Changes in pain sensitivity during neurosis in rats]

OBJECTIVE: Few cases of verrucous carcinoma of the penis with foci of invasive squamous cell carcinoma have been reported and denominated "hybrid tumors". The accuracy of this term is discussed in this paper. METHODS/RESULTS: A huge penile mass in a patient that had undergone three previous operations for lesions diagnosed as verrucous carcinoma is reported. Partial penectomy was performed. Histological examination showed a very well-differentiated squamous cell carcinoma. PCR (polymerase chain reaction) did not detect any type of human papillomavirus (HPV) in the tumor. CONCLUSIONS: Verrucous carcinoma is a strictly-defined lesion with a different biological behaviour from that of squamous carcinoma. Preoperative deep biopsy may miss the squamous cell carcinoma. Definitive diagnosis can only be achieved by histological examination of the surgical specimen. In future, DNA studies could possibly support preoperative diagnosis of this lesion.     

Use of an electric ear syringe in the emergency department

Verrucous carcinoma is a rare, highly keratinizing variant of squamous cell carcinoma of the skin or mucosae characterized by a local aggressiveness but a low potential for metastasis. The plantar form is also known as epithelioma cuniculatum. Fingers and toes are rarely affected, and tumors of the nail bed are exceptional. Clinically, the lesion presents like a wart and is then often misdiagnosed. Treatment of choice is wide surgical excision. A case of verrucous carcinoma of the nail apparatus is presented, and diagnosis is discussed.     

Histological appearances and nuclear DNA content of verrucous squamous cell carcinoma of the larynx

Of the 12 cases of verrusous squamous cell carcinoma of the larynx encountered since 1968 at the Department of Otolaryngology of Padua University (including the Verona Section) and the Department of Pathologic Anatomy of the University of Trieste, three are reported, together with an investigation of the nuclear DNA content of the tumour cells. It is suggested that such a study may assit with early detection of verrucous carcinoma. The laryngeal localization of the neoplasm has been evidenced only in some centres. The difficulties in establishing a correct diagnosis for this variant of squamous cell carcinoma are emphasized and the pathomorphological features, as well as the microscopic and macroscopic appearances, are discussed. The prognosis is excellent and the therapy of choice must be only surgical, as radiation has not only proven ineffective, but in some cases has induced anaplasia, leading to a rapid dissemination of the tumour.     

Low-grade papillary transitional-cell carcinoma of the distal urethra with focal squamous differentiation and association with human papillomavirus types 6-11

OBJECTIVE: To report a case of transitional cell carcinoma of the urethra associated with human papilloma virus (HPV) infection in areas of squamous differentiation of the neoplasm. METHODS/RESULTS: A 32-year-old male with a previously treated condylomata acuminatum of the prepuce presented with a verrucous lesion in the penile meatus, corresponding to well differentiated, low grade papillary transitional cell carcinoma with squamous differentiation. Histological viral expression of HPV was confirmed by in situ hybridization. CONCLUSION: We emphasize the rare presentation of transitional carcinoma in the distal urethra associated with HPV infection.     

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-year-old Japanese woman is reported. A firm and well-circumscribed tumor, measuring 9 x 8.5 x 8.5 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 squamoid islands with gradual transition to the spindle cell component. The immunocytochemical expression of epithelial markers was recognized in the spindle cells, as well as in the carcinomatous cells. Moreover, the spindle cell component expressed vimentin, alpha-smooth muscle actin and S-100 protein. Ultrastructurally, in addition to the features of adenocarcinoma, squamous or myoepithelial differentiation was confirmed in the spindle cell component. These findings thus suggest an epithelial origin with squamous differentiation and myoepithelial 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 overexpression 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.     

Verrucous carcinoma of the oral cavity: management by radiotherapy and surgery

Verrucous carcinoma is a distinct nonmetastasizing variant of well differentiated squamous cell carcinoma. It is frequently found in the oral mucosa, often in association with the more common type of metastasizing squamous cell carcinoma. In many centres radiotherapy is not used to treat verrucous carcinoma because this tumour is thought to be radioresistant and because "anaplastic transformation" has been reported following such therapy. In a series of 37 patients, 30 received radiotherapy, either alone or combined with surgery. Anaplastic transformation was not encountered. The best results were obtained with aggressive treatment which included both surgery and radiotherapy.     

