A rare case of acantholytic squamous cell carcinoma of the larynx
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1
Polytechnical University of Marche, Department of Clinical Specialistic and Dental Sciences, Italy
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2
University of Foggia, Department of Clinical and Experimental Medicine, Italy
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3
Ospedali Riuniti Umberto I, Department of Oral and Head-Neck Surgery, Italy
Aim. Squamous cell carcinoma (SCC) is the most common malignancy of the larynx, associated with alcohol and tobacco consumption. Acantholytic SCC (ASCC) is a rare histopathologic variant of SCC, which represents about 0.2-1% of all cases. It occurs especially in sun-exposed area of the skin and has only rarely observed in the mucosal upper aerodigestive tract. It is characterised by acantholysis of the tumour cells, creating pseudolumina and false appearance of glandular differentiation. This study presents the fourth literature case of laryngeal ASCC.
Materials and Methods. On May 2018, a 51-year-old, Caucasian man was referred to the Department of Otolaryngology, Ancona General Hospital, complaining dyspnea, stridor and dysphonia from 3 months. Past medical history was unremarkable. Clinical examination revealed a flat plaque with a well-defined, raised edge. The patient underwent to endoscopic direct microlaryngoscopy. Biopsy results showed fragments of malignant neoplasia with squamous differentiation of the left subglottis, with 1 cm diameter.
Subsequently the patient underwent to a total enlarged laryngectomy with radical neck dissection, refusing the postoperative radiotherapy. Larynx, pre-laryngeal muscles, peristomal tissue and thyroid gland were removed. The material was sent to the Institute of Pathology, Marche Polytechnic University, Ancona, for histological examination.
Results. On gross examination, the subglottic region, showed a whitish nodule, measuring cm 3x2.5x2, located cm 1.5 from the inferior margin. On microscopic examination, the lesion was composed of squamous differentiation and invasion, with acantholysis foci in tumour nests, creating the appearance of glandular differentiation. The pseudolumina contained acantholytic and dyskeratotic cells, and cellular debris. There was no evidence of true glandular differentiation or mucin production.
Immunohistochemically, tumor cells were positive to AE1/AE3, p63 and p40 supporting a squamous epithelial origin; and to CK 5/6, both in acantholytic and squamous component. In contrast to SCC, ASCC showed significant reductions of CK19, E-cadherin and concomitant up-regulation of Vimentine. Tumor cells were negative to TTF1, CK 7, D2-40, CD31 and CD34, excluding other tumors. Mib-1 ranged from 5-10% in acantholytic areas, up to 50-60% in squamous areas. Final diagnosis of well-differentiated SCC with extensive acantholytic areas was released 4th WHO Classification.
Thyroid isthmus hosted two white-brownish nodules of cm 0.3-0.6. Microscopically, the thyroid parenchyma presented struma and pluri-focal metastasis of SCC. According to AJCC Cancer Staging System, 8th Edition 2018, IVa pathological stage was attributed. Two months later, bleeding tracheostomy and clinical detection of a left peristomal neoformation, led to diagnosis of disease recurrence. The recurred lesion was excised, but after that, the patient refused further surgery and radiation treatments.
Discussion. Because of its rarity, ASCC has been excluded as a distinct histological type in 4th WHO
Classification. Prognosis is controversial due to its rarity; however, some reports suggest a worse prognosis that SCC. The overall 5-year survival rate for subglottic SCC is about 40%, with risk of spread to the upper mediastinum lymph node stations. Tracheal mucosa infiltration and poor-differentiation are unfavorable prognostic and predictive factors, reducing the survival rate up to 25%. The significant reductions of CK19 suggest an epithelial-mesenchymal transition, associated with tumor invasion and dissemination. Follow-up is critical, especially in the first two years due to the significant risk of loco-regional failure.
References
Xin Gu, et al., Acantholytic Squamous Cell Carcinoma in Upper Aerodigestive Tract: Histopathology, Immunohistochemical Profile and Epithelial Mesenchymal Transition Phenotype Change. Head and Neck Pathol (2012) 6:438–444. 1 August 2012;
Keywords:
acantholytic carcinoma,
Squamous cell carcinoma,
Acantholysis,
Subglottis,
Laryngectomy
Conference:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018.
Presentation Type:
Poster Presentation
Topic:
Oral Diseases
Citation:
Ripanti
S,
Santarelli
A,
De Lillo
A,
Giannatempo
G,
Balercia
A and
Rubini
C
(2019). A rare case of acantholytic squamous cell carcinoma of the larynx.
Front. Physiol.
Conference Abstract:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine..
doi: 10.3389/conf.fphys.2019.27.00011
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Received:
24 Oct 2018;
Published Online:
09 Dec 2019.
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Correspondence:
Dr. Silvia Ripanti, Polytechnical University of Marche, Department of Clinical Specialistic and Dental Sciences, Ancona, Italy, fedemurkez@gmail.com