Hybrid verrucous squamous cell carcinoma of sinonasal tract: a case report

Verrucous carcinoma is a variant of squamous cell carcinoma and should be distinguished from benign papilloma and well-differentiated nonverrucous squamous cell carcinoma. It is rare tumor of the sinonasal tract. Occasionally, conventional squamous cell carcinomatous components may be seen in verrucous carcinoma. This entity is called a hybrid verrucous squamous cell carcinoma. We report a case of hybrid verrucous squamous cell carcinoma occurring in the nasal cavity and paranasal sinus of a 67-year-old male. The removed mass shows the typical feature of verrucous carcinoma, but focally conventional squamous cell carcinomatous area is also noted. The treatment of this case follows verrucous carcinoma, but close follow up is mandatory because it may potentially spread to regional lymph nodes in contrast to pure form of verrucous carcinoma.     

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.     

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.     

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.     

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.     

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.     

Rescreening in gynecologic cytology. Rescreening of 8096 previous cases for current low-grade and indeterminate-grade squamous intraepithelial lesion diagnoses--a College of American Pathologists Q-Probes study of 323 laboratories

OBJECTIVE: To quantitate, characterize, and analyze errors identified in the rescreening of previous gynecologic cytology specimens with original diagnoses of within normal limits or benign cellular changes for current cases diagnosed as low-grade squamous intraepithelial lesion or squamous intraepithelial lesion of indeterminate grade. DESIGN AND SETTING: College of American Pathologists Q-Probes laboratory quality improvement study in 323 laboratories. MAIN OUTCOME MEASURE: False-negative rate in cases rescreened as a result of a current cytologic diagnosis of low-grade squamous intraepithelial lesion or squamous intraepithelial lesion of indeterminate grade. RESULTS: A total of 8096 smears performed within the 5 years preceding the current examination were rescreened. Of the rescreened cases, 284 (3.5%) were reclassified as a squamous intraepithelial lesion or carcinoma, 474 (5.9%) as atypical squamous cells of uncertain significance, 7 (0.09%) as atypical glandular cells of uncertain significance or glandular intraepithelial lesion, and 39 (0.5%) as unsatisfactory. Ninety-three percent (261/280) of all false-negative cases were identified in cases from the previous 3 years. CONCLUSION: Rescreening archival cytology cases previously diagnosed as within normal limits or benign cellular changes for current cases diagnosed as low-grade squamous intraepithelial lesion or squamous intraepithelial lesion of indeterminate grade will identify screening and diagnostic errors. This may be a useful quality improvement monitor in many laboratories.     

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.     

Carcinoma of scrotum

Twelve patients with carcinoma of the scrotum were evaluated: 9 with squamous carcinoma and 3 with basal cell carcinoma. The presenting complaint was a visible skin lesion; the interval between awareness of this lesion and diagnosis averaged 3.3 years. Three of the 12 patients were black, although this disease previously has been considered rare in blacks. No occupation predominated among the patients in this series, and scrotal carcinoma today may occur as a result of nonspecific factors such as poor hygiene and chronic irritation, rather than industrial exposure. Only 5 of 12 patients were disease-free after treatment; 5 of the others died of squamous carcinoma, 1 died of a postoperative complication, and 1 was lost to follow-up. The most significant correlative with survival was stage at initial diagnosis, indicating the need for a high index of suspicion regarding lesions of the scrotum.     

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.     

Primary basal cell carcinoma of the limbal conjunctiva

BACKGROUND: The authors describe a 66-year-old man with primary basal cell carcinoma of the conjunctiva. He presented with a fleshy nodular conjunctival lesion of 4 months' duration, located at the nasal limbus of the left eye. No associated cutaneous lesions were present. RESULTS: The lesion was completely excised, and results of histopathologic examination showed a primary basal cell carcinoma of the conjunctiva. CONCLUSION: This report provides clinicopathologic evidence that primary basal cell carcinoma can rarely occur in the conjunctiva. The authors summarize two well-documented previously reported cases of this unusual lesion.     

Myasthenia gravis and primary squamous cell carcinoma of the thymus

Occurrence of primary squamous cell carcinoma of the thymus gland in a 65-year-old man with myasthenia gravis is reported. Histologic and immunohistochemical studies confirmed the diagnosis of a differentiated squamous cell carcinoma. Extensive clinical investigations ruled out another primary site for the tumor. The patient made a full recovery postoperatively. Only three cases of primary squamous cell carcinoma of the thymus gland in association with myasthenia gravis have been reported in the literature.     