Verrucous carcinoma of the oral cavity. A review of forty-nine cases

Verrucous carcinoma is a distinctive, extremely well-differentiated, slow-growing variant of the squamous cell carcinoma. Forty-nine cases of this neoplasm were gathered from the Oral Pathology Service at the Emory University School of Dentistry from 1965 to 1979. The most common site of occurrence was the buccal mucosa, followed by the mandibular alveolar ridge and gingiva. The majority of our patients were between the ages of 50 and 80 years, and most of them were Caucasians. Although most other series of oral verrucous carcinoma show a male predominance, almost 60 percent of our cases occurred in females. The role of radiation therapy in treatment of oral verrucous carcinoma is controversial, and adequate surgical excision appears to be the treatment of choice.     

Atypical squamous cell carcinoma of the larynx and hypopharynx: radiologic features and pathologic correlation

The objective of this study was to analyze the radiologic features of atypical forms of squamous cell cancer and correlate them with clinical, endoscopic, and histopathologic findings. The CT and MRI images of 31 patients with atypical forms of squamous cell carcinoma were reviewed retrospectively and the radiologic findings were correlated with clinical, endoscopic, and histopathologic findings. Histopathologic diagnoses included undifferentiated carcinoma of nasopharyngeal type (n = 8), verrucous carcinoma (n = 18), spindle cell carcinoma (n = 3), and basaloid cell carcinoma (n = 2). Undifferentiated carcinoma of nasopharyngeal type was located in the supraglottis or piriform sinus beneath an intact mucosa and initial endoscopic biopsy was most often negative. The discrepancy between an intact mucosa at endoscopy and a solid mass with homogenous enhancement at CT or MRI was characteristic for these tumors and warranted further investigations to obtain the definitive histologic diagnosis. Verrucous carcinoma displayed characteristic clinical, radiologic, and pathologic features, namely, an exophytic tumor arising from the glottic level displaying a rugged surface with finger-like projections but with only minor submucosal infiltration. Spindle cell carcinoma appeared as a polypoid mass with a thin stalk arising from the supraglottis. Basaloid cell carcinoma displayed a distinct lobulated enhancement pattern which was observed on contrast-enhanced T1-weighted SE images. Although the MR and CT features of atypical forms of squamous cell carcinoma cannot be considered pathognomonic they should raise the differential diagnosis even if endoscopic biopsy has been negative. The radiologist's awareness of the appearance of these unusual tumors on CT and MR images may greatly facilitate the diagnostic work-up and helps to guide the endoscopist to the adequate biopsy site in order to establish the correct diagnosis.     

Prevalence of human papillomavirus types 16 and 18 in penile carcinoma: a study of 41 cases using PCR

AIMS: To determine retrospectively the prevalence of human papillomavirus (HPV) types 16 and 18 in penile carcinomas. METHODS: Forty one surgically resected penile carcinomas from the archives at Queen Mary Hospital, Hong Kong, were reviewed and classified into verrucous carcinoma, and well, moderately, and poorly differentiated squamous cell carcinomas. Paraffin wax embedded tumour tissue was sectioned and analysed for HPV 16 and HPV 18 using the polymerase chain reaction with type specific internal probes. RESULTS: There were seven verrucous carcinomas, and 11 well, 17 moderately, and six poorly differentiated squamous cell carcinomas. Six of the 41 (15%) patients had penile carcinoma containing HPV 16 or HPV 18 DNA, or both, with HPV 16 found in four (10%) and HPV 18 in four (10%). The mean ages of HPV positive and HPV negative groups of patients were 68.5 and 57.6 years, respectively (p < 0.05). None of the seven verrucous and 11 well differentiated squamous cell carcinomas was positive for HPV. The mean age of patients who had these carcinomas was 52.4 years. As a group, these low grade carcinomas occurred in patients younger by more than a decade than those who had carcinomas of the higher grades (mean age 64.4 years; p < 0.01). CONCLUSIONS: Penile carcinomas had much lower rates of infection by HPV 16 or HPV 18 than cervical carcinomas in this Hong Kong population. Based on our findings and on data collated from published findings, it is concluded that penile verrucous carcinomas are not associated with HPV 16 and HPV 18. The overall low prevalence of HPV 16 and HPV 18 in penile carcinomas suggests that other HPV types might be important in the pathogenesis of these tumours.     

Squamous cell carcinoma of the gingiva in an HIV-positive patient: a case report

This article presents a case of gingival squamous cell carcinoma in a patient who was HIV positive but who had no history of pan chewing, smoking, alcohol consumption or nutritional deficiency. Investigations also revealed the presence of superimposed pseudomembranous candidiasis. The case reported reveals that squamous cell carcinoma of the gingiva may occur as an oral manifestation of AIDS.     

