Pigmented squamous cell carcinoma of the cheek skin probably arising from solar keratosis

We report a rare case of pigmented squamous cell carcinoma (SCC) of the cheek skin probably arising from solar keratosis. An 80-year-old man was referred to our clinic because of a black skin nodule in the right cheek. The nodular lesion was 1 cm in diameter, dome-shaped, hard, sharply demarcated, partially erosive and telangiectatic at the border. The lesion was completely excised under the clinical diagnosis of probable seborrheic keratosis. Microscopically, cutaneous horn and mildly atypical squamous epithelia suggestive of previous solar keratosis were present in the surface of the lesion. The lesion consisted of atypical squamous cells with keratinization and intercellular bridges, and it was regarded as SCC. The SCC cells were seen to invade lightly into the upper dermis, where lymphocytic infiltrations and melanophages were noted. Characteristically, heavy deposition of melanin pigment was recognized in the SCC cells as well as in proliferated dendritic and pigment blockade melanocytes that were scattered or colonized within the SCC cell nests. Masson-Fontana stain revealed numerous melanin granules in the SCC cells, as well as in dendritic and pigment blockade melanocytes. Immunohistochemically, the SCC cells were positive for cytokeratins and epithelial membrane antigen, and negative for S-100 protein and HMB45 antigen. Dendritic and pigment blockade melanocytes were negative for cytokeratins, epithelial membrane antigen, and HMB45 antigen, but positive for S-100 protein. The present case suggests that SCC cells of the skin may induce proliferation of melanocytes. The differential diagnosis and the histogenesis of pigmented SCC of the skin are discussed.     

耳内镜在治疗外耳道胆脂瘤中的应用

目的 探讨耳内镜下治疗外耳道胆脂瘤的可行性和效果。方法 对26例外耳道胆脂瘤患者，在局麻耳内窥镜下清除胆脂瘸。结果 随访1—5年，仅有1例胆脂瘤复发。结论 耳内镜下治疗外耳道胆脂瘤有较好的效果，其有清晰度高、照明度好、保留结构功能好等优点，值得临床推广应用。     

食管鳞状细胞癌中VEGF与肿瘤浸润性树突状细胞的关系

目的探讨食管鳞癌中血管内皮细胞生长因子(vascu lar endothelial growth factor,VEGF)与肿瘤浸润性树突状细胞(tumor infiltrated dendritic cell,TIDC)的关系。方法运用原位杂交和免疫组化方法检测食管鳞癌组织中VEGF蛋白和mR-NA的表达、S-100蛋白标记的TIDC的密度。结果(1)46例食管鳞癌组织中VEGF蛋白在不同浸润深度、不同转移状态的肿瘤中表达阳性率差异有显著性。(2)食管鳞癌中S-100蛋白阳性树突状细胞(dendritic cell,DC)平均密度为(19.83±13.91)个/HP;不同分化肿瘤之间S-100蛋白阳性TIDC密度分别为(18.50±17.27)个/HPF、(28.08±14.05)个/HPF、(15.740±10.38)个/HPF,差异有显著性;不同浸润深度的肿瘤之间TIDC密度分别为(32.78±16.60)个/HPF、(15.20±11.96)个/HPF、(19.83±13.92)个/HPF,差异有显著性;VEGF阳性组TIDC密度为(14.93±12.83)个/HPF,显著低于VEGF阴性组的(26.79±12.61)个/HPF,VEGF表达与DC密度之间存在显著的负相关性(r=-0.462)。结论(1)VEGF蛋白表达和食管鳞癌浸润转移之间有一定的相关性。(2)首次探讨了食管鳞癌中DC密度与VEGF蛋白表达之间的关系,发现VEGF影响鳞癌组织中DC的密度,可能影响宿主的抗肿瘤免疫能力和肿瘤的浸润转移。     

