Fine-needle aspiration cytologic features of pseudovascular adenoid squamous-cell carcinoma of the lung

Pseudovascular Squamous Cell Carcinoma of the Oral Cavity: A Diagnostic Pitfall About a Case

Squamous cell carcinoma is the most common mucosal malignancy of the head and neck. Adenoid pseudo-angiosarcomatous SCC is a rare variant occurring commonly in the skin of the head and neck. However, involvement of oral cavity is extremely rare, with only few case reports in the English literature. Morphologically, the tumor shows marked acantholysis, with anastomozing channels mimicking vascular neoplasms. This variant represents a diagnostic challenge for pathologists, and immunohistochemical analysis remains essential for an accurate diagnosis. Herein, we describe the case of a pseudovascular SCC of the oral cavity in a 67 years old man with a brief revue of the literature to raise awareness on this rare variant; presenting diagnostic difficulties.

Morphologic mimicry: acantholytic squamous cell carcinoma in nondermal locations-a literature review

Acantholytic squamous cell carcinoma (acantholytic SCC) is a variant of SCC in which acantholysis develops owing to the loss of desmosomal adhesion proteins. This loss of cell-cell adhesion leads to morphologic changes that have the potential to mimic other tumor types, such as angiosarcoma or signet ring cell adenocarcinoma. Acantholytic SCC characteristically occurs in sun-exposed skin of elderly patients; however, it can occur in nondermal locations. We present a review of the literature describing cases of nondermal acantholytic SCC.

Acantholytic squamous cell carcinoma of the lung with marked lymphogenous metastases and high titers of myeloperoxidase-antineutrophil cytoplasmic antibodies: a case report

BACKGROUND

Acantholytic squamous cell carcinoma (ASQCC), histologically characterized by intercellular bridge loosening, is recognized as a rare variant of squamous cell carcinoma (SQCC). ASQCC may demonstrate a worse prognosis than conventional SQCC. Pulmonary ASQCC is particularly rare; its biological behavior and prognostic data have not been reported.

CASE PRESENTATION

We report the clinical and autopsy findings of a 71-year-old Japanese man with pulmonary ASQCC. Pulmonary lesions, suggestive of idiopathic interstitial pneumonia, were radiologically observed 3 and 6 years prior to the patient's most recent hospitalization; however, the patient did not undergo further medical examinations. Upon being discovered unconscious, the patient was admitted to our hospital. Dehydration and lower limb muscle weakness were noted, as were laboratory findings of coagulation abnormalities and renal dysfunction. Computed tomography helped confirm a 21-mm peripheral nodule in the upper left lobe of the lung, with associated swollen lymph nodes in the bilateral hilar, mediastinal, and para-aortic regions. Brain and spinal lesions, suggestive of neurological disturbances, were not found. Small cell lung carcinoma was suspected, upon admission, but high serum levels of squamous cell carcinoma antigen and cytokeratin-19 fragments were present. Therefore, advanced lung cancer, possibly SQCC, was diagnosed. The patient was treated with best supportive therapy, and died one month after admission. Hypercalcemia and high serum levels of parathyroid hormone-related protein (PTHrP) and myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers were observed. Progressive renal insufficiency was absent due to improved renal function subsequent to hydration. An autopsy helped confirm the left lung tumor as an ASQCC associated with pulmonary lymphangitic carcinomatosis and multiple metastases in the lungs and lymph nodes. Skin lesions suggesting malignant tumors were absent. The metastatic lesions consisted largely of acantholytic tumor cells, and the lungs showed usual interstitial pneumonia pattern; vasculitis was absent.

CONCLUSIONS

This is the first reported case of pulmonary ASQCC resulting in an aggressive clinical course, with marked lymphogenous metastases and PTHrP-associated hypercalcemia. The high serum MPO-ANCA titers were clinicopathologically insignificant, but may have been related to the pulmonary interstitial lesion. Pulmonary ASQCC represents a highly malignant subset of lung cancer.

Pseudovascular adenoid squamous cell carcinoma of oral cavity: A mimicker of angiosarcoma

Pseudovascular adenoid squamous cell carcinoma (PASCC) is an uncommon histological variant of squamous cell carcinoma that can mimic vascular neoplasms, particularly angiosarcoma, in its morphologic characteristics. PASCC has been reported in the head and neck, as well as in the other organs such as the breast, lungs, urinary bladder, vulva, and uterine cervix. Only two cases of PASCC arising from the upper aerodigestive tract have been reported so far. We report a case of PASCC of oral cavity in a 40-year-old man, which mimicked an angiosarcoma initially. Immunohistochemical analysis led to a conclusive diagnosis of PASCC.

Pseudoangiosarcomatous squamous cell carcinoma of the lung

Pulmonary pseudoangiosarcomatous squamous cell carcinoma (PSCC) is a rare aggressive variant of squamous cell carcinoma. Histopathologically, PSCC is characterized by interanastomosing cords and channels, lined by atypical cells, with spaces containing erythrocytes or floating tumour cells. PSCC mimics angiosarcoma, so careful attention should be paid to immunohistochemical differences. Two PSCC cases are described here: in a 79-year-old male, bronchoscopy revealed mucosal swelling and hypertrophy and an adrenal mass was found 1 month later; in a 76-year-old male, computed tomography revealed rib destruction due to a non-calcified soft-tissue tumour and, although the tumour resembled an angiosarcoma, endothelial markers were negative and cytokeratin and p63 markers were positive. Immunohistochemical analyses may be helpful in establishing an accurate diagnosis. PSCC had a progressive course in both patients, who died ≤ 3 months postdiagnosis.

