Squamous Cell Carcinoma In Situ of the Breast With the Configuration of an Intraductal Papilloma

A 64-year-old woman presented to our institution with a palpable and painful left breast mass. She denied any other breast symptoms. Subsequent imaging classified it as a US Breast Imaging-Reporting and Data System (BI-RADS) 4A lesion. A core needle biopsy was performed showing atypical proliferating fragments of squamous epithelium suspicious for malignant neoplasm. An excisional biopsy was recommended. Gross examination showed a well-circumscribed pink soft mass measuring 2.0 x 1.4 x 1.3 cm. The entire lesion was submitted for histologic evaluation, demonstrating a neoplasm with branching stroma and exuberant squamous differentiation. The lesion exhibited obvious cytologic features of malignancy like mitotic figures, prominent nucleoli, irregular nuclei, and multinucleation. Collagen IV stain ruled out invasion. The lesion was finally classified as squamous cell carcinoma (SCC) in situ with the configuration of an intraductal papilloma. The possibility of metastatic disease was suggested. A PET scan was negative, and no other foci of disease were found in the remainder of the specimen. The mass was also independent of nipple and skin. Based on the architectural features, we believe that this is a case of an intraductal papilloma that underwent complete squamous metaplasia with no residual adenomyoepithelial components and transformation into an SCC in situ demonstrated by stains. Papillomas can undergo reactive metaplastic changes, usually benign and in small foci. This is the first reported case of exuberant squamous epithelium that transformed into carcinoma in situ with papillary architecture in the breast.

Pelvicalyceal Squamous Cell Carcinoma: Incidental Diagnosis With Liver Metastasis on Follow Up

Primary squamous cell carcinoma (SCC) of the renal pelvis is a rare malignancy. We report a case of a 43-year-old male presenting with stones and a non-functioning kidney. Incidental SCC was diagnosed histopathologically on nephrectomy. The patient then returned with metastasis to the liver after one year. Nephrolithiasis is the most important risk factor implicated in renal SCC; hence, awareness of this rare entity in a patient of long-standing nephrolithiasis is important.

Intravesical Condyloma Acuminata Progressing to Squamous Cell Carcinoma of the Bladder: An Unusual Presentation

Squamous cell carcinoma (SCC) of the bladder resulting from condyloma acuminata (CA) is uncommon. Most cases of SCC are asymptomatic until an advanced stage making the diagnosis difficult. Most patients present with urinary symptoms. We present the case of a 31-year-old African American male who presented to the emergency department with right lower extremity deep vein thrombosis. His past medical history was significant for recurrent bladder and urethral CA with high-grade dysplasia. A computed tomography (CT) gave the incidental findings of pelvic and bladder masses. The masses were studied and came back concerning for malignancy. The patient will undergo surgical removal soon. This manuscript illustrates an unusual presentation of CA progressing to SCC, including the diagnostic approach and treatment. We hope to increase awareness of the clinical presentation and regular follow-up in patients with risk factors.

Clinical management of squamous cell carcinoma of the tongue: patients not eligible for free flaps, a systematic review of the literature

INTRODUCTION

The management of squamous cell carcinoma (SCC) of the tongue represents the most demanding treatment planning in head and neck surgery. Ablation followed by free flap reconstruction is considered the gold standard, but not all patients are suitable for this strategy. The aim of this review is to provide a comprehensive view of surgical reconstruction possibilities in patients not eligible for free flaps.

METHODS

Following PRISMA recommendations, a systematic literature review was conducted searching for original papers that investigated outcomes of patients treated by surgical ablation for tongue SCC followed by reconstruction with local or pedicled flaps. Selected papers were read and data extracted for qualitative analysis.

RESULTS

Twenty articles met the inclusion/exclusion criteria. The study design was case series in sixteen papers, cohort study in the remaining four. Four different local flaps (BMM, FAMM, NLIF, SMIF) and four regional flaps have been discussed in included studies (IHF, SFIF, SCM, PMMC).