Comparative study of the external auditory canal in humans and large mammals

Given the limited source of human external auditory canal (EAC) skin, animal experiments remain an important approach for studying functional EAC reconstruction. However, differences between humans and animals in terms of the general EAC structure, histological characteristics of EAC skin, and cell markers of its specific glands in cartilaginous EAC skin remain unknown. We compared the characteristics of the EAC between humans and large animals, as a basis for appropriate animal model selection. Temporal bone computed tomography was used to compare the EACs of humans, goats, pigs, and dogs. EAC skin samples were harvested and their histological characteristics evaluated. The skin's ultrastructure and the histological structure of specific glands and cell markers related to cell phenotype and function were further identified. The EAC structure in goats was similar to that in humans in terms of diameter, length, and cartilaginous segment ratio of the EAC, while that of pigs and dogs differed markedly. Furthermore, histological evaluation showed that there were abundant ceruminous and sebaceous glands in the goat's cartilaginous skin, while dogs and pigs showed notably fewer of these glands in cartilaginous skin than humans. Nevertheless, ceruminous glands in all species studied showed similar expression of cell biomarkers and secretion function. Goats might have advantages in terms of surgery and reconstruction of the functional EAC skin compared to dogs and pigs and can be a useful candidate for ceruminous gland cell sources.     

Distinct compartmental distribution of mature and immature dendritic cells in esophageal squamous cell carcinoma

Dendritic cells (DCs) play a critical role in generating anti-tumor immunity. DC functional defect has been related to the growth and progression of various human cancers. In esophageal squamous cell carcinoma (ESCC), the examination of DCs using immunohistochemistry (IHC) with anti-S100 antibody has demonstrated an increased infiltration of DCs into the tumor mass, however, the distribution patterns of DCs at different maturation states in ESCC are not fully evaluated. In this study, we immunohistochemically analyzed the DC maturation status by examining the S100-positive DCs, CD1α-positive immature DCs (iDCs), and CD208-positive mature DCs (mDCs) and their distribution patterns in 45 ESCCs and 10 control tissues. The IHC analysis showed that the number of S100-positive DCs was increased in both the cancer epithelium and tumor stroma. Further phenotypic analyses revealed that intraepithelial DCs in the cancer mass were predominantly CD1α-positive iDCs. Whereas DCs presented in the tumor stroma were exclusively CD208-positive mDCs, CD208-positive mDCs were particularly dense in the margin of cancerous lesions and formed clusters with CD3-positive lymphocytes. The number of CD208-positive mDCs in the tumor mass was significantly lower than the number of CD1α-positive iDCs. The current results suggest that ESCC tissue comprises a high frequency of iDCs in the cancerous epithelium and a low density of mDCs in the tumor stroma. Such a distinct distribution pattern may reflect the ongoing DC tracking in ESCCs.     

Adenoid squamous cell carcinoma of the larynx: an uncommon histological variant of squamous cell carcinoma

Adenoid squamous cell carcinoma (ASCC) or acantholytic squamous cell carcinoma is a well-recognized variant of squamous cell carcinoma. ASCC commonly occurs in the sun-exposed areas of the skin and has only rarely been observed in mucosal sites. We report a case of ASCC in the larynx of a 75-year-old man with a history of odynophagia and dysphonia of 3 months' duration that presented as an exophytic lesion on the right vocal cord. Biopsy was performed and the histological diagnosis was squamous cell carcinoma. Treatment consisted of total laryngectomy and radical neck dissection. Microscopically, the tumor showed a prominent alveolar pattern with cystic degeneration of the neoplastic epithelium and formation of pseudoglandular structures. In the lumina there were acantholytic cells. Transition areas from conventional squamous cell carcinoma to adenoid pattern were found. To the best of our knowledge this is only the third case of ASCC reported in the larynx. We reviewed the nine mucosal ASCCs of the upper aerodigestive tract reported. The assertion that these tumors are associated with an aggressive behavior and poor prognosis cannot be estimated in this review as the number of cases is small and the tumors are located in different places.     

Mixed tumor of the external auditory canal

A mixed tumor with apocrine differentiation seen in the r external auditory canal of a 39 year old male is reported. The i well demarcated polypoid tumor showed proliferation of elongated gland-like or duct-like structures lined by two rows of epithelial cells, occasionally accompanied by foci of kera-tinization. There were fat cells in the myxoid stroma, in which no chondroid elements were seen. This neoplasm is considered to have arisen from the ceruminous gland, the modified apocrine gland of the skin.     