5-hydroxytryptamine1A receptor-mediated effects on adenylate cyclase and nitric oxide synthase activities in rat ventral prostate

AIM: To investigate the patterns of expression of transforming growth factor alpha (TGF-alpha) and epidermal growth factor receptor (EGFR) in squamous metaplasia and squamous cell carcinomas of the urinary bladder with and without schistosomiasis. METHODS: Immunohistochemical study of the expression of TGF-alpha and EGFR in squamous metaplasias (n = 12) and various grades of squamous cell carcinomas (n = 21) of the bladder with and without schistosomiasis. RESULTS: Focal cytoplasmic and membranous positivity for EGFR and TGF-alpha was seen in all cases of squamous metaplasia. The markers were diffusely coexpressed in a concordant pattern in areas of hyperplastic keratinising squamous metaplasia. A similar pattern of positivity was seen in verrucous carcinomas (n = 2) and well differentiated squamous carcinomas (n = 6). Progressive loss of differentiation was associated with increasing loss of EGFR staining while TGF-alpha staining was retained. Squamous cell carcinoma in situ (n = 2) showed focal positivity for TGF-alpha and EGFR. There were no differences in staining patterns between cases with and without schistosomiasis. CONCLUSIONS: The coexpression of TGF-alpha and EGFR by well differentiated squamous cell carcinomas and hyperplastic keratinising squamous metaplasia is consistent with the active regulatory role exerted by this autocrine loop. There is regional absence of expression of EGFR but not of TGF-alpha in squamous cell carcinomas of lesser differentiation, suggesting heterogeneity of such control in these tumours. The focal expression of the two markers in squamous cell carcinomas in situ indicates a possible second pathway of oncogenesis for less differentiated tumours. These observations may have important implications for the effectiveness of putative growth factor based treatments.     

The sign of Leser-Trelat associated with esophageal carcinoma

A 79-year-old woman was admitted to our hospital with complaints of dysphagia and multiple verrucous papules that had developed over the previous year. The diagnosis of esophageal carcinoma was based on upper gastrointestinal radiography and endoscopic examination with biopsy. The clinical syndrome was consistent with the sign of Leser-Trelat associated with esophageal carcinoma. Although radiation therapy and chemotherapy were undertaken, the patient died 8 months later because of the sign of Leser-Trelat in association with squamous cell esophageal carcinoma.     

Biomechanical analysis and clinical treatment of blunt renal trauma

Moesin, one of the ERM (ezrin; radixin; moesin) family members, is directly associated with the cytoplasmic domain of CD44, which is now thought to be related to the metastatic potential of tumor cells. Using immunohistochemistry we investigated the expression of moesin in normal epidermis and various kinds of epithelial skin tumors: squamous cell carcinoma, verrucous carcinoma, Bowen's disease, solar keratosis, keratoacanthoma, basal cell carcinoma, and extramammary Paget's disease. Normal skin showed positive epidermal staining for moesin with the exception of the stratum corneum. The expression of moesin varied with the type of skin tumor. In basal cell carcinoma, Bowen's disease, and extramammary Paget's disease, moesin expression was either faint or negative. In contrast to Bowen's disease, invasive squamous cell carcinoma showed more intense and heterogeneous staining of the cytoplasm and the cell membrane. Verrucous carcinoma was weakly positive, with a tendency for the moesin to be distributed in the cell membrane. The staining pattern of moesin varied among the different kinds of epithelial skin tumors, and its expression was generally similar to that of the standard form of CD44. These results suggest that moesin is closely inter-related with CD44 in epithelial skin cells as seen in other cellular systems, and that the variable pattern of moesin staining among the skin tumor cells could reflect expression disorders associated with the transformation.     

Simultaneous manifestation of squamous cell carcinoma in identical twins with epidermolysis bullosa

We report a case of identical twins with recessive dystrophic epidermolysis bullosa, who developed squamous cell carcinoma in the hand at the latter half of their third decade. To our knowledge, this is the first case of manifestation of squamous cell carcinoma in identical twins and may contribute to the understanding of oncogenesis in such patients.     