CONCLUSION

The improved anatomical knowledge makes local flaps a reliable alternative to free tissue transfer in cases requiring small-/medium-sized defects. Regional flaps still represent cornerstones in reconstruction of the tongue. Ease of execution, costs-to-benefit ratio, low-rate complications, minimal donor site morbidity represent the best advantages choosing local/regional flaps.

Human Papillomavirus (HPV)-Associated Squamous Cell Carcinoma In situ With Positive p16 and Ki-67 Immunohistochemical Stains in a Young Immunocompetent Patient

There is an oncogenic role of human papillomavirus (HPV) in the development of premalignant and malignant skin cancers, especially squamous cell carcinomas (SCCs). Some of the major risk factors for SCC include older age, fair skin types, immunosuppression, ultraviolet radiation (UVR), history of epidermodysplasia verruciformis (EV), and co-carcinogenesis by the HPV. Our case report exemplifies a unique case of a low-risk, 34-year-old female who developed an HPV-associated squamous cell carcinoma in situ (SCCIS) on her left palmar hand, despite having none of the contributing risk factors. The biopsy also showed full-thickness keratinocyte atypia and increased mitotic activity throughout all the layers of the epidermis. Immunohistochemical stains showed strong and diffuse nuclear staining of p16 and Ki-67 throughout the SCCIS, confirming HPV etiology. We speculate that tumor development in our patient relied on the combined effects of UVR exposure, localized immunosuppression, and the co-carcinogenic effects of HPV infection.

Melanoma and non-melanoma skin cancer among patients who attended at King Khalid University Hospital in Riyadh, Saudi Arabia from 2007 - 2018

OBJECTIVES

To assess the prevalence of melanoma and non-melanoma skin cancer for patients attended King Khalid University Hospital, Riyadh, Saudi Arabia. We are also assessing the most common category of skin cancer to be encountered among those patients. Methods: The authors conducted a retrospective study including all patients (Saudi and non-Saudi) who attended King Khalid University Hospital (KKUH) at the period of (2007-2018). Data were collected from archives of Pathology Department at KKUH and categorized into: melanoma skin cancer (MSC), non-melanoma skin cancer (NMSC), which included: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), pre-neoplastic lesions, and non-neoplastic skin lesions. Results: A total of 111 patients were reported to have skin cancer out of 9828 cases, which had other skin pathology. Majority of cases were basal cell carcinoma with a total number of 76 (68.5%) of all cases. 18 patients (16.2%) were diagnosed with MSC. The remaining 17 patients (15.3%) were diagnosed with squamous cell carcinoma. Conclusion: Skin cancer prevalence and incidence is increasing worldwide. In our study, BCC was the most common type of skin cancer to be reported in our institute, which is similar to the majority of other international studies.

Five year experience of the treatment of squamous cell carcinoma of the anus

OBJECTIVES

The best treatment of early stage anal squamous cell carcinoma (SCC) is under debated. Wide local excision (WLE) may be considered adequate for stage 1 anal margin cancer. This study demonstrates our experience in treatment of patients with SCC over 5 years.

PATIENTS AND METHODS

We conducted a retrospective study of patients who had undergone anal screening or anal cancer surveillance between October 2010 and 2015 in our department. Each patient underwent anal Pap test, HPV test PCR HPV DNA and cytology by Thin Prep. The examinations were performed by Proctostation THD©. Data were collected and analysed.

RESULTS

We included 25 patients, 16 male (64%) and 9 female (36%). Twenty-four patients had SCC and 1 patient had adenocarcinoma. Of this cohort: 10 underwent chemoradiotherapy (CRT) because T3-4 N1-2 M0, 13 underwent only surgery because T1/T2 and 2 patients had CRT and surgery because they already have had anal cancer treated in the past with CRT. Seventeen patients (68%) of this cohort, including 5 with micro-invasive SCCs, had regular follow-up without recurrences. Four patients (17%) died from metastatic disease and 4 patients (17%) had recurrent disease.

