Adenoid Squamous Cell Carcinoma


Adenoid squamous cell carcinoma (adenoid SCC) is an uncommon histopathologic type of SCC that was first recognised by Lever in 1947 [211]. It resembles an ordinary SCC, but because of the acantholysis of malignant squamous cells, pseudoluminae are formed, creating the appearance of glandular differentiation. There is no evidence of true glandular differentiation or mucin production.

Adenoid SCC has been referred to by a variety of names such as pseudoglandular SCC, acantholytic SCC, SCC with gland-like features and adenoacanthoma.

In the head and neck it arises most frequently in the skin (especially in sun-exposed areas) [259, 260], and less frequently in mucosal sites of the upper aerodiges-tive tract, including the lip, oral cavity, tongue and nasopharynx [27, 37, 105, 135, 173, 348, 375, 388].

Adenoid SCCs are composed of islands and cords of keratinising SCC; because of the acantholysis of neo-plastic cells, pseudoglandular (adenoid) structures are formed that have central lumina containing detached acantholytic neoplastic cells, necrotic debris, or they may be empty (Fig. 1.18a). The conventional squamous cell carcinoma component is nearly always present.

Acantholysis may lead to the formation of anastomosing spaces and channels, thus mimicking an an-giosarcoma (Fig. 1.18b). This variant of adenoid SCC is termed pseudovascular adenoid SCC or angiosarcoma-

like SCC, and has been reported in the skin of the head and neck [260], as well as in other organs, such as breast and lungs [18].

Immunohistochemically, adenoid SCCs are positive for epithelial markers, such as cytokeratins and epithelial membrane antigen (EMA); it may also express car-cinoembryonic antigen (CEA) and vimentin [105].

Ultrastructural analysis revealed hemidesmosomes and attached tonofilaments, with no glandular features, thus supporting the squamous origin of the adenoid SCC [388].

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