Unusual prostatic carcinomas

Over 90% of malignant epithelial tumors of the prostate are common carcinomas. Uncommon or rare prostate carcinomas can histogenetically be related to 4 epithelial types of the prostate: the secretory epithelium, the basal cells, the endocrine cells and the transitional epithelium. The rare, purely mucinous carcinoma and the ductal papillary carcinoma belong to the type of secretory epithelium. The latter is rarely seen in the large central prostatic ducts, it develops more frequently in peripheral ducts and is combined with common prostate carcinoma. The so-called endometrioid carcinomas of the utriculus described in the literature are probably ductal prostate carcinomas. To date no carcinoma has been found in the utriculus. The adenoid cystic carcinoma of the prostate is a basal cell tumor with preponderantly good prognosis. Endocrine cells are disseminated in most common prostate carcinomas. Thereby mixed forms showing both portions of a common adenocarcinoma and of a carcinoid may occur. Pure carcinoids of prostate are rare findings. The small cell carcinoma of the prostate is the highly malignant variant of the endocrine cell type. Immunohistochemically, a multitude of proteohormones are demonstrable in endocrine tumor cells. The ectopic ACTH production with Cushing's syndrome is of particular clinical significance.     

Cytology of metastatic cutaneous basal cell carcinoma

Although basal cell carcinoma is the most common malignant skin tumor, it rarely metastasizes. Because of the infrequency of basal cell carcinoma metastases, the cytomorphologic findings have not been well documented. We retrospectively reviewed the cytologic findings of six cases of metastatic basal cell carcinoma from two patients. Five of these specimens were fine-needle aspiration biopsies, and one was a bronchial brush specimen. All cases were confirmed by and compared to either the concurrent tissue biopsy or to a previous surgical specimen. The microscopic findings of these specimens reveal tight clusters of cells with high nuclear to cytoplasmic ratio. The nuclei were crowded and overlapping, and on Diff Quik stain, peripheral palisading of nuclei could be appreciated. The small hyperchromatic nuclei were round to oval with finely granular chromatin. Nucleoli were inconspicuous. Basophilic cytoplasm was scant with indistinct borders. Cytologic findings of basal cell carcinoma have not been well documented in the English literature. Our experience suggests that there are unique cytormorphologic features of metastatic basal cell carcinoma and that in the right setting such a diagnosis can be rendered. Diagn. Cytopathol. 1998; 19:113–115. © 1998 Wiley-Liss, Inc.     

Metastatic basal cell carcinoma exhibits reduced actin expression

Basal cell carcinoma is the most common malignancy in Caucasian individuals. Metastatic basal cell carcinoma is extremely rare (with a rate estimated as 0.03%). Actin has been detected in aggressive forms of basal cell carcinoma, but their expression in metastatic lesions is not known. We compared the expression of actin and actin-related cytoskeletal proteins in relatively less aggressive basal cell carcinoma (nodular), aggressive basal cell carcinoma (infiltrative/morpheaform), and metastatic basal cell carcinoma. We studied 12 cases of nodular basal cell carcinoma, 10 cases of infiltrative basal cell carcinoma, and 10 cases of metastatic basal cell carcinoma with immunohistochemistry for alpha-smooth muscle actin, calponin, myosin, and E-cadherin. Expression was interpreted as positive when at least 5% of the tumor exhibited at least weak expression. Five of the ten patients with metastatic basal cell carcinoma had an antecedent history of radiotherapy. Actin was present in 3 of 12 (25%) of the nodular, all 10 of the infiltrative, and 3 of 10 of the metastatic basal cell carcinomas (P<0.05 for metastatic vs infiltrative and nodular vs infiltrative). Calponin was present in 50% of the nodular, 60% of the infiltrative, and 30% of the metastatic basal cell carcinomas (not statistically significant). Myosin expression was not detected in any of the cases. E-cadherin was present in 75% of the nodular, 70% of the infiltrative, and all of the metastatic basal cell carcinomas (P<0.05 for metastatic vs nodular). Our results suggest that increased actin may contribute to local invasiveness, but it is lost in the metastatic phenotype. History of previous radiotherapy may contribute to development of the metastatic phenotype.     