CONCLUSIONS

In this small cohort we demonstrated satisfactory results in treatment of SCCs, underlining the effective role of surgery in early stages of SCC. Screening program and follow up were fundamental to identify early stage and recurrent disease. Also we found the High-resolution video-proctoscopy a valid diagnostic tool.

Topically applied Hsp90 inhibitor 17AAG inhibits UVR-induced cutaneous squamous cell carcinomas

We present here that heat-shock protein 90 (Hsp90) inhibitor 17-(allylamino)-17-demethoxygeldanamycin (17AAG), when topically applied to mouse skin, inhibits UVR-induced development of cutaneous squamous cell carcinoma (SCC). In these experiments, DMSO:acetone (1:40 v/v) solution of 17AAG (500 nmol) was applied topically to mouse skin in conjunction with each UVR exposure (1.8 kJ m(-2)). The UVR source was Kodacel-filtered FS-40 sun lamps (approximately 60% UVB and 40% UVA). In independent experiments with three separate mouse lines (SKH-1 hairless mice, wild-type FVB, and protein kinase C epsilon (PKCɛ)-overexpressing transgenic FVB mice), 17AAG treatment increased the latency and decreased both the incidence and multiplicity of UVR-induced SCC. Topical 17AAG alone or in conjunction with UVR treatments elicited neither skin nor systemic toxicity. 17AAG-caused inhibition of SCC induction was accompanied by a decrease in UVR-induced (1) hyperplasia, (2) Hsp90β-PKCɛ interaction, and (3) expression levels of Hsp90β, Stat3, pStat3Ser727, pStat3Tyr705, pAktSer473, and matrix metalloproteinase (MMP). The results presented here indicate that topical Hsp90 inhibitor 17AAG is effective in prevention of UVR-induced epidermal hyperplasia and SCC. One may conclude from the preclinical data presented here that topical 17AAG may be useful for prevention of UVR-induced inflammation and cutaneous SCC either developed in UVR-exposed or organ transplant population.

Tomotherapy concomitant with cetuximab, followed by cetuximab as single-agent therapy for unresectable squamous cell carcinoma of the skin: a case report

BACKGROUND

Cutaneous squamous cell carcinoma (SCC) is the second most frequency of all skin tumors. Incidence of SCC has risen significantly due to an increased sun exposure and the number of immunodeficient patients. Cutaneous SCC is characterized by high Epidermal growth factor receptor (EGFR) expression with low frequency of RAS mutations. Generally, locoregional surgery is curative and systemic therapy is not indicated. We evaluated the activity and toxicity profile of tomotherapy concomitant with Cetuximab, followed by Cetuximab as single agent therapy in a patient affected by unresectable, locally advanced cutaneous SCC.

CASE PRESENTATION

At our institution, on March 2012 we treated a 45 years-old patient affected by locally advanced, unresectable G1 SCC of the lumbar region. At our first observation, the patient was asthenic, with severe pain and functional limitations. There was also a superinfection due to Pseudomonas Aeruginosa resistant to antibiotics, and a G3 anemia secondary to the bleeding lesion. ECOG Performance Status was 2. Tomotherapy has been performed concomitant with the Cetuximab (400 mg/m2, followed by weekly doses of 250 mg/m2) at the total dose of 60 Gy (2 Gy/fx), followed by Cetuximab monotherapy.The lesion reduced progressively until disappear even after the suspension of the treatment and the patient achieved complete response. Toxicity resulted in G1 cutaneous rash and G2 toxicity to the nails, appeared after 5 months of treatment, typical toxicity profile of the anti-EGFR therapies. After one month of therapy the Pseudomonas Aeruginosa superinfection totally disappeared. Quality of life resulted significantly improved with reduction until discontinuation of the anti-pain drugs, and progressive increase of the hemoglobin levels. At follow up of 15 months there was no evidence of active disease and the ECOG Performance Status was 0 (zero).