Penile cancer in Taiwan--20 years' experience at National Taiwan University Hospital

To analyze the characteristics and prognostic factors of penile cancer in Taiwanese, we retrospectively reviewed the clinical data of patients with a diagnosis of penile cancer treated during a 20-year period (1977-1996) at National Taiwan University Hospital (NTUH). Of 71 patients treated for penile cancer during the study period, 17 were referred from other hospitals or clinics. Our analyses focused on the 54 previously untreated patients. Growth on the penis was the main symptom in all cases. Palpable inguinal lymph nodes were found only in 14 patients. All 54 patients with primary tumors were treated surgically. Pathologic examination showed squamous cell carcinoma (SCC) in 43 cases, extra-mammary Paget's disease in three, verrucous carcinoma in three, Bowen's disease in two, cutaneous lymphoma in two and basal cell carcinoma in one. Twenty-six (48%) patients had stage I penile cancer, 13 (24%) had stage II, seven (13%) had stage III, and eight (15%) had stage IV cancer. The five-year survival rate was 78% among patients with SCC and 84% among those with nonsquamous malignancies (p = 0.80). The five-year cumulative survival rates according to Jackson's cancer stage were 100% for patients with stage I, 88.9% for those with stage II, 66.7% for those with stage III, and 0% for those with stage IV (p < 0.001). Tumor staging (p = 0.027) and adjuvant chemotherapy (p = 0.042) were found to be the most significant prognostic factors. Penile cancer accounted for 0.254% of all malignancies among male patients at the NTUH during the study period. Our findings indicate that penile cancer is uncommon in Taiwanese and its prognosis is closely related to tumor staging and management. Early diagnosis and appropriate treatment may lead to prolonged survival.     

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.     

Squamous cell carcinoma in situ involving mesonephric remnants. A potential diagnostic pitfall

A case of uterine cervical squamous cell carcinoma in situ (CIS) in which there was extensive endocervical glandular involvement was found to have, in addition, a deep-seated squamous epithelial lesion within the cervical stroma. Because of the deep location of this lesion, which was composed of nests of pleomorphic squamous epithelial cells, found at a site not usually occupied by endocervical glands, it was initially thought to be an invasive squamous cell carcinoma (SCC). However, on review it was found that there was CIS in the deep cervical stroma that appeared to involve small tubular structures and dilated ducts that were lined by mucin-free cuboidal epithelial cells. There was no stromal reaction to this lesion. Tubules had a poorly defined lobular arrangement and had intraluminal bright eosinophilic hyaline material. Tubular epithelial cells demonstrated immunohistochemical staining for low-molecular-weight keratin (LMWK) and vimentin but showed no staining for carcinoembryonic antigen (CEA) and high-molecular-weight keratin (HMWK). It was apparent that these tubular structures and ducts were mesonephric remnants and that this lesion represented involvement of mesonephric remnants by CIS. Although involvement of endocervical glands by CIS is well recognized, a similar lesion involving mesonephric remnants has not been previously described. Familiarity with the histological features of these lesions is essential to avoid a misdiagnosis and potential mismanagement.     

Squamous cell carcinoma arising in thyroglossal duct remnant cyst epithelium

The extremely rare occurrence of invasive squamous cell carcinoma arising from normal epithelial lining of a thyroglossal duct remnant cyst is documented by demonstrating the histopathologic transition from normal squamous epithelium to squamous cell carcinoma. The requirements that must be fulfilled to accept a lesion as arising de novo from the epithelial lining are outlined, and all requirements are achieved. The lesion is differentiated from the less rare papillary or papillary-follicular adenocarcinoma of residual thyroid tissue of the thyroglossal duct tract remnants. This is the sixth report in the world literature of invasive squamous cell carcinoma arising from benign thyroglossal remnant squamous epithelium, and the second demonstrating the transition from normal squamous epithelium to invasive squamous cell carcinoma.     

Necrotizing sialometaplasia: literature review and presentation of five cases

Necrotizing sialometaplasia is a benign, ulcerative, inflammatory process of the minor salivary glands, primarily found in the hard palate. It is often mistaken clinically and histologically for a malignant tumor (that is, mucoepidermoid or squamous cell carcinoma). The lesion heals spontaneously in six to 12 weeks. It occurs primarily in persons between the ages of 40 and 60 and has been reported more frequently in men than women. In necrotizing sialometaplasia the squamous metaplasia and tissue necrosis is confined to the existing ductal and lobular pattern of the salivary glands, a unique characteristic that aids in diagnosis. Five additional cases are presented.     

Histochemistry of mucin secreting components in mucoepidermoid and adenosquamous carcinoma of the oesophagus

AIMS: To determine the direction of differentiation of the mucin secreting components in a rare group of oesophageal tumours--oesophageal squamous cell carcinomas with prominent mucin secreting components (mucoepidermoid carcinomas and adenosquamous carcinomas). METHODS: In a review of 617 cases of primary carcinoma of the oesophagus, 16 cases of squamous cell carcinoma with prominent mucin secreting components were studied using a battery of histochemical techniques. RESULTS: The mucin produced by these tumours was mixed and included a variable content of enzyme labile sialomucin (positive for mucicarmine, periodic acid Schiff, and alcian blue, and sensitive to sialidase digestion and negative for high iron diamine-alcian blue). Retrospective analysis of endoscopic biopsy specimens taken from these tumours showed that mucin was present in five (42%) cases. CONCLUSIONS: The glandular component of this group of tumours histochemically differentiated in the direction of oesophageal glands: examination of the mucin secreting component in squamous cell carcinoma in resected specimens is therefore required for recording the true incidence of this type of tumour.