Case report and literature review: primary cutaneous carcinosarcoma

Carcinosarcomas are rare but aggressive neoplasms commonly described in organs such as the breast, urinary bladder, uterus, liver, and lungs. Histopathologically, they are characterized by the presence of malignant epithelial and mesenchymal components. The exact histogenesis of carcinosarcomas remains unknown and is debated in the literature. Primary carcinosarcomas of the skin are uncommon. To our knowledge, 20 cases of primary cutaneous carcinosarcoma have been described in the world literature. Most of these tumors were seen on the head and neck region of older individuals, both male and female. Microscopically, the more common carcinoma component is a squamous cell carcinoma followed by basal cell carcinoma, whereas the most common sarcoma component is an osteosarcoma. We report an example of this rare entity and speculate on its histogenesis in the skin.     

The contribution of epidermal stem cells to skin cancer

Tumors arising from the skin are of multiple phenotypes, with differing degrees of malignant potential. In mouse models of skin carcinogenesis, tumors of squamous phenotype are the most common; however, human disease indicates that multiple phenotypes may arise from a common pool of stem cells that are then influenced by epigenetic factors. The use of transgenic and knockout gene technologies with mice is unraveling some of the specific genes regulating fate determination in stem cells other than squamous lineage, including basal cell carcinoma and sebaceous adenomas. The following review examines the evidence for the stem cell origin of epidermal tumors and the contribution of some specific gene families toward stem cell fate decisions during epidermal tumor progression.     

Basal cell adenoma: a diagnostic dilemma on fine needle aspiration cytology

Basal cell adenoma (BCA) is a rare neoplasm which is one of the basaloid tumors of salivary gland. Basaloid tumors are the most difficult problem in salivary gland fine needle aspiration cytology (FNAC). There are various benign and malignant tumors such as; cellular pleomorphic adenoma, basal cell adenocarcinoma, adenoid cystic carcinoma, metastatic basal cell carcinoma, metastatic basaloid squamous carcinoma and small cell carcinoma in differential diagnosis. We present a case of BCA, membranous type in a 39-year-old female with right submandibular swelling misinterpreted as adenoid cystic carcinoma (ACC) on FNAC.     

Basal cell carcinoma metastatic to the salivary glands: Differential diagnosis in fine-needle aspiration cytology

A disparate group of salivary gland neoplasms is characterized by small, uniform, hyperchromatic, basaloid cells. This “small blue cell” pattern is most common in non-Warthin's types of monomorphic adenoma, or in adenoid cystic carcinoma. Small cell anaplastic carcinoma (primary or metastatic), metastatic basaloid squamous cell carcinoma, basal cell adenocarcinoma, and metastatic nasopharyngeal carcinoma are rarely encountered but may present a cytologically similar appearance. We report one female and two male patients (median age = 84 yr) with cutaneous-type basal cell carcinoma (BCC) aspirated from metastatic deposits in the parotid (2 cases) or the submandibular (1 case) gland. One was correctly classified at the time of aspiration, based on a previous history of multiple facial BCC. One was interpreted as carcinoma, the previous history being unavailable at the time of FNA. Smears in these two cases show necrosis and rare keratotic cells. The third case was mistaken for pleomorphic adenoma (PA); the smears showed metachromatic fragments of collagenous tumor stroma that were misinterpreted as the matrix material typical of PA. Similar material was identified in the other two cases. When the “small blue cell” pattern is encountered in salivary gland cytology, one should consider BCC, especially if necrosis is identified. The desmoplastic tumor stroma of BCC may mimic the chondroid matrix of PA. Careful consideration of previous history is very important. Diagn. Cytopathol. 16:247–252, 1997. © 1997 Wiley-Liss, Inc.     

Ultrastructural comparison of the interface between epithelium and stroma in basal cell carcinoma and control human skin.

