A Case of Acantholytic Squamous Cell Carcinoma: DISCUSSION part 2

Posted by James

The histopathologic differential diagnosis includes adenoid basal cell carcinoma (BCC), eccrine adeno- carcinomas, metastatic adenocarcinomas, and epi- thelioid angiosarcomas. BCC must show, at least in part, the typical peripheral palisading, peritu- moral lacunae, and stromal mucin. Most eccrine neoplasms are positive for S-100, EMA, CEA, and CKs, while A-SCC stains positive for only EMA and CKs. Epithelioid angiosarcoma shows positivity for endothelial markers. Metastatic adenocarcinoma shows multiplicity, acantholytic dyskeratosis and the absence of clear epidermal attachments.

The prognosis of A-SCC is matter of debate. According to the study by Nappi et al in 1989, 11 patients had local recurrence, 5 had visceral metastases, and 2 died of local intracranial extension of the tumor in their review of 36 patients, and the total mortality was 19%. It is thought this high mortality rate may have been due to refusal of treatment or a reporting bias. In a more recent study by Petter and Haustein in 1998, only 1 patient developed a local recurrence. There are some reasons for the difficulty to evaluate the metastatic potential of A-SCC. First, there are no precise clinical data about the size of the lesiones. Second, most of the reported lesions located on mucosa to have a high malignant potential. Third, many patients have predisposing factors associated with metastasis (i.e., immunosuppression). Although various reports have shown controversial results, the overall malignant potential of A-SCC seems not to be higher than that of typical invasive SCC.
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A-SCC is an uncommon variant of SCC and it has a characteristic ‘pseudoglandular’ appearance, so making the differential diagnosis via immunohis- tochemistry to exclude eccrine neoplasms and vascular sarcomas may be important. Herein we report a case of A-SCC that showed well-defined cystic structures, confirmed by immunohistochemi- cal staining.