Coexistence of primary squamous cell carcinoma of thyroid with classic papillary thyroid carcinoma

Primary squamous cell carcinoma of the thyroid gland is very rare and its histogenesis is poorly defined so far. Although there have been some cases of squamous cell carcinoma with variant types of papillary thyroid carcinoma (PTC), the present case is the first primary squamous cell carcinoma with classic PTC to be reported. A 43‐year‐old woman presented with a 20 year history of neck mass. Neck ultrasound indicated a 6 × 4 × 3 cm large mass. The patient underwent total thyroidectomy. Histopathology indicated a well‐differentiated squamous cell carcinoma and squamous metaplasia in conjunction with classic PTC. On immunohistochemistry cytokeratin 7 was positive in papillary carcinoma and squamous metaplasia, thyroglobulin was positive only in papillary carcinoma, and p63 was positive in squamous metaplasia and squamous cell carcinoma. Postoperatively, the patient received 59.4 Gy adjuvant radiotherapy, hormonal therapy and radioactive iodine therapy. At 8 months after surgery the patient remained disease free.     

含有鳞状细胞癌成分的乳腺化生性癌临床病理特征

目的探讨含有鳞状细胞癌成分的乳腺化生性癌(metaplastic carcinoma with squamous cell component,MCSC)的临床病理特征和免疫表型特点。方法复习20例MCSC的临床病理资料,总结其巨检、组织学、免疫表型和预后特点。结果本组肿瘤中纯鳞状细胞癌(squamous cell carcinoma,SCC)6例、腺鳞癌(adenosquamous carcinoma,ASC)13例、癌肉瘤1例。全组平均发病年龄52·4岁,多表现为无痛性乳腺肿块。SCC和ASC腋淋巴结转移率分别为60%和66·7%。巨检45%病例呈囊性。镜下角化型SCC2例、棘层松解型1例、角化与棘层松解混合型2例、角化与梭形细胞混合型1例。ASC中的SCC成分均为角化型,腺癌成分则为浸润性导管癌,仅1例混有少量黏液癌。1例癌肉瘤含有鳞癌、腺癌和软骨肉瘤成分。进行免疫组化染色病例的SCC成分均呈CK34βE12、CK5/6、CK14和p63阳性,ER、PR阴性。5例腺癌成分呈CK34βE12灶性阳性,各有1例腺癌成分灶性表达CK14和CK5/6。CK8阳性见于所有腺癌成分,仅1例SCC成分呈灶性阳性。SMA在本组肿瘤的腺鳞两种成分均呈阴性。结论MCSC以ASC最为常见,眼观呈囊性是其特点之一。SCC成分的组织学类型和分化程度存在不同程度变异。CK14、p63和CK8作为一种组合可能有助于SCC的鉴别诊断。规范诊断标准的大样本研究将会提供更有价值的临床病理资料。     

Pigmented squamous intraepithelial neoplasia of the esophagus

Squamous cell carcinoma (SCC) usually lacks melanocytes within the tumor. A few reports have documented invasive SCC or SCC in situ (intraepithelial neoplasia, IEN) with melanocytic hyperplasia within the tumor, referred to as pigmented SCC, in some organs. However, case series of pigmented SCC or IEN of the esophagus have not yet been reported. This is the first study to analyze the incidence and clinicopathological features of pigmented SCC or IEN of the esophagus. We reviewed 18 surgically-resected and 122 endoscopically-resected esophageal specimens, including 79 cases of IEN. Three cases of pigmented IEN were observed in this series, and all of them were located in the middle to lower third of the esophagus. Two of 3 cases had melanocytosis in the non-neoplastic squamous epithelium around the IEN. The incidence of pigmented IEN was 2.5% of all endoscopically resected specimens and 3.8% of IEN cases. No pigmented invasive SCC was detected in both endoscopically-resected and surgically-resected specimens. The mechanism of pigmentation of esophageal IEN is unknown. However, production of melanocyte chemotactic factors by tumor cells has been demonstrated in pigmented SCC of the oral mucosa. Moreover, two of 3 cases of pigmented IEN in the present series had melanocytosis in the non-neoplastic squamous epithelium, and melanocytosis is thought to be associated with chronic esophagitis, therefore, it has been hypothesized that various stimuli can cause pigmentation in squamous epithelium. Additional studies are needed to clarify the mechanism of pigmentation in squamous IEN of the esophagus.     

