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Presented by Fred Askin, M.D. and prepared by Jeffrey Seibel, M.D. Ph.D.
Case 4: The patient is a 58-year-old man with a lesion on the left posterior tongue.
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1. Question
Week 84: Case 4
The patient is a 58-year-old man with a lesion on the left posterior tongue./images/040102case4a.jpg
/images/040102case4b.jpg
/images/040102case4c.jpgCorrect
Answer: Squamous carcinoma
Histology: The tumor cells have prominent pink cytoplasm. There is loss of cell cohesion and a prominent pseudopapillary appearance in many areas.
Discussion: This lesion is a good example of a relatively specific form of pseudosarcomatous squamous carcinoma. This variant has been described as “acantholytic” or “pseudoangiosarcomatous” because of the loss of cell cohesion and the prominent pseudopapillary appearance in many areas. This variant of squamous cancer has been described in a variety of sites (Human Pathology 1994; 25:373-378) including lung, breast and skin. In our patient, the tumor cells were positive with markers for various cytokeratins. They were negative for endothelial markers. Malignant melanoma would have been a reasonable consideration since pseudoangiosarcomatous forms of melanoma have also been described (Histopathology 2000; 36: 387-402). The prominent pink cytoplasm in the tumor cells might have suggested rhabdomyosarcoma, but no cross striations were apparent and the tumor cells were negative for immunohistochemical stains for myogenin and other muscle markers.
The key to the diagnosis of this pseudoangiosarcomatous form of squamous carcinoma is knowledge of the entity and, often, discovery of other more recognizable patterns of squamous carcinoma admixed in the lesion or at the periphery.
Incorrect
Answer: Squamous carcinoma
Histology: The tumor cells have prominent pink cytoplasm. There is loss of cell cohesion and a prominent pseudopapillary appearance in many areas.
Discussion: This lesion is a good example of a relatively specific form of pseudosarcomatous squamous carcinoma. This variant has been described as “acantholytic” or “pseudoangiosarcomatous” because of the loss of cell cohesion and the prominent pseudopapillary appearance in many areas. This variant of squamous cancer has been described in a variety of sites (Human Pathology 1994; 25:373-378) including lung, breast and skin. In our patient, the tumor cells were positive with markers for various cytokeratins. They were negative for endothelial markers. Malignant melanoma would have been a reasonable consideration since pseudoangiosarcomatous forms of melanoma have also been described (Histopathology 2000; 36: 387-402). The prominent pink cytoplasm in the tumor cells might have suggested rhabdomyosarcoma, but no cross striations were apparent and the tumor cells were negative for immunohistochemical stains for myogenin and other muscle markers.
The key to the diagnosis of this pseudoangiosarcomatous form of squamous carcinoma is knowledge of the entity and, often, discovery of other more recognizable patterns of squamous carcinoma admixed in the lesion or at the periphery.
