|Year : 2009 | Volume
| Issue : 2 | Page : 124-126
Cylindric cell carcinoma of the base of the tongue: A rare variant of squamous cell carcinoma
Milind Kumar1, Amit Bahl1, DN Sharma1, Ruchi Sharma1, Ruchika Gupta2, Shamim Ahmed3, PK Julka1, GK Rath1
1 Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi - 110 029, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi - 110 029, India
3 Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029, India
|Date of Web Publication||16-Jun-2009|
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
Cylindric cell carcinomas (transitional cell carcinomas) are a rare and distinct histopathological entity presenting in the head and neck region. They have been known by myriads of nomenclature like cylindric carcinomas, nonkeratinizing sinonasal carcinoma, papillary carcinoma, cylindrical or columnar cell carcinoma, intermediate cell carcinoma, Schneiderian carcinoma, and Ringertz carcinoma. They are considered a variant of nonkeratinizing squamous cell carcinoma. Cylindric carcinomas are usually described in the sinus and nasal cavity and rarely said to involve nasopharynx and larynx. Only passing references have been made for its presentation in oropharynx including tonsils and the base of the tongue. We report here a rare case of transitional cell carcinoma presenting in the base of the tongue. There are no separate treatment recommendations in the literature, and the management is on the lines of treatment of squamous cell carcinoma. We report here a case of cylindric cell carcinoma presenting in the base of the tongue. The patient was staged as having cT2 N3 M0 (Stage IV B) disease. The patient received palliative radiotherapy of 20 Gy in five fractions followed by chemotherapy with injection paclitaxel and carboplatin. A partial response to treatment was achieved at the time of writing this report.
Keywords: Base of the tongue, cylindric carcinoma, transitional carcinoma
|How to cite this article:|
Kumar M, Bahl A, Sharma D N, Sharma R, Gupta R, Ahmed S, Julka P K, Rath G K. Cylindric cell carcinoma of the base of the tongue: A rare variant of squamous cell carcinoma. J Can Res Ther 2009;5:124-6
|How to cite this URL:|
Kumar M, Bahl A, Sharma D N, Sharma R, Gupta R, Ahmed S, Julka P K, Rath G K. Cylindric cell carcinoma of the base of the tongue: A rare variant of squamous cell carcinoma. J Can Res Ther [serial online] 2009 [cited 2019 Nov 23];5:124-6. Available from: http://www.cancerjournal.net/text.asp?2009/5/2/124/52795
| > Introduction|| |
Cylindric cell carcinomas (transitional cell carcinomas) are considered a rare variant of squamous cell carcinoma. Other terms applied to this entity have been nonkeratinizing sinonasal squamous cell carcinoma, Ringertz carcinoma, Schneiderian carcinoma, sinonasal cylindrical cell carcinoma, sinonasal Schneiderian carcinoma, and sinonasal transitional cell carcinoma. This entity was described by Ringertz in 1938 and has been infrequently reported in the literature since then.  They are pathologically characterized by a plexiform or ribbon-like growth pattern, cytological atypia, and lack of histological evidence of keratinization. This pathology commonly involves the sinuses and nasal cavity, and rarely nasopharynx and larynx. Maxillary antrum remains the commonest site to be involved. Oropharynx is a rare site of involvement. The estimated incidence of transitional cell carcinoma in the sinonasal tract is 2-11%.  There are little data on the biological behavior of these tumors. , Treatment is usually on the lines of squamous cell carcinoma. In this case report, we attempt to discuss the clinical presentation, histopathology features, radiology, PET characteristics, and clinical management of this infrequently encountered tumor presenting in the base of the tongue.
| > Case Report|| |
A 58-year-old man presented to our Head and Neck Tumor Clinic with complaints of swelling of 6-month duration in the right side of the neck [Figure 1]. The swelling had progressively increased in size and was associated with moderate pain since the last 1 month. It was associated with difficulty in eating both solids and semisolids. The patient did not give any history of respiratory difficulty, hoarseness of voice, or visual or hearing problems. There was no past history of tuberculosis, diabetes, seizures, or hypertension. He gave a history of tobacco chewing for 10 years and smoking cigarettes occasionally (less than three per week). There was no history of alcohol intake.
On examination, the patient had a Karnfosky performance status (KPS) of 70. Bilateral neck nodes were palpable. In the left neck, a single, level II lymph node was palpable, 6 × 4 cm in size. It was firm in consistency with restricted mobility. A 7 × 4 cm, firm, level IV lymph node mass, with restricted mobility was palpable in the right neck. The cranial nerve examination was normal. Chest and abdomen were clinically unremarkable. Oral examination revealed induration in the base of the tongue in right side. Indirect laryngoscopy showed an ulceroproliferative growth in the base of the tongue with an extension to the vallecula on the right side. Chest X-ray evaluation was normal. A biopsy taken from the base of the tongue revealed cylindric (transitional) cell carcinoma. Histopathologically stratified cylindrical cells with nuclear atypia and frequent mitoses were seen. Focal invasion into the underlying stroma was also seen [Figure 2]. A contrast-enhanced CT scan revealed a soft tissue arising from the right vallecular region with bilateral cervical lymph node enlargement. A PET scan evaluation showed increased FDG uptake in the vallecular region and bilateral neck masses with a maximum SUV of 13.8 [Figure 3]. The patient was diagnosed as having cylindric cell carcinoma of the base of the tongue (cT2 N3 M0, Stage IV B). He was planned for palliative radiotherapy to a dose of 20 Gy in five fractions. The treatment was delivered using a cobalt-60 machine using parallel opposed bilateral face and neck portals, covering the primary and lymph node areas. At a 2-month follow-up, the disease was stable with a slight reduction in the size of the mass along with a good relief in pain. The patient received further treatment with palliative chemotherapy using injection of paclitaxel, 175 mg/m 2 , and carboplatin (AUC 6). At the end of four cycles of chemotherapy, the patient had a partial response in the neck node with minimal residual induration in the base of the tongue.
