Adenosquamous carcinoma of the tongue: report of a case with histochemical, immunohistochemical, and ultrastructural study and review of the literature

Adenosquamous Carcinoma with the Acantholytic Feature in the Oral Cavity: A Case Report and Comprehensive Literature Review

Adenosquamous carcinoma (ASC) is an aggressive subtype of squamous cell carcinoma (SCC). Due to its poor prognosis, a precise pathological diagnosis of ASC is essential but challenging because its pathological criteria are still unclear. Here, we present a rare case of oral ASC accompanied by acantholytic features. The tumor was raised in the mandibular gingiva and recurred locally approximately 13 months after the initial surgery with cervical lymph node metastasis. Pathological specimens of the primary lesion showed acantholysis in a large area of the SCC. Mucous cells, the characteristic finding indicating glandular differentiation, were imperceptible in the initial surgical specimen but increased in the locally recurrent and metastatic lymph node specimens. In a comprehensive literature review of oral ASC cases, the present case was the only case of ASC with acantholytic features. We reconfirmed that ASC has poor prognoses, such as low 5-year overall survival and disease-free survival, high locoregional recurrence, and high distant metastasis rates. A precise diagnosis of ASC is required for estimating prognosis and undergoing close follow-up, even if the adenocarcinomatous component is limited to a small area in the lesion.

Rare variants of head and neck squamous cell carcinoma -differential immunohistochemical profiles

We aimed to immunohistochemically characterize the pattern of expression of epithelial markers in rare head and neck squamous cell carcinoma (HNSCC) variants: carcinoma cuniculatum (CC) and adenosquamous carcinoma (ASC). We also present an additional variant of HNSCC with concomitant basaloid and squamous components that has overlapping morphological features with odontogenic and non-odontogenic tumors, which we termed basalo-squamous carcinoma (BSC). The selected markers included CK5/6, p40, CK19, BerEP4, p16 and SOX10. All tumors were CK5/6 and p40 positive. CK19 and BerEP4 were positive in BSC and focally in ASC but negative in CC. p16 was positive in 3 (60%) of the CCs, focally positive in ASC and negative in BSC. SOX10 was negative in all three variants. Our results highlight the plasticity of the lining epithelium revealing differential profiles of immuno-expression of the selected molecular markers, possibly reflecting their diverse histopathogenesis.

Serum starvation-induces down-regulation of Bcl-2/Bax confers apoptosis in tongue coating-related cells in vitro

Tongue squamous epithelial cells are the main component of tongue coating, with proliferation, differentiation and apoptosis being the root cause of the formation and maintenance of tongue coating. The present study aimed to explore the molecular mechanism by which serum influences tongue coating, to enable a better understanding for future investigations. Tongue carcinoma squamous cells were exposed to serum‑starvation in vitro. Cellular proliferation and apoptosis were observed by using 3‑[4,5‑dimethyl‑2‑thiazolyl]‑2,5‑diphenyl‑2‑H‑tetrazolium bromide (MTT) assay, flow cytometry, Hoechst staining, scanning electron microscope (SEM), transmission electron microscope (TEM), and by measuring the expression ratio of B‑cell lymphoma 2 apoptosis regulator (Bcl‑2)/Bcl‑2 associated protein X apoptosis regulator (Bax) mRNA and protein by reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR) and western blotting, respectively. MTT assays revealed that serum‑starvation results in suppression of cellular proliferation, while flow cytometry data revealed that serum‑starvation induces cell cycle arrest at G1 phase and increases apoptosis. In addition, chromatin condensation and membrane blebbing were observed through Hoechst staining, TEM and SEM. The Bcl‑2/Bax ratio was found to be significantly decreased in cells that had undergone serum‑starvation by both RT‑qPCR and western blotting analysis, further indicating that serum‑starvation induces apoptosis. Therefore, tongue carcinoma squamous cells in a serum‑free medium can simulate apoptosis related to the formation of tongue coating, which may offer guidance for future investigations about other factors.

Adenosquamous Carcinoma of the Tongue

A 51-year-old white female presented with a painful ulcer of the left ventrolateral tongue. An incisional biopsy confirmed a diagnosis of adenosquamous carcinoma. The adenosquamous carcinoma is an uncommon malignant tumor with histopathological features of a squamous carcinoma and an adenocarcinoma. A definitive diagnosis requires histopathological examination of a deep biopsy involving the submucosal tissue. This malignant tumor shows aggressive behavior with early invasive growth and a poor prognosis. The histopathological findings and differential diagnosis of a case of adenosquamous carcinoma of the tongue are discussed.

Importance of tumor extent in adenosquamous carcinoma of the head and neck: a retrospective cohort study

OBJECTIVE

The aim of this study was to determine the correlates of survival for patients diagnosed with adenosquamous carcinoma (ASC) of the head and neck.

STUDY DESIGN

Patients diagnosed with ASC of the head and neck between 1973 and 2012 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier and Cox proportional hazard regression analyses were conducted to investigate the prognostic factors and treatment modalities that determine overall survival (OS) and disease-specific survival (DSS).

