A Case of Acantholytic Squamous Cell Carcinoma: CASE REPORT

Posted by James

An 82-year-old woman presented with an ery- thematous nodule on the left eyebrow with a 4-months-history. The patient was on medication for hypertension, but otherwise healthy without any other systemic diseases. She had a history of Mohs micrographic surgery for SCC on the right cheek 2 months previously. On examination, a non-inflamed slightly pruritic hyperkeratotic papule with tender­ness was located on the left eyebrow (Fig. 1). Clinically prurigo nodularis, seborrheic keratosis, and SCC were suspected and then a shaving biopsy was performed for making the diagnosis.

Fig. 1. An erythematous hyperkeratotic papule on the left eyebrow.

Histologic examination revealed that the tumor was composed of epidermal-derived cystic structures. The central spaces contained floating individual acantholytic cells and atypical dyskeratotic cells (Fig. 2A). At the periphery of the tumor, the cells formed a cohesive layer that was one to two cells thick. The acantholytic cells appeared extremely bizarre, large, and multinucleated (Fig. 2B). On the immunohistochemical studies, the acantholytic tumor cells were negative for dPAS, mucicarmine, and CEA staining and they were positive for CKs with a crisp cytoplasmic staining pattern (Fig. 3).
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Fig. 2. (A) A large central cavity contained many individual floating acantholytic cells and atypical dyskeratotic cells (H&E, x40). (B) Extremely bizarre, large, and multinucleated acantholytic cells (H&E, x400).

The whole lesion was removed after skin biopsy and no recurrence was noted for 6 months.

Fig. 3. Positive staining for cytokeratins with a crisp cytoplasmic staining pattern (Pan-CK, x400, Avidin- biotin complex method).