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Wang NR, Wang MM, Zhou L, Liu ZL, Chen NP, Hu JP, Deng YJ, Qi XQ, Huang XF, Su Y, Zhang SY, Tong F, Zhang Y, Lu Q, Zhu ZY, Deng H. Cutaneous clear cell/signet-ring cell squamous cell carcinoma arising in the right thigh of a patient with type 2 diabetes: combined morphologic, immunohistochemical, and etiologic analysis. Diagn Pathol 2016; 11:36. [PMID: 27066782 PMCID: PMC4827219 DOI: 10.1186/s13000-016-0487-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/02/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The clear cell/signet-ring cell variant of cutaneous squamous cell carcinoma (cSCC) is extremely rare. Its carcinogenesis has consistently been linked to ultraviolet radiation and HPV in the literature. However, there is little definite information about the contribution of diabetes mellitus (DM) to cSCC. CASE PRESENTATION A 78-year-old Chinese woman with type 2 DM presented with a mushroom-like lump in her right thigh. Histological findings revealed that the lesion was mainly composed of clear cells and signet-ring cells. The septa of vacuoles in cytoplasm displayed positivity for periodic acid schiff (PAS) and cytokeratins such as AE1/AE3, CK5/6, CK14, and CK19. Malignant cells did not express CK7, CK8, CK18, CK20, p16, p53, or c-erbB-2, and the Ki-67 index was less than 5 %. We further explored the etiology of clear cell/signet-ring cell cSCC using human papillomavirus (HPV) type-specific PCR and genotyping and confirmed that the patient was not infected with HPV. Nucleus positivity for p63 indicated the involvement of the p53 family in the lesion. Meanwhile, the expression of fibroblast growth factor receptor-2 (FGFR2), a downstream effector of p63, was upregulated in tumor cells. CONCLUSIONS This study provides the first report on the clear cell/signet-ring cell variant of cSCC found in the right thigh of a patient with type 2 DM. Metabolic imbalance in addition to conventional pathogens such as UV and HPV may contribute to the development of the lesion via p63/FGFR2 axis.
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MESH Headings
- Aged
- Biomarkers, Tumor/analysis
- Biopsy
- Carcinoma, Signet Ring Cell/chemistry
- Carcinoma, Signet Ring Cell/etiology
- Carcinoma, Signet Ring Cell/pathology
- Carcinoma, Signet Ring Cell/surgery
- Carcinoma, Squamous Cell/chemistry
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Female
- Humans
- Immunohistochemistry
- Predictive Value of Tests
- Risk Factors
- Skin Neoplasms/chemistry
- Skin Neoplasms/complications
- Skin Neoplasms/pathology
- Skin Neoplasms/surgery
- Thigh
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Affiliation(s)
- Nong-Rong Wang
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meng-Meng Wang
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lv Zhou
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Ze-Lin Liu
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
- />Department of Endocrinology, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Nan-Ping Chen
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jin-Ping Hu
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Yan-Juan Deng
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Xiao-Qing Qi
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Xiao-Feng Huang
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
| | - Yue Su
- />Medical College, Nanchang University, Nanchang, China
| | - Si-Yao Zhang
- />Medical College, Nanchang University, Nanchang, China
| | - Fei Tong
- />Medical College, Nanchang University, Nanchang, China
| | - Yu Zhang
- />Medical College, Nanchang University, Nanchang, China
| | - Qi Lu
- />Medical College, Nanchang University, Nanchang, China
| | - Zi-Yu Zhu
- />Medical College, Nanchang University, Nanchang, China
| | - Huan Deng
- />Molecular Medicine and Genetics Center, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
- />Department of Pathology, The Fourth Affiliated Hospital of Nanchang University, 133 South Guangchang Road, Nanchang, 330003 China
- />Renmin Institute of Forensic Medicine, Nanchang, China
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