Differential diagnosis

The most critical distinction in the differential diagnosis of PSCC is ruling out the possibility of metastatic squamous cell carcinoma, whose incidence is greater than true PSCC. PSCC must also be distinguished from mucoepidermoid carcinoma (MEC). MEC is typically composed of a variable cell population, including mucocytes, basaloid, and intermediate cells, in addition to epidermoid cells. However, prominent keratinization is not characteristic of MEC. MEC may exhibit cystic areas and focal clear cell differentiation, features not observed in PSCC. Histochemical stains for intracellular mucin to rule out high-grade MEC are recommended before making a definitive diagnosis of PSCC {669}. Squamous metaplasia in infarcted or surgically manipulated tumours can be misinterpreted as PSCC.

Keratocystoma is a recently described, rare lesion of salivary glands that may be confused with squamous cell carcinoma {1822}. It is characterized by multicytic spaces lined by stratified squamous cells containing keratotic lamellae and focal solid epithelial nests. The consistent absence of metastasis, necrosis or invasion, as well as the lack of cytologi-cal atypia and minimal cellular prolifera-tive activity in keratocystoma is essential in distiguishing this lesion from PSCC.

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