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Presented by Pedram Argani, M.D. and prepared by Shien Micchelli, M.D.
Case 3: This is a 79 year-old female with a pulmonary mass which is noted after resolution of an episode of pneumonia.
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1. Question
Week 291: Case 3
This is a 79 year-old female with a pulmonary mass which is noted after resolution of an episode of pneumonia.images/11_20_06_3a.jpg
images/11_20_06_3b.jpg
images/11_20_06_3c.jpgCorrect
Answer: Squamous cell carcinoma, basaloid type
Histology: This is a high grade neoplasm, as the tumor cells have high mitotic rate and are associated with extensive necrosis. Overt areas of squamous differentiation are noted, consisting of keratin pearls and abundant keratinous debris. Associated with the squamous differentiation are islands of primitive-appearing epithelium, forming nests. These cells have fairly vesicular chromatin, with readily apparent nucleoli. Nuclear molding is not a prominent feature. The tumor cells are diffusely immunoreactive for high molecular weight cytokeratin 34betaE12, and nonreactive for neuroendocrine markers chromogranin, synaptophysin and CD56.
Discussion: Small cell carcinoma or mixed small cell-squamous carcinoma is the main differential diagnosis here. Basaloid squamous carcinoma is distinguished from small cell carcinoma by expression of high molecular weight cytokeratins and absence of significant reactivity for neuroendocrine markers. Cytologically, basaloid squamous carcinoma lacks the nuclear molding and diffuse, hyperchromatic chromatin of a small cell carcinoma. Large cell neuroendocrine carcinoma has a nested (neuroendocrine) growth pattern, but features cells with vesicular nuclear chromatin and prominent nucleoli. Squamous differentiation would not be a feature.
Incorrect
Answer: Squamous cell carcinoma, basaloid type
Histology: This is a high grade neoplasm, as the tumor cells have high mitotic rate and are associated with extensive necrosis. Overt areas of squamous differentiation are noted, consisting of keratin pearls and abundant keratinous debris. Associated with the squamous differentiation are islands of primitive-appearing epithelium, forming nests. These cells have fairly vesicular chromatin, with readily apparent nucleoli. Nuclear molding is not a prominent feature. The tumor cells are diffusely immunoreactive for high molecular weight cytokeratin 34betaE12, and nonreactive for neuroendocrine markers chromogranin, synaptophysin and CD56.
Discussion: Small cell carcinoma or mixed small cell-squamous carcinoma is the main differential diagnosis here. Basaloid squamous carcinoma is distinguished from small cell carcinoma by expression of high molecular weight cytokeratins and absence of significant reactivity for neuroendocrine markers. Cytologically, basaloid squamous carcinoma lacks the nuclear molding and diffuse, hyperchromatic chromatin of a small cell carcinoma. Large cell neuroendocrine carcinoma has a nested (neuroendocrine) growth pattern, but features cells with vesicular nuclear chromatin and prominent nucleoli. Squamous differentiation would not be a feature.