Human pancreatic RNase1-human epidermal growth factor fusion: an entirely human 'immunotoxin analog' with cytotoxic properties against squamous cell carcinomas

The gene encoding human pancreatic ribonuclease 1 (hpRNasel) was fused with a gene encoding human epidermal growth factor (hEGF). The hybrid human protein was isolated from Escherichia coli inclusion bodies, refolded and purified to homogeneity. The fusion protein competed with 125I-hEGF for binding to hEGF receptors (EGFR) and had ribonucleolytic activities approaching those of hpRNase1. Several conformations having different enzymatic activities could be detected after reversed-phase high-performance liquid chromatographic analysis, the less hydrophobic molecules being the most active. The hybrid protein was specifically cytotoxic to A431, an EGFR overexpressing squamous carcinoma cell line, with an IC50 of approximately 10(-7) M. In contrast, recombinant hpRNase1 had an IC50 higher than 10(-4) M. A mixture of free hEGF and free hpRNasel was not more cytotoxic than hpRNasel alone and no cytotoxicity was detected in EGFR-deficient control cells. Taken together, these data suggest that this construct might be useful for targeted therapy of esophageal, lung and other squamous cell carcinomas and also breast cancers overexpressing EGFR, which correlate with a poor prognosis and cannot be cured by surgery alone. Engineering hybrid molecules with endogenous human proteins for targeted therapy may alleviate the dose-limiting immunogenicity and toxicity of conventional immunotoxins.     

The 1st case in Spain of detection of occult squamous carcinoma using LIFE system

LIFE system (lung imaging fluorescence endoscope) is a new system of detection for early lung cancer using a He-Cd laser through a conventional fiberoptic bronchoscope. This system is able to capture and processing the autofluorescence from the bronchial mucosa and to show it in a video screen in real time. In the screen the normal tissue appears in green colour and the neoplastic tissue in brown colour. The first studies performed with LIFE system show the same specificity of the conventional bronchoscopy but the sensibility is 50% higher. In this paper we present the first case of detection of a occult squamous cell carcinoma with sputum and bronchial aspiration cytology positive for carcinoma but chest X ray, CT scanner and bronchoscopy negative for lung cancer. The LIFE system was able to detect carcinoma in the carina.     

Trace analysis of benzalkonium chloride on skin by flow injection ionspray mass spectrometry-mass spectrometry

We report a case of symptomatic hypercalcemia in a patient with muscle-invasive, resectable squamous cell carcinoma of the bladder. Serum parathyroid hormone was consistent with secretion of parathyroid hormone-related protein. After radical cystoprostatectomy, calcium levels returned to normal. Patients with squamous cell carcinoma and an abnormal serum calcium level may have localized disease and should not be denied definitive local therapy.     

The multicentric occurrence of squamous epithelial dysplasia and squamous cell carcinoma in the esophagus

BACKGROUND: The biologic significance of esophageal dysplasia has not yet been completely elucidated, especially regarding the process of multiple occurrences of squamous cell carcinoma. METHODS: The multiplicity of dysplasia in 73 patients with solitary carcinoma of the esophagus (Group I) and 21 with multiple carcinomas (Group II) was compared in surgically resected specimens. RESULTS: Thirty-nine second carcinomas were identified in 13 patients of Group II, and all were superficial. The incidences of five or more isolated dysplasias in cases without continuity to a carcinomatous lesion, was 6.8% and 66.7% in Groups I and II, respectively (P < 0.01). In a case with three or more carcinomas, the incidence increased to 84.6%. The coexistence of all grades of isolated dysplasias was observed in 10 patients (47.6%) in Group II but in only 6 patients (8.2%) in Group I (P < 0.01). CONCLUSIONS: These findings suggest that various degrees of evolving biologically related lesions, such as dysplasia and carcinoma, can occur multicentrically in the same esophagus.     

Metastasis of carcinoma of cervix uteri to convexity meningioma

A cerebral collision tumor in which a convexity meningioma was invaded by a metastatic squamous cell carcinoma of the cervix uteri is described. This is the first time such a lesion has been reported to invade a cerebral meningioma. The patient lived three active years postoperatively until the lesion recurred. Her status then deteriorated, and she died five years after the operation. This was a longer follow-up than any among the other 17 cases of carcinomatous metastases to meningiomas found in the literature.     

Orthostatic hypotension in organic dementia: relationship between blood pressure, cortical blood flow and symptoms

Basal cell and squamous cell carcinomas are the most common skin cancers, occurring mainly on sun-damaged skin of old persons. Basal cell carcinoma is a neoplasm of follicular germinative cells which may infiltrate and destroy adjacent tissues, but rarely metastasizes. Five clinico-pathologic types of basal cell carcinomas can be recognized, namely, nodulo-ulcerative, superficial, morpheiform, fibroepithelial, and infundibulo-cystic. Actinic keratosis and Bowen's disease are intrepidermal proliferation of atypical keratinocytes that eventually may progress to become over squamous cell carcinoma. Lesions arising in sites of chronic injury or scarring bear an higher risk of metastases. Keratoacanthoma is a rapidly evolving tumor of keratinocytes that resolves spontaneously. Keratoacanthoma might represent a self-healing type of squamous cell carcinoma.