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Presented by Pedram Argani, M.D. and prepared by Bahram R. Oliai, M.D.
Case 5: 48 year old male with a maxillary tumor.
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1. Question
Week 67: Case 5
48 year old male with a maxillary tumor./images/01-50714a.jpg
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/images/01-50714d.jpgCorrect
Answer: Squamous cell carcinoma (adenoid/acantholytic type)
Histology: The tumor connects with the surface epithelium, and this merging is key to establishing the diagnosis. While the deeper tumor has an unusual growth pattern where epithelial cells surround open spaces (simulating glands or vascular spaces), closer inspection of these cells demonstrates bridges of the intercellular type that are characteristic of squamous epithelium. These cells are strongly immunoreactive for cytokeratin AE1/3 and cytokeratin 903 (34 Beta E12), and non-immunoreactive for CD31 or CD34. Mucicarmine stain was negative.
Discussion: Angiosarcomas of the epithelioid type may label for cytokeratin: however, angiosarcomas should label for vascular markers, and would not have a surface epithelial component. Adenocarcinoma would not have a surface squamous component and would demonstrate mucicarmine positivity. Ameloblastomas do not demonstrate a surface component, and would be characterized by palisaded basaloid cells at the periphery with central stellate reticulum-like areas.
The adenoid/acantholytic pattern of squamous cell carcinoma is not known to have specific prognostic significance; however, its importance lies in its distinction from vascular or glandular neoplasms. Close attention to the tumor’s cytology and the surface epithelial component helps avert these potential mistakes.
Incorrect
Answer: Squamous cell carcinoma (adenoid/acantholytic type)
Histology: The tumor connects with the surface epithelium, and this merging is key to establishing the diagnosis. While the deeper tumor has an unusual growth pattern where epithelial cells surround open spaces (simulating glands or vascular spaces), closer inspection of these cells demonstrates bridges of the intercellular type that are characteristic of squamous epithelium. These cells are strongly immunoreactive for cytokeratin AE1/3 and cytokeratin 903 (34 Beta E12), and non-immunoreactive for CD31 or CD34. Mucicarmine stain was negative.
Discussion: Angiosarcomas of the epithelioid type may label for cytokeratin: however, angiosarcomas should label for vascular markers, and would not have a surface epithelial component. Adenocarcinoma would not have a surface squamous component and would demonstrate mucicarmine positivity. Ameloblastomas do not demonstrate a surface component, and would be characterized by palisaded basaloid cells at the periphery with central stellate reticulum-like areas.
The adenoid/acantholytic pattern of squamous cell carcinoma is not known to have specific prognostic significance; however, its importance lies in its distinction from vascular or glandular neoplasms. Close attention to the tumor’s cytology and the surface epithelial component helps avert these potential mistakes.