RESULTS

In the analysis, of the 235 patients diagnosed with adenosquamous of the head and neck, 66.8% were male and 33.2% were female with a median age at diagnosis of 64 years. Kaplan-Meier analysis determined 5-year survival rates of 30% for OS and 50% for DSS. Univariate and multivariate analyses found that age at diagnosis, tumor size, tumor extent of disease, surgical resection, and radiation therapy were independent predictors of OS and DSS.

CONCLUSIONS

This study, to our knowledge, is the largest study, to date, determining the correlates of survival for ASC of the head and neck. Older age at diagnosis, larger tumor size, and further extent of disease were correlated with decreased survival. Surgical resection improves survival in patients with localized or regional disease, whereas radiation therapy confers survival benefit in patients with distant extent.

Adenosquamous carcinoma of the tongue: clinicopathologic study and review of the literature

Adenosquamous carcinoma (ASC) of the tongue is an uncommon malignant oral neoplasm with mixed glandular and squamous differentiation and a propensity for aggressive clinical behavior. Here, we report a rare case of ASC of the lateral border of the tongue in a 65-year-old Japanese man. The patient was treated by radical operation and remained well for 6 months before developing metastasis of the hilar and pretracheal lymph nodes. Subsequently, the patient was treated with combined chemotherapy (nedaplatin plus docetaxel and S-1 for two cycles, intravenously) and radiotherapy. Radiation therapy of metastatic lymph nodes was performed at a total dose of 60 Gy and was delivered in 2 Gy fractions 5 days/week. The patient is currently tumor free and is being followed up carefully. This article describes a rare case of ASC of the tongue and its conventional histologic, immunohistochemical, and electron microscopic findings, together with a review of the literature. The findings provide important information to better understand the possible clinical and therapeutic approaches for this uncommon tumor of the tongue.

Adenosquamous carcinoma of the head and neck: report of 20 cases and review of the literature

PURPOSE

To assess the clinical profile and prognostic factors in patients with adenosquamous carcinoma (ASC) of the head and neck treated by surgery and/or radiation therapy with or without chemotherapy.

METHODS

Data from 20 patients with stage I-II (n = 4), III (n = 5), or IVA (n = 11) head and neck ASC, treated between 1989 and 2010 were collected in a retrospective multicenter Rare Cancer Network study. Surgery was performed in 16 patients. Seventeen patients received combined modality treatment.

RESULTS

After a median follow-up of 15.5 months, 12 patients recurred. The 3-year and median overall survival, disease-free survival (DFS), and loco-regional control were 52% and 39 months, 32% and 12 months, and 47% and 33 months respectively. In multivariate analysis, DFS was negatively influenced by the presence of extracapsular extension and advanced stage.

CONCLUSION

Overall prognosis of locoregionally advanced ASC remains poor. However, early stage ASC patients managed with combined modality treatment may have prolonged DFS.

Adenosquamous carcinoma of the head and neck: relationship to human papillomavirus and review of the literature

Adenosquamous carcinoma (ADSC) of the head and neck is an aggressive variant of squamous cell carcinoma (SCC). Certain variants of head and neck SCC are human papillomavirus (HPV)-related and have better prognosis. The relationship of HPV to head and neck ADSC has not been investigated. We searched our files for the term "adenosquamous" and head and neck subsites and found cases from 1998 to 2009. The requisite histologic criteria were the presence of SCC combined with distinct gland formation and/or intracellular mucin. DNA in situ hybridization for high-risk HPV, RNA in situ hybridization for high risk HPV E6 and E7 transcripts, and immunohistochemistry for p16 and p53 were performed. The existing literature on ADSC was also reviewed. Of the 18 cases, eight were from the larynx and hypopharynx, four from the oral cavity, three from the oropharynx, and three from the nasal cavity. Three cases (16%) showed both high risk HPV E6 and E7 and p16 expression, one from the nasal cavity and two from the oropharynx. Both oropharyngeal carcinoma patients were alive and disease free at 34 and 103 months, respectively. ADSCs of the head and neck are a heterogeneous group of tumors. A small minority of cases harbor HPV and most of these, particularly those occurring at sites with known high prevalence of HPV, show active viral transcription with detectable E6 and E7 and overexpression of p16. The HPV-related oropharyngeal cases, though rare, appear to do very well clinically, while the remaining cohort of ADSC patients do quite poorly. Head and neck ADSC appears to be a mixed variant that can be further classified according to its HPV status.

Primary colonic-type adenocarcinoma of the base of the tongue: a previously unreported phenotype

Primary lingual adenocarcinomas are rare and typically of salivary or seromucinous glands origin. Similarly, metastatic adenocarcinoma from distant primary sites to the tongue is an uncommon event, with only 3 cases from a colonic primary site reported. We present, for the first time, 2 primary colonic-type adenocarcinomas of the base of the tongue and discuss their putative origin and the clinicopathologic characteristics.

