in a 72-year-old woman is presented. A review of the previous 28 cases of endometrial squamous cell carcinoma (ESCC) that are adequately substantiated in the literature revealed several misconceptions about this rare tumor: the association with pyometra is not as frequent; the lesion does occur in premenopausal women; squamous metaplasia of the endometrium is not always coexistent; and malignant transformation of squamous metaplasia to ESCC has never been convincingly demonstrated. In the current case, a focal sarcomatoid spindle-cell tumor was associated with typical ESCC; however, light and electron microscopic examinations provided convincing evidence that the tumor was composed solely of ESCC. Ultrastructure of the spindle-cell tumor revealed it to be essentially identical to that of a spindle-cell variant of squamous cell carcinoma reported previously.     

同时性卵巢癌合并非小细胞肺癌1例并文献复习

目的:探讨多原发癌的临床诊断、治疗和预后,提高对多原发癌的认识,从而延长患者生存期,改善预后。方法:报道1例卵巢癌同期并非小细胞肺癌的多原发癌病例,并通过文献复习,阐述其发病率、发病机制、临床诊治方法及预后。结果:1名54岁女性以卵巢癌收住入院,行胸部CT及病理穿刺活检诊断同时合并肺腺癌,遂采用紫杉醇联合卡铂3周方案化疗,并肺部病灶射频消融。6周期化疗后,持续口服埃克替尼靶向治疗近13个月,肺部病灶较前明显缩小,卵巢癌无复发及转移征象。结论:临床需提高多原发癌的诊断意识,掌握多原发癌发病特点、诊疗方法,以提高治疗水平。     

Four primary malignant neoplasms in a single patient

A 60-year-old Caucasian male, with a previous history of a 10-year occupational exposure to ionizing radiation, chemical carcinogens, and a long history of tobacco and alcohol abuse, developed synchronous squamous cell carcinoma of the floor of the mouth and adenocarcinoma of the lung. Four years later, squamous cell carcinoma of the larynx followed by squamous cell carcinoma of the tongue were diagnosed. In this case report, we suggest that increased exposure to multiple carcinogenic factors may result in an increased incidence of both synchronous and metachronous primary malignant neoplasms.     

A patient with small-cell carcinoma of the esophagus with synchronous liver metastasis surviving 48 months after surgery]

Small-cell carcinoma of the esophagus is regarded as having a poor prognosis with frequent and early systemic metastasis. Recently, several reports have described small-cell carcinoma satisfactorily treated by chemotherapy and radiation therapy combined with surgery. We herein report a patient with small-cell carcinoma of esophagus with synchronous multiple liver metastasis who survived 44 months after surgery. A 70-year-old man was found to have a polypoid lesion at the abdominal esophagus by upper gastrointestinal endoscopy. A biopsy specimen of the lower esophagus demonstrated undifferentiated carcinoma of the esophagus. Ultrasonographic investigation demonstrated solitary SOL in the liver. The patient underwent a total gastrectomy and lower esophagectomy by an abdominal approach. As ultrasonographic evaluation during laparotomy revealed multiple liver metastases, a hepatic artery infusion catheter was inserted into the proper hepatic artery. A pathological study of the resected esophagus and a biopsy specimen of the liver revealed undifferentiated cell carcinoma of the esophagus (small-cell type). During hospitalization, hepatic artery infusion therapy (CDDP 20 mg/4 h and 5-FU 750 mg/5 h) was given for 4 days starting on days 14 and 28. After chemotherapy, liver metastasis could not be detected by ultrasonographic investigation. At the outpatient clinic bi-weekly hepatic artery infusion of 5-FU (1,500 mg/body/5 h) was continued for 30 months. The patient is alive 48 months after surgery without any evidence of recurrence.     

Primary squamous cell carcinoma of the breast during lactation: a case report

A case of primary squamous cell carcinoma of the breast during lactation is reported. The patient was a 32-year-old woman, in post-partum lactating 18 months after delivery, who was referred to our hospital following detection of a lump in her left breast during physical examination in mass screening for breast cancer. The tumor, palpated in the upper outer quadrant of the left breast, was firm, well-defined and 2.8 x 2.6 cm in size. Ultrasonograms identified an irregular-shaped hypoechoic lesion and mammograms revealed a well-defined, circumscribed tumor. Based on these findings, breast cancer was suspected and an excisional biopsy was performed. The resected specimen was a firm, solid and circumscribed tumor with central hemorrhage. Microscopic findings demonstrated that the tumor consisted of an invasive ductal carcinoma with marked squamous metaplasia, such as keratinization and squamo-columnar junction. Breast-conserving surgery was performed and no lymph node involvement was noted. Both estrogen and progesterone receptors of the tumor were negative. Generally, the size of both squamous cell carcinoma and carcinoma during the lactation period tends to be larger than ordinary carcinomas. In this case, the cancerous lesion was detected at a relatively early stage. Although the cancerous lesion was detected at a relatively early stage and no lymph node involvement was noted, lung metastases occurred within 12 months of the surgery. Malignant potential is generally considered to be high in cases of squamous cell carcinoma of the breast with lactation and thus intensive treatment potentially resulting in severe side effects was considered to be necessary for this patient.     

Re-irradiation of metastatic disease in the neck from xeroderma pigmentosum

Background

Xeroderma pigmentosum, an autosomal recessive disease that occurs with a frequency of 1:250,000, is caused by a genetic defect in nucleotide excision repair enzymes. Mutation of these enzymes leads to the development of multiple basal cell and squamous cell carcinomas.

Objectives

We present a case of xeroderma pigmentosum in a patient with cervical and intraparotid metastatic disease from recurrent cutaneous squamous cell carcinomas of the face and scalp, treated with neck dissection and re-irradiation. With the illustrative case report, we include a literature review of diagnosis, prognostic factors, and treatment, with emphasis on surgical and radiation treatment of cervical metastatic disease from recurrent skin carcinomas.

Case Presentation

A xeroderma pigmentosum patient presented to our clinic with a 2-cm right submental and 1-cm right infra-auricular mass after resection of multiple squamous cell carcinomas of the scalp and face, and external-beam radiation therapy to the right face and neck. Fine-needle aspiration biopsy of the submental mass revealed poorly differentiated squamous cell carcinoma. The patient was brought to the operating room for a right modified radical neck dissection and excision of the right submental and intraparotid mass. Surgical pathology revealed 3 level ia and supraclavicular lymph nodes that were positive for metastatic squamous cell carcinoma. Re-irradiation to the entire right hemi-neck and left submandibular nodal region was performed using opposed oblique portals for the upper neck and a low anterior en face hemi-neck portal. The left parotid region was also included in the re-irradiation volume. Treatment was completed without delayed complications or recurrences to date.

Conclusions

To our knowledge, this is the first case report in the literature of a patient with xeroderma pigmentosum who subsequently developed metastatic disease from recurrent cutaneous squamous cell carcinoma. Because of the rarity of xeroderma pigmentosum, this case report is also the first to describe re-irradiation to treat cervical and intraparotid metastatic disease in a xeroderma pigmentosum patient.