Comparative ultrastructural studies of basal cell carcinomas, seborrheic keratoses, actinic keratoses, and control nontumor skin from human patients demonstrate structural differences between invasive and noninvasive tumor cells. Compared to the other specimen groups, biopsies of basal cell carcinomas reveal a decrease in hemidesmosomes and an increase in actin-like microfilaments in cells at the margins of the tumors. Benign tumors, i.e., seborrheic keratoses and actinic keratoses, have hemidesmosome areas and microfilament contents resembling control nontumor skin. The most striking hemidesmosome areas and microfilament contents resembling control nontumor skin. The most striking increase in microfilaments is in the most infiltrative "morphea" variants of basal cell carcinoma. These findings, in the context of other published reports, suggest that increased microfilaments are related to enhanced motility of invasive carcinoma cells in vivo and that decreased hemidesmosomes may be related to loss of cell to substratum or "anchorage" dependence of growth in malignant cells.     

Basal cell hyperplasia and basal cell carcinoma of the prostate: a comprehensive review and discussion of a case with c-erbB-2 expression

Prostatic basal cell proliferations range from ordinary basal cell hyperplasia (BCH) to florid basal cell hyperplasia to basal cell carcinoma. The distinction between these forms of BCH, including the variant with prominent nucleoli (formerly called atypical BCH), and basal cell carcinoma depends on morphological and immunohistochemical criteria and, in particular, on the degree of cell proliferation. In florid BCH, the proliferation index is intermediate between ordinary BCH and basal cell carcinoma. Immunohistochemistry is also useful for identifying the cell composition of the basal cell proliferations, including the basal cell nature of the cells, their myoepithelial differentiation, and c-erbB-2 oncoprotein expression. Based on the information derived from the literature and on the appearance and follow up of the case presented here, florid BCH might represent a lesion with an intermediate position between ordinary BCH and basal cell carcinoma. However, criteria useful for the identification of those cases with a true precursor nature are not available. In general, basal cell carcinoma is seen as a low grade carcinoma. The immunohistochemical expression of the c-erbB-2 oncoprotein, similar to that seen in breast cancer, might have therapeutic importance.     

Albinism and skin cancer in Southern Africa

The presence of skin cancer was investigated in 111 albinos belonging to the black (Negro) population of Johannesburg, South Africa. The overall rate was 23.4%, the risk increasing with age. Identifiable risk factors included: environmental exposure to ultraviolet radiation; inability to produce ephelides ('freckles'); and possibly ethnicity. The head was the site most commonly affected, and squamous was far more common than basal cell carcinoma. No melanomas were detected. Recommendations are made regarding prevention of skin cancer in the at-risk group.     

Undifferentiated sinonasal carcinoma in a patient with nevoid basal cell carcinoma syndrome

Nevoid basal cell carcinoma syndrome is an autosomal dominant multisystem disorder characterized by developmental anomalies and occurrence of multiple basal cell carcinomas and other tumors in early childhood. In this article, the authors report a case of a 19-year-old African American male with nevoid basal cell carcinoma syndrome and a history of medulloblastoma at age 2, meningioma at age 14, thyroid follicular adenomas with papillary carcinoma at age 15, and 2 basal cell carcinomas at ages 16 and 18. Recently, he developed sinonasal undifferentiated carcinoma (SNUC). The radiology and pathology of the sinonasal carcinoma are presented in this report. Review of the literature reveals that this is the first case of SNUC occurring in a patient with nevoid basal cell carcinoma syndrome.     

Pigmented cutaneous squamous cell carcinoma

Squamous cell carcinoma is an extremely common cutaneous neoplasm, with an incidence second only to basal cell carcinoma and steadily rising, and specimens regularly crossing the reporting pathologist’s bench. Cutaneous pigmented squamous cell carcinoma is a relatively uncommon and perhaps under-recognized pathological variant of squamous cell carcinoma. Florid examples causing clinically evident pigmented lesions are quite rare, with less than 30 cases of cutaneous pigmented squamous cell carcinoma reported in the English literature to date. The pathophysiology of this entity is unknown, and literature addressing this is limited. The diagnosis of cutaneous pigmented squamous cell carcinoma is an important one, as it may be a source of confusion for both clinicians and pathologists because it can be mistaken for other entities including malignant melanoma. In this paper we report a case of cutaneous pigmented squamous cell carcinoma and discuss its clinical and histopathologic features, underlying pathophysiology and important differential diagnoses.     