Adenosquamous carcinoma of maxillary sinus: case showing complete response to S-1

Background:

Adenosquamous carcinoma is a very rare tumour which is characterised pathologically by the simultaneous presence of distinct areas of adenocarcinoma and squamous cell carcinoma. Generally, adenosquamous carcinoma has an aggressive clinical course and is associated with a poor prognosis. Most cases have been treated by surgery alone or combined with radiotherapy. Chemotherapy is rarely used in treating adenosquamous carcinoma, and it has been difficult to establish treatment guidelines due to the paucity of cases.

Case:

We report a case of adenosquamous carcinoma which arose in the maxillary sinus of a 77-year-old man. Despite surgical treatment and chemoradiotherapy to the primary site, he developed bilateral neck metastases after the surgery. The patient was treated with S-1, a novel oral fluoropyrimidine anticancer agent, with a complete (albeit finite) response.

Conclusion:

This report presents the aggressive character of adenosquamous carcinoma and the possible role of S-1 in the treatment of this uncommon neoplasm.

Clinicopathological features of head and neck adenosquamous carcinoma

Adenosquamous carcinoma is a rare tumour which is characterized pathologically by the simultaneous presence of distinct areas of squamous cell carcinoma and adenocarcinoma. The origin of adenosquamous carcinoma is controversial; however, it is generally considered to be aggressive and associated with a dismal prognosis. In the present study, the medical and pathological records of 4 patients with head and neck adenosquamous carcinoma are reviewed. In 1 patient, the tumour arose from an area of carcinoma in situ of surface epithelium. The origin from surface epithelium was not evident in any of the others. Perineural invasion was present in 3 patients. Three patients had evidence of cervical metastases. One patient died of postoperative complications, 1 suffered from local recurrence and developed distant metastases and 2 were alive with no evidence of disease over 30 months later. Adenosquamous carcinoma is an aggressive tumour; however, with appropriate treatment, some patients may remain well beyond 2 years.

Adenosquamous carcinoma of the head and neck: criteria for diagnosis in a study of 12 cases

AIMS

Adenosquamous carcinoma (ASC) of the head and neck is an unusual neoplasm in which a general consensus with regard to diagnostic criteria has not yet been reached. In this study we report the clinicopathological results of 12 ASCs, with special attention to their histological and immunohistochemical characteristics in order to define this neoplasm more precisely.

METHODS AND RESULTS

All the patients were male with a peak incidence in the sixth decade of life. The tumours were located most frequently in the larynx and oral cavity, followed by the nasal cavity and pharynx. ASCs had two distinct histological components. The most extensive one was an usual keratinizing squamous cell carcinoma, arising from the surface epithelium, where characteristically severe dysplasia or carcinoma in situ was found in all cases. The second component was an adenocarcinoma, usually displayed in the deepest areas of the tumour. Evidence of origin from salivary or seromucinous glands was not found. Immunohistochemical studies demonstrated in most cases positivity of glandular differentiated areas for carcinoembryonic antigen (CEA) (11/12), CK7 (9/12) and CAM5.2 (7/12), whereas the squamous cell component was unreactive or reacted only focally for these markers. High-molecular-weight cytokeratin 34BE12 was positive in both components and CK20 was always negative. All cases showed high expression of Ki67 antigen. Most of them had overexpression of p53 (8/12) and DNA aneuploidy (10/12). Fifty percent of patients with ASC died of disease after a mean period of 23 months (range 12-35 months).

CONCLUSIONS

ASC of the head and neck is an aggressive neoplasm that originates in the surface epithelium of the upper respiratory tract. Severe dysplasia or carcinoma in situ is usually found and its recognition helps to make the diagnosis. In addition to mucin stains, positive immunoreactivity for CEA, CK7 and CAM5.2 helps to identify the glandular component.

Clinical characteristics of oral adenosquamous carcinoma: report of a case and an analysis of the reported Japanese cases

We present a case of adenosquamous carcinoma (ASC) which developed in the floor of the mouth of a 72-year-old Japanese man, and review 19 reported ASC cases in Japan from between 1986 and 2001, including the subject case herein. These ASCs occurred at an average age of 63 years, with 74% of the ASCs occurring in the floor of the mouth (8) and the tongue (6); the other sites of occurrence were the palate (3) and mandibular alveolus (2). Chief complaints were painless mass formation (28%), pain and/or sensational abnormality (28%), painful ulcer or swelling (22%), simple ulcer (11%), and miscellaneous others (11%). The clinical presentations of ASC were tumor with ulceration (58%), tumorous mass (26%), and ulcer (16%). Tumor size at first examination varied from bean-size to approximately 65 x 40 mm. In the pretreatment period, 31.3% were known to have cervical lymph node involvement, and descriptions on distant metastasis were not noted in any of the 19 cases. Some of the ASCs were initially diagnosed as other types of lesions, such as squamous cell carcinoma (SCC; 41%), adenocarcinoma (Ad.C; 12%) mucoepidermoid carcinoma (MEC; 6%), and MEC or SCC (6%). After initial treatments, neck and distant metastases were ascertained in 47.1 and 17.6% of the cases, respectively. Generally, a surgical procedure was performed as one of the most critical methods of treatment. The overall 5-year survival rate was 57.0%, with that of patients who underwent active treatment at 60.6%. Our study demonstrates the extent of the varied nature of ASC.