Cylindrical Cell Carcinoma


Cylindrical cell carcinoma, also known as non-keratinis-ing squamous cell carcinoma, transitional cell carcinoma or schneiderian carcinoma, is a tumour composed of malignant proliferating cells derived from sinonasal respiratory (schneiderian) epithelium. The name cylindrical cell carcinoma was first coined by Ringertz in 1938 [212] and recommended as the preferred term by Shanmugaratnam in the WHO classification of 1991 [226].

Grossly, the tumours grow in most cases as exophyt-ic masses showing either a corrugated or a smooth surface. They may arise from the antrum, the lateral nasal wall or the ethmoid, the maxillary antrum being the most frequent site [193, 194]. They may occur con-comitantly with other non-neoplastic polypoid formations. Microscopically, cylindrical cell carcinoma is composed of papillary fronds (Fig. 2.9a), thick ribbons and polystratified masses of cells that give rise quite often to invaginations of the surface epithelium, which at low magnification may mimic inverted papilloma. The tumour cells are commonly cylindrical and have a tendency to form palisade arrangements perpendicular to the underlying basement membrane (Fig. 2.9b). The nuclei are atypical and show increased mitotic activity, as well as abnormal mitotic figures. The pattern of invasion is usually expansive, being characterised by pushing margins with focal infiltration of the stroma. The basement membrane remains in most cases conspicuous, despite stromal infiltration, which should not be regarded as carcinoma in situ. Foci of squamous metaplasia, with transition from cylindrical to squamous epithelium, are not uncommon and when extensive these tumours may be indistinguishable from squamous cell carcinoma. This resulted in denominations such as "transitional cell carcinoma" and "non-keratinising squamous cell carcinoma", which may be confusing. The first because the term transitional has also been applied to carcinomas of the lymphoepithelial type, and the second due to the fact that tumours called "non-keratinising squamous cell carcinoma" also have foci of keratinisation [267a]. In addition, the term cylindrical cell carcinoma should be preferred to non-ke-ratinising squamous cell carcinoma because "pure" cylindrical cell carcinomas, without any squamous cell component, carry a better prognosis than conventional squamous cell carcinomas [84]. Very recent observations suggest a strong etiologic relationship of cylindrical cell carcinoma to high-risk human papilloma-virus [69a]. A high proportion of these tumours show marked immunoreactivity for p16.

More aggressive types of carcinoma, such as sinona-sal undifferentiated carcinoma (SNUC) or high-grade adenocarcinoma, may appear occasionally intermingled with cylindrical cell carcinoma [226]. Two cases of cylindrical cell carcinoma with endodermal sinus-like features have been reported [162]. A full examination of the resected specimen is therefore mandatory before labelling a tumour a "pure cylindrical cell carcinoma".

The two main differential diagnoses of cylindrical cell carcinoma are the schneiderian papillomas of the inverted and oncocytic types, especially when they have concomitant carcinomatous changes. Both types of papilloma lack the atypical cellularity constantly seen in cylindrical cell carcinoma. When schneiderian papillomas coexist with cylindrical cell carcinomas, or with other types of carcinoma, the two components usually appear demarcated from one another although in contiguity. When the invaginating crypts of an inverted papilloma are filled with the cords and ribbons of a keratinising or non-keratinising squamous cell carcinoma, the lesion represents a conventional squamous cell carcinoma arising in an inverted papilloma, which implies a worse prognosis than that of cylindrical cell carcinoma.

Cylindrical Cell
Fig. 2.9. Cylindrical cell carcinoma. a Papillary structures covered by malignant cells with cylindrical cytoplasm and basal nuclei arranged in palisades. b Marked immunoreactivity of the epithelial neoplastic cells for p16, which is related to high-risk HPV
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