Atypical acinar proliferations of the prostate

Small acinar lesions of the prostate may mimic prostate cancer. In the central and transition zone of the prostate, atypical adenomatous hyperplasia (AAH) must be differentiated from low grade carcinoma (Gleason score 2-5). In the dorso-peripheral zone, high grade prostatic intraepithelial neoplasia (PIN) and atypical small acinar proliferations (ASAP) are the most important lesions mimicking carcinoma. Further differentiation is necessary between high grade PIN and intraductal carcinoma. ASAP, on the other hand, may mimic low grade carcinoma. The significance of basal cell type cytokeratin immunohistochemistry (IHC) in the differentiation between ASAP and low grade carcinoma of the prostate was substantiated by additional MIB-1 IHC. The status of the basal cell layer in ASAP was found to be variable (complete, fragmented and absent). Independent of the status of the basal cell layer, the mean MIB-1 proliferation index of ASAP was significantly higher than that of clearly benign lesions and did not differ from that of low grade carcinoma. As carcinoma is frequently detected in rebiopsies, close clinical follow up of patients with ASAP is advisable.     

The histopathology of the skin basal cell carcinoma with areas of intermediate differentiation. A metatypical carcinoma?

The histopathology of the skin basal cell carcinomas (BCCs) with areas of intermediate differentiation (ID) has been investigated. In a series of 127 BCCs, areas of ID were found in 28 tumors (22%), and also in an additional 10 cases of other series. These areas consisted of compact masses of cells without peripheral palisading, and with intermediate differentiation between basal and squamous cells. In comparison with the common undifferentiated BCCs, the BCCs with the ID areas may behave in a more aggressive fashion, since they displayed more precocious ulceration in small tumors (p less than 0.001), greater infiltrative features (p less than 0.001), more atypical cells (p less than 0.001) with increased nuclear-cytoplasmic ratio and more mitoses (p less than 0.001). The relation of such basal cell carcinomas to the metatypical carcinoma of the skin was discussed. Metatypical carcinoma, however, has been poorly defined and thus has no general acceptance in the literature. The new definition of the basosquamous cell carcinoma and the presence of intermediate areas of differentiation in this tumor were emphasized, and it was suggested that metastatic basal cell carcinoma and metatypical carcinoma may be the same tumor.     

Basal cell carcinoma of the skin with areas of squamous cell carcinoma: a basosquamous cell carcinoma?

The diagnosis of basosquamous cell carcinoma is controversial. A review of cases of basal cell carcinoma showed 23 cases that had conspicuous areas of squamous cell carcinoma. This was distinguished from squamous differentiation and keratotic basal cell carcinoma by a comparative study of 40 cases of compact lobular and 40 cases of keratotic basal cell carcinoma. Areas of intermediate tumour differentiation between basal cell and squamous cell carcinoma were found. Basal cell carcinomas with areas of squamous cell carcinoma may be called basosquamous carcinoma.     

Reporting basal cell carcinoma: a survey of the attitudes of histopathologists

AIMS: To investigate the histopathological reporting of basal cell carcinoma. METHODS: Methods of classification and attitudes to excision margins were ascertained from histopathologists in 130 centres; 82 replies were obtained (63% response rate). RESULTS: 24% of those replying did not use any classification system for basal cell carcinoma. The remainder (76%) used a wide variety of different classification systems. A small number (9%) of those questioned felt reporting on completeness of excision was not important. The majority of histopathologists considered the excision margin was worth reporting but there were differences in methods of processing and reporting biopsies. CONCLUSIONS: There is considerable variation in histopathological reporting of basal cell carcinoma. There is a need for uniformity of histopathological reporting to allow both improved management decisions and comparative audit of this extremely common skin cancer.     

Research progress in the cell origin of basal cell carcinoma

Identification of the cell origin of human neoplasms remains a challenging but important task in cancer research. The outcomes in this area of study may allow us to design novel strategies for early cancer detection and targeted cancer therapeutics. Skin is a great organ to study cancer stem cells because stem cells in skin have been well investigated and approaches of genetic manipulation in specific cell compartments are available to mimic clinical skin cancer in a mouse model. Recently, by using different genetic engineered mouse models, several groups have tried to discover which cell type in skin was responsible for the initiation of basal cell carcinoma, the most common type of skin cancer. These studies raised more questions but also showed more ways for future investigation.     

