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LETTER TO THE EDITOR
Year : 2015  |  Volume : 11  |  Issue : 2  |  Page : 492-493

Basaloid squamous cell carcinoma of cervix showing neuroendocrine differentiation


Department of Pathology, Adyar Cancer Institute (WIA), Chennai, Tamil Nadu, India

Date of Web Publication7-Jul-2015

Correspondence Address:
Urmila Majhi
Department of Pathology, Adyar Cancer Institute (WIA), 38, Sardar Patel Road, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.146114

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How to cite this article:
Majhi U, Murhekar K, Sundersingh S, Srinivasan V. Basaloid squamous cell carcinoma of cervix showing neuroendocrine differentiation. J Can Res Ther 2015;11:492-3

How to cite this URL:
Majhi U, Murhekar K, Sundersingh S, Srinivasan V. Basaloid squamous cell carcinoma of cervix showing neuroendocrine differentiation. J Can Res Ther [serial online] 2015 [cited 2019 Nov 15];11:492-3. Available from: http://www.cancerjournal.net/text.asp?2015/11/2/492/146114

Sir,

Basaloid squamous cell carcinoma of the uterine cervix is an extremely rare malignant tumor of the female genital tract with a poorer clinical outcome than squamous cell carcinoma. Pure basaloid squamous cell carcinomas do not show neuroendocrine differentiation. [1],[2],[3] We present here a case of cervical cancer in a 67-year-old female showing features of basaloid squamous cell carcinoma.

The patient presented with bleeding per vagina. On examination, patient had an infiltrating growth involving the cervix. Biopsy showed strips of malignant squamous epithelium and necrotic material showing small clusters of malignant epithelial cells. Cervical smear showed poorly differentiated malignant epithelial cells. Preoperative investigations were within normal limits. Magnetic resonance imaging showed growth confined to cervix. Parametria was not infiltrated. A Type II hysterectomy with bilateral salpingo-oophorectomy was carried out along with bilateral pelvic nodal dissection. Grossly, the tumor was confined to cervix and measured 3.5 cm Χ 2.5 cm Χ 2.5 cm. Histopathology showed alveolar masses of tumor cells mostly composed of immature basaloid squamous cells with scanty cytoplasm and hyperchromatic nuclei [Figure 1]a. Areas showing keratinizing squamous cells [Figure 1]b were also seen. Peripheral palisading was seen [Figure 1]c. The lining squamous epithelium showed malignant transformation at places. Areas of necrosis and increased mitotic activity were seen [Figure 1]d. The tumor extended up to the parametrium.
Figure 1: (a) Tumor shows both squamoid islands and small basaloid cells (H and E, ×20), (b) Tumor shows squamoid areas (H and E, ×40), (c) Tumor shows basaloid areas with peripheral palisading (H and E, ×20), (d) Basaloid area showing high mitotic activity (H and E, ×20)

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The endodometrium, myometrium, ovaries, tubes and resected vaginal cuff were free of tumor infiltration. All the 20 pelvic lymph nodes were free of metastasis. The tumor cells showed positivity for neuron specific enolase [Figure 2]a, 34ίE12 (HMWK-Figure 2b), CD57 [Figure 2]c, B-cell lymphoma-2 [Figure 2]d, vimentin [Figure 3]a, chromogranin [Figure 3]b and synaptophysin. Focal positivity for epithelial membrane antigen, CK-19 [Figure 3]d and EGFR were seen. Reactions for CD56, carcinoembryonic antigen, thyroid transcriptional factor-1 (TTF-1), C-kit were negative. The proliferative index (Ki 67) [Figure 3]c and the p53 activity were high. A diagnosis of basaloid squamous cell carcinoma with neuroendocrine differentiation was made.
Figure 2: (a) Tumor cells show strong positivity for neuron specific enolase (IHC, ×20), (b) Tumor cells show strong positivity for 34ßE12 (IHC, ×20), (c) Tumor cells show strong positivity for CD57 (IHC, ×20), (d) Tumor cells show strong positivity for B-cell lymphoma-2 (IHC, ×20)

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Figure 3: (a) Tumor cells show positivity for vimentin (IHC, ×20), (b) Tumor cells show positivity for chromogranin (IHC, ×20), (c) Tumor cells show high proliferative activity (IHC, ×20), (d) The peripheral cells show positivity for CK 19 (IHC, ×20)

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The major differential diagnosis of basaloid squamous cell carcinoma includes solid variant of adenoid cystic carcinoma, which, usually, shows positivity for C-kit, small cell neuroendocrine carcinoma, which shows a positive reaction for TTF-1 and negative reaction for 34ίE12. Positive staining for 34ίE12 excludes large cell neuroendocrine carcinoma. TTF-1 and 34ίE12, in association with the specific neuroendocrine markers, are believed to be useful panel of antibodies for differentiating basaloid carcinomas from other carcinomas with small cell morphology. Accurate diagnosis is of prognostic importance due to the biologically aggressive behavior. [4],[5] The patient received postoperative radiotherapy. The responsiveness of chemotherapeutic agents to basaloid squamous cell carcinoma and carcinomas with neuroendocrine differentiation needs further clinical evaluation. [6]

 
 > References Top

1.
Kwon YS, Kim YM, Choi GW, Kim YT, Nam JH. Pure basaloid squamous cell carcinoma of the uterine cervix: A case report. J Korean Med Sci 2009;24:542-5.  Back to cited text no. 1
    
2.
Kim DJ, Kim KD, Shin DH, Ro JY, Chung KY. Basaloid carcinoma of the lung: A really dismal histologic variant? Ann Thorac Surg 2003;76:1833-7.  Back to cited text no. 2
    
3.
Fresvig A, Qvigstad G, Halvorsen TB, Falkmer S, Waldum HL. Neuroendocrine differentiation in bronchial carcinomas of classic squamous-cell type: An immunohistochemical study of 29 cases applying the tyramide signal amplification technique. Appl Immunohistochem Mol Morphol 2001;9:9-13.  Back to cited text no. 3
    
4.
Wang LC, Wang L, Kwauk S, Woo JA, Wu LQ, Zhu H, et al. Analysis on the clinical features of 22 basaloid squamous cell carcinoma of the lung. J Cardiothorac Surg 2011;6:10.  Back to cited text no. 4
    
5.
Moro-Sibilot D, Lantuejoul S, Diab S, Moulai N, Aubert A, Timsit JF, et al. Lung carcinomas with a basaloid pattern: A study of 90 cases focusing on their poor prognosis. Eur Respir J 2008;31:854-9.  Back to cited text no. 5
    
6.
Tan D, Zander DS. Immunohistochemistry for assessment of pulmonary and pleural neoplasms: A review and update. Int J Clin Exp Pathol 2008;1:19-31.  Back to cited text no. 6
    


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