CONCLUSION

The treatment was effective and feasible. Considering these excellent results, further studies about concomitant tomotherapy with Cetuximab for advanced/inoperable SCC of the skin are needed.

High CRP values predict poor survival in patients with penile cancer

BACKGROUND

High levels of circulating C-reactive protein (CRP) have recently been linked to poor clinical outcome in various malignancies. The aim of this study was to evaluate the prognostic significance of the preoperative serum CRP level in patients with squamous cell carcinoma (SCC) of the penis.

METHODS

This retrospective analysis included 79 penile cancer patients with information about their serum CRP value prior to surgery who underwent either radical or partial penectomy at two German high-volume centers (Ulm University Medical Center and Hannover Medical School) between 1990 and 2010. They had a median (mean) follow-up of 23 (32) months.

RESULTS

A significantly elevated CRP level (>15 vs. ≤ 15 mg/l) was found more often in patients with an advanced tumor stage (≥pT2) (38.9 vs. 11.6%, p=0.007) and in those with nodal disease at diagnosis (50.0 vs. 14.6%, p=0.007). However, high CRP levels were not associated with tumor differentiation (p=0.53). The Kaplan-Meier 5-year cancer-specific survival (CSS) rate was 38.9% for patients with preoperative CRP levels above 15 mg/l and 84.3% for those with lower levels (p=0.001). Applying multivariate analysis and focusing on the subgroup of patients without metastasis at the time of penile surgery, both advanced local tumor stage (≥pT2; HR 8.8, p=0.041) and an elevated CRP value (>15 mg/l; HR 3.3, p=0.043) were identified as independent predictors of poor clinical outcome in patients with penile cancer.

CONCLUSIONS

A high preoperative serum CRP level was associated with poor survival in patients with penile cancer. If larger patient populations confirm its prognostic value, its routine use could enable better risk stratification and risk-adjusted follow-up of patients with SCC of the penis.

Spontaneous primary squamous cell carcinoma of the lung in a rhesus macaque (Macaca mulatta)

A 3-y-old male rhesus macaque (Macaca mulatta) was noticed to be lethargic in the compound. Physical exam revealed cyanotic mucous membranes, dyspnea, bilateral harsh lung sounds, wheezing on expiration, and a firm mass possibly associated with the liver. Radiographs revealed bilateral soft tissue opacities in the thorax. Due to poor prognosis, the rhesus was euthanized, and a necropsy was performed. Both right and left lung lobes were consolidated and had multifocal white-tan masses. On cut section, the masses were firm, had areas of necrosis, hemorrhage, and often contained a tenacious exudate. Masses were identified in the liver and both kidneys. Given the morphologic features of the neoplasm, a diagnosis of squamous cell carcinoma was made. Immunohistochemistry staining for thyroid transcription factor, a nuclear transcription factor normally found in lung, thyroid, and tumors arising from either of those tissues, confirmed that the masses originated from the lung. Malignant primary lung tumors are divided into 8 main histologic subtypes: squamous cell carcinoma, small-cell carcinoma, large-cell carcinoma, adenocarcinoma, adenosquamous carcinoma, sarcomatoid carcinoma, carcinoid tumor, and salivary gland tumors. Clinical signs associated with lung tumors include, but are not limited to, dyspnea, coughing, hemoptysis, lethargy, anorexia, and weight loss. Although squamous cell carcinoma will be low on the differential list for these clinical signs, we encourage clinicians and researchers to not rule it out solely based on incidence and age of the animal.