Small cell type neuroendocrine carcinoma colliding with squamous cell carcinoma at esophagus

Collision tumor is an extremely rare tumor which defined as the concrescence of two distinct primaries neoplasms. We report here a case of collision tumor at lower third esophagus composed of small cell type neuroendocrine carcinoma (NEC), which is an very rare, highly aggressive and poorly prognostic carcinoma and squamous cell carcinoma (SqCC). In our case, pathologically, the small cell carcinoma display the characteristic of small, round, ovoid or spindle-shaped tumor cells with scant cytoplasm, which colliding with a moderately differentiated squamous cell carcinoma. Immunohistochemical staining demonstrated positive activities for CD56, synaptophysin, 34βE12, CK 5/6, ki-67 (70%-80%), but negative for CD99, chromogranin A, and TTF-1. Accurate diagnosis was made base on these findings.     

Autosomal dominant atresia of the auditory canal and conductive deafness

We report autosomal dominant atresia and/or stenosis of the external auditory canal with or without conductive deafness. In the family described here the anomaly had occurred in 12 individuals in five generations. Penetrance was very high, expressivity quite variable. The clinical, audiometric, radiographic, and operative findings in three patients (grandfather, father, and son) are presented. This condition has been reported only once previously.     

Papillary squamous cell carcinoma of the mandibular gingiva

Papillary squamous cell carcinoma (PSCC) has rarely been reported in the oral cavity. Herein reported is a case of PSCC in the mandibular gum. A 70-year-old man consulted our hospital because of a papillary tumor in the left mandibular gum. Physical examination revealed an exophytic papillary tumor of the left mandibular gum, and an excision of the tumor was performed. Grossly, the tumor was exophytic and papillary, and measured 1 x 1 x 0.8 cm. Microscopically, the tumor showed exophytic papillary proliferation with fibrovascular cores and consisted of atypical squamous epithelial cells. The tumor cells showed hyperchromasia, nuclear atypia, mitotic figures, apoptotic bodies, cancer pearls, and individual keratinization. Mild stromal invasion was seen. Immunohistochemically, the tumor cells were positive for pancytokeratin AE1/3, pancytokeratin CAM5.2, p63, p53, and Ki-67 (labeling index=40%), but negative for human papilloma virus (HPV). HPV in situ hybridization revealed no signals. Therefore, PSCC was diagnosed. The lateral and vertical margins are negative for tumor cell. The pathological diagnosis was PSCC. The patient was healthy and free from tumor three months after the operation.     

Follicular dendritic cell sarcoma mimicking giant cell carcinoma of the pancreas

Extranodal follicular dendritic cell (FDC) tumors are rare. Recognition of the morphological spectrum of FDC tumors is important to clinical diagnosis. Herein is presented a case of pancreatic FDC sarcoma with unusual clinicopathological features. A 64-year-old male patient presented with weight loss, poor appetite, abdominal fullness, mild anemia and mild peripheral eosinophilia. Histologically, the tumor was composed of both epithelioid and spindle cells with abundant intracytoplasmic hyaline globules. These tumor cells were positive for CD21, CD23, CD35, S-100 protein, fascin and clusterin. Both epithelioid and spindle tumor cells independently colonized the liver and formed two tumor nodules 18 months after the initial resection. Notably, the two hepatic metastases additionally acquired patchy expression of human leukocyte antigen-DR. The epithelioid FDC in one of the hepatic lesions transformed into numerous bizarre giant cells, which could easily be confused with a metastatic giant cell carcinoma from the pancreas. FDC tumor should therefore be included in the differential diagnoses when dealing with a giant cell tumor.