| > Discussion|| |
Ringertz was the first to describe 'solid cylindric cell cancer' in the nasal cavity and paranasal sinuses in 1938.  Larsson and Martensson reported another series on this rare entity about half a century ago.  Surprisingly, the literature is sparse on this variant of squamous cell carcinoma after these two reports. Transitional cell carcinomas or cylindric carcinomas are considered to be a very rare variant of squamous cell carcinomas with a confusing array of different names. These tumors show morphological resemblance to papilloma and hence they have been referred to as papillary carcinoma. They are also called as 'Schneider's carcinoma' a name derived from Schneider's epithelium lining the paranasal sinuses and the nasal cavity. In the WHO classification, the nomenclature 'cylindric' is preferred to transitional carcinoma  due to the varied interpretation of term 'transitional' because of its resemblance to transitional epithelium of urinary bladder or 'transition' referring to intermediate features between respiratory epithelium cells and squamous epithelium.
Pathologically, these tumors are well-differentiated nonkeratinizing carcinomas. They have ribbons of cells which may invaginate and form crypts. Sometimes invaginations of these ribbons of cells may be filled completely by solid tumor cells. Islands of stroma may be seen when these tumor columns become confluent. These cylindrical cells are seen at right angles to the basement membrane. A distinct feature described by Osborn et al . is the phenomena of dedifferentiation occurring in the basement membrane.  Foci of malignant squamous metaplasia are usually seen in cylindric cell carcinoma which may create diagnostic dilemma for squamous cell carcinoma. These tumors show early spread to cervical lymph nodes via the venous route, and lymphadenopathy may develop early in the course of the disease. This was also seen in our case as the patient developed neck nodes first and only later developed other local symptoms like difficulty in swallowing. There have been suggestions that cylindric cell carcinomas of paranasal sinuses have a better prognosis than squamous cell carcinoma. In the series from Larsson and Martensson, the 5-year survival was 36% versus 28% for squamous cell carcinomas.  Osborn et al . reported the 5-year survival for transitional cell carcinoma to be 45% as compared to 11.5% for squamous and 20% for anaplastic carcinomas of paranasal sinuses.  However, Manivel et al. reported on two cases of cylindric cell carcinoma having foci of yolk sac carcinoma and associated them with an aggressive clinical course. They recommended the use of germ-cell-tumor-directed chemotherapy in the treatment of such tumors with features of germ cell differentiation. 
Little is known about the biological behavior and treatment of transitional or cylindric cell carcinomas, particularly those presenting in the oropharynx. In light of the sparse knowledge, these tumors are best treated on lines of squamous cell carcinoma. There are no published reports on the use of newer chemotherapeutic agents or targeted therapy specifically for cylindric cell carcinomas seen in oropharynx. In view of good response to the regimen of paclitaxel and carboplatin, these drugs may be used along with radiotherapy. The treatment of such cases should be individualized due to the infrequent occurrence of such malignancy.
| > References|| |
|1.||Ringertz N. Pathology of malignant tumors arising in the nasal and paranasal cavities and Maxilla. Acta Otolaryngol 1938;27:1-405. |
|2.||Hopkin N, McNicoll W, Dalley VM, Shaw HJ. Cancer of the paranasal sinuses and nasal cavities. Part I. Clinical features. J Laryngol Otol 1984;98:585-95. |
|3.||Manivel C, Wick MR, Dehner LP. Transitional (Cylindric) cell carcinoma with endodermal sinus tumor like features of the nasopharynx and paranasal sinuses: Clinicopathologic and immunohistochemical study of two cases. Arch Pathol Lab Med 1986;110:198-202. |
|4.||Katz TS, Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, Villaret DB. Malignant tumors of the nasal cavity and paranasal sinuses. Head Neck 2002;24:821-9. |
|5.||Larsson LG, Martensson G. Carcinoma of the paranasal sinuses and the nasal cavities. Acta Radial 1954;42:149-72. |
|6.||Shanmugaratnam K. Histological typing of tumors of the upper respiratory tract and ear. 2 nd ed. Berlin: Springer Verlag; 1991. |
|7.||Osborn DA. Nature and behavior of transitional tumors in the upper respiratory tract. Cancer 1970;25:50-60. |
[Figure 1], [Figure 2], [Figure 3]