Degenerated Keratinized Tumor Cells in Oropharyngeal Human Papilloma Virus-Associated Squamous Cell Carcinoma: A Pitfall in p16 Immunostaining of Fine-Needle Aspiration Specimens

2018 ◽  
Vol 62 (5-6) ◽  
pp. 339-345 ◽  
Author(s):  
Shuanzeng Wei ◽  
Hormoz Ehya

Objective: High-risk human papilloma virus (HPV) testing should be performed on all patients with newly diagnosed oropharyngeal HPV-associated squamous cell carcinoma (OPHPVSCC), and p16 immunostaining can be used as a surrogate marker. Although in surgical pathology specimens p16 staining in > 70% of the tumor cells is considered a positive result, the interpretation in fine-needle aspiration (FNA) specimens has remained controversial. Study Design: FNA of neck lymph nodes and corresponding surgical specimens from 42 patients with OPHPVSCC were reviewed. Results: In FNA specimens, 38 cases (90.5%) had viable tumor cells, 32 (76.2%) had keratin debris, and 36 (85.7%) had degenerated keratinized tumor cells. Twenty-seven of 27 (100%) had positive p16 staining in > 70% of viable tumor cells, while the degenerated tumor cells were negative. Twenty of 24 (83.3%) primary OPHPVSCC exhibited focal degenerated keratinized tumor cells and/or keratin debris. Conclusions: This study showed that the majority of the OPHPVSCC metastases in lymph nodes had degenerated keratinized tumor cells and keratin debris. Many primary OPHPVSCC also demonstrated focal keratinization and/or degeneration. The degenerated tumor cells showed no immunoreactivity to p16. The same 70% cutoff used in histologic specimens should be applied in cytologic specimens, but only the viable tumor cells should be counted.

Author(s):  
V. G. Kravtsov

Introduction. Primary pulmonary lymphoepithelial carcinoma is a poorly differentiated squamous cell carcinoma admixed with variable amounts of lymphoplasmacytic infiltrate, frequently associated with EBV. It is a rare cancer and have a better prognosis than other non-small cell lung cancer. The tumor can mimic metastatic non-keratinizing SCC of the naso-pharynx, poorly differentiated non-small cell carcinoma and NUT carcinoma arising in the lung, and non-Hodgkin lymphomas. Materials and methods. A 75-year-old man presented with peripheral mass of left lower lobe, maximal diameter was 5.1 cm, involving lingula and medial pleura, with mediastinal, and retroperitoneal lymphadenopathy revealed by computer tomography. Fine needle aspiration-EBUS was performed from hilar and interlobar lymph nodes. Papanicolaou smears and cell blocks were prepared. Additional CT-guided cor-needle biopsy and FNA were performed from lung lesion later. Results. A few large malignant epithelial cells, consistent with non-small lung cancer, were found on a background of lymphocytes in fine-needle aspiration from lymph nodes. Immunostain results: Pan-CK (AE1/AE3), p63 and Ki67 were positive in malignant cells, leukocyte common antigen (CD45) was positive in lymphocytes (negative in tumor cells), and negative markers were TTF1, chromogranin and synaptophysin. Cytological diagnosis was metastatic non-small lung cancer, favor squamous cell carcinoma. Biopsy and aspiration from left lung showed syncytial groups of large malignant epithelial cells with scant cytoplasm and prominent nucleoli on a background of prominent inflammatory infiltrate,consistent with lymphoepithelial carcinoma. Conclusion. It is impossible to correctly diagnose metastasis of lymphoepithelial carcinoma in lymph node by FNA only without FNA or biopsy of primary lesion, because cytological features and immunostains are identical to non-keratinizing squamous cell carcinoma.


2002 ◽  
Vol 19 (3) ◽  
pp. 122-126 ◽  
Author(s):  
Erin S. Herring ◽  
Mark M. Smith ◽  
John L. Robertson