Clinical findings in two African-American families with the nevoid basal cell carcinoma syndrome (NBCC)

The nevoid basal cell carcinoma syndrome (NBCC) is an autosomal dominant multisystem disorder with variable expressivity. We present the clinical findings on 11 African-American NBCC cases from 2 families and a review of the literature of NBCC in African-Americans. The 2 new families, as well as those previously reported, suggest minimal expression of the basal cell carcinomas and full expression of the other components of the syndrome. The 3 most common findings in the 11 cases were jaw cysts, palmar and/or plantar pits, and calcification of the falx cerebri. Only 44% (4/11) of these cases had one or more confirmed basal cell carcinomas. This frequency is substantially less than that observed in whites (90% with basal cell carcinomas). The relative lack of these skin tumors in African-Americans partly reflects ultraviolet radiation protection resulting from increased skin pigmentation. Future research should help identify the specific mutation(s) in blacks as well as other modifying genes and environmental exposures that may contribute to the varied manifestations of the syndrome. © 1994 Wiley-Liss, Inc.     

Microcystic adnexal carcinoma: an immunohistochemical reappraisal.

Even though immunohistochemical comparisons of microcystic adnexal carcinoma vs infiltrative basal cell carcinoma and desmoplastic trichoepithelioma exist, they are mostly restricted to the use of a single stain. In addition, a comparison with squamous cell carcinoma has not been reported previously. In this study, we compare the expression of cytokeratin (CK) 15, CK7, CK20, CK903, carcinoembryonic antigen (CEA), CD10, CD15 and BerEP4 in 13 microcystic adnexal carcinoma, eight desmoplastic trichoepithelioma, 10 infiltrative basal cell carcinoma, and eight squamous cell carcinoma of which five exhibited ductal differentiation. We found that the majority of microcystic adnexal carcinoma (92%) and desmoplastic trichoepithelioma (100%) cases expressed CK15 while the infiltrative basal cell carcinoma and squamous cell carcinoma cases were all negative. Forty percent of infiltrative basal cell carcinoma expressed CK7; while only two microcystic adnexal carcinoma cases (15%) and one squamous cell carcinoma with ductal differentiation (12%) expressed CK7 in the remaining three tumor categories. None of the desmoplastic trichoepithelioma expressed CK7. All tumors were strongly positive for CK903. While the neoplastic cells were negative, luminal staining of ductal structures was noted for CK7, CD15 and CEA in some of the microcystic adnexal carcinoma, desmoplastic trichoepithelioma and squamous cell carcinoma with ductal differentiation cases. Sixty percent of infiltrative basal cell carcinoma, 31% of microcystic adnexal carcinoma, and 25% of squamous cell carcinoma express CD10. BerEP4 expression was noted in 38% of microcystic adnexal carcinoma, 57% of desmoplastic trichoepithelioma, 100% of infiltrative basal cell carcinoma, and 38% of squamous cell carcinoma. In conclusion, we found CK15 to be a useful marker in distinguishing microcystic adnexal carcinoma from infiltrative basal cell carcinoma and squamous cell carcinoma with ductal differentiation. Our experience indicates that microcystic adnexal carcinoma and desmoplastic trichoepithelioma have a similar immunohistochemical profile that is, CK15+ and BerEP4+/-; thus, additional studies are needed to separate these two entities.     

The fibroepithelial variant of basal-cell skin cancer (Pincus' "premalignant" fibroepithelioma)

12 cases of the basal cell carcinoma fibroepithelial variant are studied morphologically. This variant of basal cell carcinoma is erroneously diagnosed as adenoid variant of seborrheic keratosis, tubular syringoadenoma or the reverse. Main differential-diagnostic criteria allowing to distinguish a fibroepithelial variant of basal cell carcinoma from an adenoid variant of seborrheic keratosis are multicentric foci of superficial basalioma as well as the absence of hyperkeratosis and intraepithelial carcinomatous cysts. The tumour differs from tubular syringoadenoma by the lack of tubular structures with two-layer epithelial lining and cysts with signs of secretory activity.