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Photographic image of the patient with a large mass having a verrucous surface and ulceration on the right maxillary gingiva and palate.
Source publication
Rationale:
Acantholytic squamous cell carcinoma (ASCC) is an uncommon histopathologic variant of squamous cell carcinoma (SCC), which is the most common malignancy of the oral cavity. Though ASCC showed poor prognosis, the exact diagnosis is challenging.
Patients concerns:
A 59-year-old female patient with 1-month long symptoms of pain and burni...
Context in source publication
Context 1
... 59-year-old female patient with 1-month long symptoms of pain and burning sensation in the right maxilla visited the department of oral medicine at our hospital. Clinical examination revealed an irregular hypertrophic lesion with a verrucous erythematous surface and ulceration on the right palate and edentulous gingiva of the right maxilla (Fig. 1). The pathology result of an incisional biopsy sample reported SCC and recommended re-sampling from a deeper portion of the lesion. The patient was referred to the department of oral and maxillofacial surgery where cancer work-up was performed for surgery. ...
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Pseudo-vascular adenoid squamous cell carcinoma (PASCC) is an uncommon histological variant. It is characterized by an acantholysis of the tumor cells and the formation of anastomosing spaces and channels. It gives a false appearance of glandular differentiation mimicking angiosarcoma. PASCC has been reported in the head and neck, as well as in oth...
Citations
... It is also known as a biological indicator for the poor prognosis of ASCC [1]. In a study, it was discovered that both ASCCs and angiosarcoma were cytokeratin-positive but angiosarcoma had less cytokeratin-positive tumor cells than ASCC did [8,[14][15][16][17]. Pictures of H&E staining and immunostains cytokeratin 5/6 ( Figure 4), p63 ( Figure 5), CD 34 ( Figure 6) and SMA (Figure 7) from our patient are added here. ...
... 2,3 Acantholytic SCC (ASCC) was first defined as a specific type of SCC in 1947, as a malignant epithelial tumor with a strong glandular pattern extending into the dermis, referred to as adenoacanthoma of the sweat gland. [4][5][6] It was also noted as a rare variant of SCC, with distinctive histological features compared with classic SCC, but its aggressiveness has been interpreted differently by several authors. [6][7][8][9] The clinical and radiological features of ASCC are nonspecific, the tumors are resistant to therapy, and the prognosis is poor. ...
HER2-positive acantholytic squamous cell carcinoma (ASCC) of the breast is exceptionally rare, and its clinicopathologic features are poorly understood. The impact of neoadjuvant therapy on HER2-positive breast ASCC is unclear. Here we report on a 58-year-old woman who was diagnosed with HER2-positive ASCC of the right breast, who underwent neoadjuvant treatment with albumin-paclitaxel, carboplatin, and trastuzumab, and surgery. Neoadjuvant therapy was effective, with no recurrence or metastasis after 1.5 years of postoperative follow-up.
... The acantholytic variant is characterized by histopathological features that involve a non-solid component containing either single or grouped acantholytic and dyskeratotic epithelial cells or cellular debris beneath the conventional squamous cells. This non-solid component is also known to create pseudo-glandular or pseudo-vascular structures [20]. Our histopathological specimen showed solid sheets, finger-like extensions of sheets, cords, a pseudo-glandular structure, and a papillaroid structure of squamous cells. ...
... Treatment approaches for primary OSSN have traditionally involved surgery. However, topical chemotherapy is increasingly gaining traction among corneal specialists [20]. A recent study on the standard of care in treating OSSN revealed that while 66% of corneal specialists previously relied solely on surgery for primary OSSN, this percentage decreased to 51% in 2012, with more doctors opting for medical treatments instead [21,22]. ...
Ocular surface squamous neoplasia (OSSN) is a spectrum of intraepithelial and invasive neoplastic lesions of the conjunctiva and cornea. OSSN is a rare but potentially sight-threatening ocular malignancy that can be challenging to diagnose due to its clinical and histopathological resemblance to benign ocular surface lesions. However, OSSN can lead to significant ocular and systemic morbidity, including vision loss and metastasis. Various risk factors have been identified, including ultraviolet radiation exposure, human papillomavirus infection, and immunosuppression. The histopathological analysis of the lesion is of utmost importance in diagnosing and further managing squamous cell carcinoma. The acantholytic variant of squamous cell carcinoma is uncommon. Here, we present the case of a 69-year-old male who presented with an invasive mass of progressive growth on the left eyeball extending into the visual axis. The patient underwent extended enucleation, and a histopathological analysis demonstrated a rare acantholytic variant of squamous cell carcinoma.