A retrospective study was performed to report the histologic examination results of regional lymph nodes of dogs and cats with oral or maxillofacial neoplasms. Twenty-eight dogs and 3 cats were evaluated. Histologic examination results of standard and serial tissue sectioning of regional lymph nodes were recorded. When available, other clinical parameters including mandibular lymph node palpation, thoracic radiographs, and pre- and postoperative fine needle aspiration of lymph nodes were compared with the histologic results. Squamous cell carcinoma, fibrosarcoma, and melanoma were the most common neoplasms diagnosed in dogs. Squamous cell carcinoma and fibrosarcoma were diagnosed in cats. Of the palpably enlarged mandibular lymph nodes, 17.0 % had metastatic disease histologically. Radiographically evident thoracic metastatic disease was present in 7.4 % of cases. Preoperative cytologic evaluation of the mandibular lymph node based on fine needle aspiration concurred with the histologic results in 90.5 % of lymph nodes examined. Postoperative cytologic evaluation of fine needle aspirates of regional lymph nodes concurred with the histologic results in 80.6 % of lymph nodes examined. Only 54.5 % of cases with metastatic disease to regional lymph nodes had metastasis that included the mandibular lymph node. Serial lymph node sectioning provided additional information or metastasis detection. Cytologic evaluation of the mandibular lymph node correlates positively with histology, however results may fail to indicate the presence of regional metastasis. Assessment of all regional lymph nodes in dogs and cats with oral or maxillofacial neoplasms will detect more metastatic disease than assessing the mandibular lymph node only.


Radiology ◽  
2001 ◽  
Vol 218 (1) ◽  
pp. 289-293 ◽  
Author(s):  
David R. Colnot ◽  
Eline J. C. Nieuwenhuis ◽  
Michiel W. M. van den Brekel ◽  
Rik Pijpers ◽  
Ruud H. Brakenhoff ◽  
...  

2021 ◽  
Vol 49 ◽  
Author(s):  
Beatriz Crepaldi Aléssio ◽  
Juliana Paniago Lordello de Paula ◽  
Gustavo Gomes de Oliveira ◽  
Silvana Marques Caramalac ◽  
Alda Izabel de Souza ◽  
...  

Background: Squamous cell carcinoma is a malignant neoplasm that originates from the keratinized stratified squamous epithelium and predominantly affect light-skinned animals. In dogs, breeds such as American Staffordshire Terriers, white or speckled Bull Terriers, and Beagles have a higher predisposition. Squamous cell carcinoma presents in the skin, at slightly pigmented or hairy sites, especially in digits, but also may occur in the nasal planum, oral mucosa, and rarely, in the eye. Considering that few reports have been published on eye neoplasms, the aim of this paper is to describe a dog with a lesion in the third eyelid of his right eye which was diagnosticated with squamous cell carcinoma. Case: A 10-year-old male American Staffordshire dog was admitted to the Veterinary Medical Teaching Hospital of the Veterinary Medicine and Zootechnics College, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Brazil with injury to the right eye. During the physical examination, there was also a non-adhered lump near the foreskin, measuring 1.5 cm in diameter. In addition, there was another lump in the third eyelid of the right eye, approximately 3 mm in diameter. Cytology of the dermal nodule was performed by fine-needle aspiration cytology; however, the sample was insufficient for cytological evaluation. Therefore, the animal was placed under general anesthesia for skin lump excision and for fine-needle aspiration cytology of the third eyelid nodule. The histopathological exam revealed high cellularity of epithelial cells, intense anisocytosis and pleomorphism, cytoplasmic basophilia and vacuolation, multiple evident nucleoli, and anisocariosis and coarse chromatin. These finds were compatible with squamous cell carcinoma, which was the same result suggested by fine-needle aspiration cytology of the third eyelid sample. Based on these results, the dog underwent a surgical procedure for enucleation and subsequent histopathological evaluation of the nodule in the third eyelid, which confirmed the squamous cell carcinoma diagnosis.Discussion: Squamous cell carcinoma is an extremely aggressive tumor with low metastatic potential, characterized by invasion of the dermis by proliferation of malignant epithelial cells from the prickly layer. It is most common in elderly animals, and American Staffordshires are among the breeds that are predisposed to develop this tumor. The clinical presentation is highly variable, depending on the tissue involved. In this case, the dermal nodule was an elevated area on the skin and the third eyelid nodule resembled an ulcerative mass. Cytological examination from the lesion located on the third eyelid, showed malignancies cytoplasmic changes frequently found in carcinomas such as anisocytosis, cytoplasmic basophilia, and cell pleomorphism. In addition, nuclear changes had also occurred, such as crass chromatin, multiple evident nucleoli, and multinucleated cells. A presumptive diagnosis was made based on cytology and was confirmed after biopsy and histopathological examination. Because it is uncommon in dogs, squamous cell carcinoma of the third eyelid may be misdiagnosed, delaying correct treatment, and accelerating the development of the tumor. Currently, various therapeutic approaches are available, such as surgical excision, electrosurgery, cryosurgery, radiation, and hyperthermia. The choice of treatment depends on the location and stage of the lesions. Surgical treatment should be aimed at removing sufficient tissue to leave surgical margins free of neoplastic cells.


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