Epithelioid angiosarcoma of the kidney: a diagnostic dilemma in fine-needle aspiration cytology

Epithelioid angiosarcomas (EAS) of kidney are rare and aggressive tumors with noncharacteristic imaging features that overlap with those of inflammatory conditions and renal cell carcinoma (RCC). We report the fine-needle aspiration (FNA) cytology findings of a case of EAS that involved the left kidney of an 83-year-old male. The smears and cell block sections showed pleomorphic epithelioid cells with ample cytoplasm, eccentric nuclei, occasional cytoplasmic hyaline globules, and rare intracytoplasmic lumina. Immunohistochemical stains performed on cellblock sections showed that the tumor cells were positive for vimentin, CD31, CD34, Factor VIII, and CD10, but showed no staining for cytokeratins AE1/AE3 and 8/18, HMB45, CD45, smooth muscle actin, and S100. The morphological and immunohistochemical distinction between EAS, primary tumors of the kidney, and other epithelioid and rhabdoid neoplasms is discussed.

Pseudoangiomatous Squamous Cell Carcinoma in the Oral Cavity of a Dog

An 8-year-old, spayed, female Labrador Retriever mixed-breed dog was presented to the Cornell University Hospital for Animals with an invasive oral mass involving the upper left fourth premolar and first molar teeth. Initial biopsy results suggested a poorly differentiated squamous cell carcinoma, whereas further histologic examination of the surgically removed mass revealed a hemangiosarcoma-like mass composed of numerous vascular clefts and variable numbers of keratinizing epithelial cells. Histologic and immunohistochemical characteristics were compatible with pseudoangiomatous squamous cell carcinoma, a well-recognized human variant of acanthomatous squamous cell carcinoma. Because of histomorphologic similarities with canine gingival hemangiosarcoma, diagnosticians should be aware of the present tumor variant as a differential diagnosis for vascular-like growths in the oral cavity of dogs.

Cytology of head and neck squamous cell carcinoma variants

The most common diagnosis rendered with head and neck fine needle aspiration (FNA) biopsy is metastatic squamous cell carcinoma (SCC). While most cases of metastatic SCC pose little diagnostic difficulty, the diagnosis of metastatic histologic variants of SCC, often coupled with less common etiologies, can be more problematic. This manuscript reviews the clinicopathologic features of the histologic variants of upper aerodigestive tract SCC (verrucous, papillary, spindle cell, undifferentiated, acantholytic, and basaloid) and uncommon etiologies of head and neck SCC (human papillomavirus, Epstein-Barr Virus, and NUT midline carcinomas). Particular attention is paid to the cytologic features of these lesions. Differential diagnoses and the use of ancillary testing are discussed.

Pseudoangiosarcomatous Squamous Cell Carcinoma of Skin Arising Adjacent to Decubitus Ulcers

Pseudoangiosarcomatous, or pseudovascular, squamous cell carcinoma of skin is an unusual form of acantholytic (adenoid, pseudoglandular) squamous cell carcinoma that mimics the histolopathologic appearance of angiosarcoma. We report a case of pseudoangiosarcomatous squamous cell carcinoma arising adjacent to decubitus ulcers. The histopathologic examination of a wedge biopsy specimen revealed infiltrative cords of neoplastic cells that formed interanastomosing channels imitating angiosarcoma. Immunohistochemical staining was negative for the endothelial markers (CD31, CD34, and factor VIII-related antigen) and positive using cytokeratin antibodies (AE1/AE3 and 34 betaE12). Because of metastatic disease, palliative measures were undertaken and the patient died four months later. To our knowledge, our patient is the first with pseudoangiosarcomatous squamous cell carcinoma of skin developing within decubitus ulcer.

Cytologic findings of malignant vascular neoplasms: a study of twenty-four cases

Cytologic characterization of malignant vascular neoplasms (MVN) is difficult due to the wide range of differential diagnoses and sampling errors. The objective of this study was to identify criteria helpful in the cytologic diagnosis of MVN. The clinical presentation and cytomorphologic features of 22 angiosarcomas and two hemangioendotheliomas were analyzed. The criteria evaluated included cellularity, cellular arrangement, cell shape and size, pleomorphism, cytoplasmic borders, nuclear shape and number, chromatin pattern, nucleoli, background, and presence of angioformative structures. A previous history of MVN was noted in 18 of 24 patients. Specimens with epithelioid morphology were more cellular and pleomorphic and contained multinucleated cells. Specimens with spindle morphology were usually less cellular and less pleomorphic. Angioformative structures were identified in 11 of 24 cases. Awareness of features suggestive of MVN is necessary to raise the possibility of vascular origin, which can be confirmed with appropriate immunocytochemical studies.