... Cases other than the lip were found in the gingiva, tongue, floor of the mouth, and buccal mucosa [5]. After an extensive literature review in year 2018 [5], seven more cases have been added to the literature which includes lesion associated with the upper lip, maxilla, buccal mucosa, and tongue region [8,9,11,12]. The present case is seen within the mandibular jaw. ...
Introduction:
Adenoid (acantholytic) squamous cell carcinoma (ASCC) is a histological variant of squamous cell carcinoma which occurs mainly in the sun-exposed areas of the head and neck region. It is commonly seen among males which mainly occurs in the sixth and seventh decade of life with lip being predominately affected. Limited scientific literature is documenting the intraoral presentation of ASCC in contrast to its usual extraoral lesions associated with the skin. Characteristic pseudo glandular alveolar space formation seen in ASCC often mimics carcinoma of salivary gland origin. In-depth knowledge of histopathological features of ASCC is important to diagnose this uncommon variant. Case Description. An 80-year-old female presented with the chief complaint of the nonhealing lesion in the right lower back region of the jaw for 2 months, associated with pain. A provisional diagnosis of oral cancer was considered, and an incisional biopsy was done. Histopathological presentation of the epithelial tumor island, pseudo glandular duct-like structures, and neoplastic cells showing features of dysplasia and keratin pearl formation confirmed the diagnosis as adenoid (acantholytic) squamous cell carcinoma.
Conclusion:
The histopathological presentation of adenoid (acantholytic) squamous cell carcinoma reflects the prognosis and metastatic behavior of the diseases. The knowledge of histopathological features of ASCC would be a guide to the untrained eye for the diagnosis and management of this uncommon variant to minimize the rate of metastasis or reoccurrence.
Background
Acantholytic squamous cell carcinoma (ASCC) is an uncommon histological variation of oral squamous cell carcinoma (OSCC), accounting for fewer than 4% of all occurrences. The tumor shows a slight masculine predisposition, with the lower lip being the most commonly affected location. ASCC is reported to have a diverse biologic behavior, which explains its ability to metastasize to distant places and, thus, its poor prognosis. Similarly, clear cell change in OSCC is a rare occurrence with an unknown etiology that suggests its aggressive nature.
Method and Results
Histopathology reveals central acantholytic cells with numerous duct-like features. The presence of distinct cytological atypia contributes to the diagnosis of SCC. Special stains and IHC aid in distinguishing tumor from other histopathologically similar entities.
Conclusion
The case of a 29-year-old male presented here with an updated literature review highlights the need for histological study of the unique and seldom seen oral ASCC with clear cell change, which can be ignored because of similarities with other entities. Because recurrence rates are so high for ASCC, amalgamated clear cell change makes it critical for proper treatment initiation with a definite diagnosis. To the best of our knowledge, this is the first documented occurrence. Our experience with the present case suspected a more aggressive behavior due to a high Ki-67 index, anticipating a poorer prognosis in the oral cavity considering the patient's young age.
Keywords:
Oral Squamous Cell Carcinoma; Acantholytic Squamous Cell Carcinoma; Clear Cells; immunohistochemistry
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Oral squamous cell carcinoma is the most common malignant neoplasm arising from the oral epithelium. Despite advances in the diagnosis and treatment modalities the patient outcome has not improved vastly. Among the various histological variants, acantholytic squamous cell carcinoma is a rare yet an aggressive subtype with poorer prognosis. There is dearth in information regarding the data pertaining to the pathogenesis of acantholysis in this variant. Thus, in the present paper we made an attempt to explain the pathobiology of acantholysis in oral acantholytic squamous cell carcinoma in purview of acantholysis, resistance to anoikis and collective cell migration. We opine that the characteristic histomorphological appearance of ASCC could be attributable to a temporal interplay between the factors mentioned above which may further dictate the grave outcome of this rare variant of oral squamous cell carcinoma.
Oral potentially malignant disorders (OPMDs) are clinical symptoms that are associated with oral cancer. They were first described in the WHO Classification of Head and Neck Tumors 4th edition.
Oral epithelial dysplasia (OED) is an epithelial lesion that results from the accumulation of gene mutations and increases the risk of progression to oral squamous cell carcinoma (OSCC). The histopathological features of OED and the grading are mentioned in this chapter. It also describes immunohistochemical features that are useful for the diagnosis of OED.
There is a carcinoma in situ (CIS) specific to the oral cavity in addition to the types conventionally explained in the WHO classification.
Over 90% of oral cancers are OSCC that originates in the oral mucosal epithelium. Herein, the histopathological image of OSCC is described in accordance with the WHO classification. Differentiation classification is used to evaluate the histological malignancy of OSCC (well-differentiated, moderately differentiated, or poorly differentiated). OSCC has immunohistochemical characteristics, and immunohistochemical markers are useful for diagnosis. There are many histological subtypes in OSCC, which also include those characteristically found in the oral cavity.