Polo-like kinase 1 (Plk1) in non-melanoma skin cancers

Polo-like kinase 1 (Plk1) is becoming an increasingly attractive target for cancer management. Plk1 has been shown to be overexpressed in a variety of cancers; however its role in skin cancers is not well-understood. We recently demonstrated that Plk1 is overexpressed in human melanoma and gene-knockdown as well as chemical-inhibition of Plk1 resulted in a significant decrease in melanoma cell viability and growth without affecting the growth of the normal human epidermal melanocytes (NHEMs). Further, the observed anti-proliferative response of Plk1 was found to be accompanied with a significant G(2)/M cell cycle arrest, mitotic catastrophe and induction of apoptosis in melanoma cells. In this study, we determined the expression profile of Plk1 in non-melanoma skin cancers viz. basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Our data demonstrated that like melanoma, Plk1 is significantly overexpressed in BCC and SCC samples. Further, we also found that compared to normal human epidermal keratinocytes (NHEKs), Plk1 was overexpressed at both the protein and mRNA levels in squamous A253 and A431 cells. In addition, a similar protein expression pattern was found for the downstream targets of Plk1, viz. Cdk1, Cyclin B1 and Cdc25C. We believe that the expression pattern of Plk1 in the various skin cancers, the observed insusceptibility of normal cells to Plk1 inhibition and the easy accessibility for topical applications lends the skin as an attractive tissue for Plk1 based cancer chemoprevention and chemotherapeutic applications.

Factors prior to dry period associated with high and low levels of cow milk somatic cell counts in next lactation

Data from a randomized controlled field study of selective dry cow therapy were used in which 686 cows had been allocated to 2 control groups (sampling only or placebo) or 2 therapy groups. Possible factors from previous lactation were assessed in determining their association with the probability of 'failure', designated as a cow milk somatic cell count (CMSCC) of greater than 399,000 per ml in geometric mean of several measurements during subsequent lactation. Success cows were those with a CMSCC of less than 200,000 per ml. For our analyses, this targeted 187 success cows and 186 failure cows. Therapy was given as a total dose of 400,000 IU penicillin and 100 mg neomycin per infected quarter as dry cow preparation once, or as a lactation formula with a total dose of 1.2 million IU penicillin and 1,200 mg dihydrostreptomycin per infected quarter during a 1-week period. Significant factors in the predictive model for success included therapy, low level of CMSCC (geometric mean of the 3 last tests) in previous lactation, low level of CMSCC (weighted by daily milk yield mean) in the herd, young cows, and not having had a case of treatment for chronic clinical mastitis. Additional information on the probability of failure in treated and untreated cows can be predicted by number of quarters infected with Staphylococcus aureus approximately 1.5 months before drying off. The models derived are considered for use as tools in selective treatment and culling decisions.

The effect of sour milk as a postmilking teat dip for mastitis prevention in a dairy herd

In a preliminary in vitro study, the growth of Staphylococcus aureus was totally inhibited during incubation for 24 h at 35 degrees C-37 degrees C in a solution of cooked commercial milk with 1% of uncooked commercial sour milk ("A piimä"). In a subsequent clinical trial, "A piimä" sour milk with 5% glycerol was used as a postmilking teat dip from February to June. Quarterly milk samples were drawn once a month aseptically from 133 cows. Percentages of pathogen positive samples and somatic cell count (SCC) from teats dipped with the sour milk were compared with those dipped with a commercial iodine teat dip and those of undipped controls. During March-June there were fewer isolations of S. aureus (2.09%) and coagulase-negative staphylococci (2.52%) in the sour-milk group than in the control group (3.09% and 4.07%, respectively). In iodine group, there were fewer isolations of S. aureus (0.83%) but more isolations of coagulase-negative staphylococci (5.26%) than in the control group. During the study period, the percentages of bacterial isolates did not differ statistically significantly between treatments, p = 0.291. The percentage of quarters with a SCC over 125,000 at the end of the study was one third lower in the sour-milk group than in the control group (16.67% and 26.23% respectively) but the difference was not statistically significant (p = 0.074). The results indicate that a sour-milk teat-dip preparation can inhibit new intra mammary infections (IMI).