Cases reported • Carcinoma, Basosquamous

1/18. Mohs' surgery as an approach to treatment of multiple skin cancer in rhinophyma.

BACKGROUND: skin cancer arising within a rhinophyma is rare, less than would be expected from the coexisting chronic active inflammatory process. In rhinophyma, multiple coexisting tumours of different histologic types present an unusual challenge and have never been described in the literature. OBJECTIVE: The treatment approach to multiple tumours occurring in rhinophyma, utilizing Mohs' surgery, is reported and discussed. PATIENT: The case of a 64-year-old farmer with basal cell carcinoma, squamous cell carcinoma, and basosquamous carcinoma occurring in the setting of longstanding rhinophyma is described. CONCLUSION: skin cancer, especially basal and squamous cell carcinoma, diagnosed simultaneously in a rhinophyma creates a challenge; the enlarged, inflamed, and hypertrophied tissue masks their margins. In our opinion, Mohs' micrographic surgery is the treatment of choice and should be primarily considered in view of the malignant potential of these tumours, as is shown by the substantial tumour extension in the case described.

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2/18. Basosquamous carcinoma after ultraviolet therapy with artificial sunlight.

We report a 63-year-old Japanese man with basosquamous carcinoma developing after ultraviolet therapy with artificial sunlight. Because he had had an eczematous lesion on the right leg five years previously, he had received ultraviolet therapy with artificial sunlight from a mercury-quartz lamp for a total of 30 sessions over a 3-year period. physical examination revealed an irregular erythematous plaque measuring 5 x 6 cm, with slight eruptions and erosions, on the right leg. A brownish plaque, measuring 9 x 12 cm, surrounded the erythematous plaque. Histopathologically, in the nests of atypical cells in the dermis, nuclear palisading was present at the edge of each tumor cluster. Adjacent clusters exhibited transitions to squamous cells and contained horn pearls. Most of the cells of the epidermis and adnexa were atypical, but cells of the normal adnexal epithelium extended over the atypical cells of the epidermis in an umbrella-like fashion in other lesions. We believe that, in the present case, artificial sunlight therapy caused solar keratosis and that this developed into basosquamous carcinoma. To our knowledge, skin cancer developing after ultraviolet therapy with artificial sunlight without PUVA has not previously been reported in the English literature.

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keywords = cancer
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3/18. Two unusual tumors in a patient with xeroderma pigmentosum: atypical fibroxanthoma and basosquamous carcinoma.

xeroderma pigmentosum (XP) is a rare autosomal recessive disease, characterized by a genetic defect in dna repair. The consequence is a high incidence of skin cancers on sun-exposed cutaneous surfaces of affected children. First lesions appear in the first years of life: telangiectasia, actinic keratosis and keratoacanthomas. Squamous cell and basal cell carcinomas are the most frequent neoplasms. We report the case of a 6-year-old girl affected with XP, who developed two unusual tumors: an atypical fibroxanthoma and a basosquamous carcinoma. In both tumors, immunohistochemical study showed abnormal accumulation of the p53 protein, suggesting the presence of mutation of the p53 tumor suppressor gene. Such p53 mutations may be ultraviolet (UV)-induced, as they are frequently observed in tumors occurring in XP.

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keywords = neoplasm, cancer
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4/18. Invading basal cell carcinoma of the jaw: an under-evaluated complex entity.

Basal cell carcinoma (BCC) is a locally invasive neoplasm, rarely metastatic, yet capable of significant local destruction and disfigurement. Invasion into the bone is uncommon and only a few cases of invasion into facial bones, but never to the mandible or maxilla, have been described. We report three patients with BCC lesions invading their jaws, as a consequence of which either their mandible or maxilla had to be partially resected. This resulted in facial mutilation which required comprehensive multi-disciplinary therapy to restore function and esthetics. Such therapy requires a combination of modalities offered by both plastic and maxillofacial surgeons, as well as oral and dental rehabilitators.

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keywords = neoplasm
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5/18. Basosquamous carcinoma of the supraglottic larynx with sudden death from asphyxia.

Excluding laryngeal papillomas, neoplasms of the hypopharynx rarely cause sudden asphyxial death in adults. We describe the first such death from a carcinoma and review the literature for similar cases since 1966. A high clinical index of suspicion and early laryngoscopy in individuals with symptoms suggestive of hypopharyngeal neoplasia are important.

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6/18. Marjolin's ulcer on the nose.

Malignancies in scars are generally known as Marjolin's ulcer. The majority of these arise from burn injuries. Although Marjolin's ulcer consists of all kinds of skin cancer, squamous cell carcinoma is the main cancer type reported in the literature. The pathogenesis of this tumor is due to chronic irritation of the effected area and mostly involves the extremities and scalp area. This report presents an unusually located and rare type of Marjolin's ulcer: on the nose and baso-squamotic in type. A 54-year-old man, 33 years after burn, presented with an unhealed ulcer on his nose which had been present for 2 years. The case was managed by tumor excision and a naso-labial transposition flap. To our knowledge, this is the first report of Marjolin's ulcer developing on post-burned skin of the nose.

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7/18. Basaloid squamous cell carcinoma report of a case and review of literature.

Basaloid squamous cell carcinoma (BSCC) is an aggressive distinct variant of squamous cell carcinoma that mandates recognition as a separate entity owing to the difference in its clinical behaviour. Histologically this tumor can mimic other neoplasms like adenoid cystic carcinoma, neuroendocrine carcinoma and basal cell adenocarcinoma. BSCC occurs most commonly in older men and has a site predilection for the upper aero-digestive tract. We report a case of basaloid squamous cell carcinoma for its relative rarity, which was diagnosed in a 52 year old woman, with a brief review of literature.

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8/18. Fine-needle aspiration cytology of thymic basaloid carcinoma: case studies and review of the literature.

We report the features in fine-needle aspiration biopsy (FNAB) of thymic basaloid carcinomas. This is a rare neoplasm, of which there are only three documented in our hospital files. To the best of our knowledge, this is the first fine-needle aspiration (FNA) report on basaloid carcinoma of the thymus. This is a tumor in which the FNA diagnosis is difficult and the differential diagnosis is broad. We describe the cytologic features encountered in the three cases, and immunohistochemical and ultrastructural findings so as to raise awareness of this entity in the differential diagnosis of thymic neoplasms on FNABs. The cases studied included three male patients, aged 73, 65, and 50, who presented with anterior mediastinal masses, with no primary tumor elsewhere. FNAB was performed on two cases, followed by thymectomy. One case, additionally, had metastasis to a cervical lymph node, and the other two were associated with thymic cysts. The diagnoses on all three cases were thymic basaloid carcinoma.

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keywords = neoplasm
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9/18. Basosquamous carcinoma-an under-recognized, high-risk cutaneous neoplasm: case study and review of the literature.

Basosquamous carcinoma of the skin is a relatively rare cutaneous neoplasm that has been shown to have significant metastatic potential. Histopathologists debate whether these lesions arise de novo or differentiate from pre-existing basal cell carcinomas. We present a case in which a longstanding lesion initially diagnosed as basal cell carcinoma was later found to have basosquamous histology and regional metastases. Review of the literature reveals a metastatic rate greater than that of basal cell and squamous cell carcinoma, and identifies several important characteristics that impact prognosis after surgical resection. For physicians treating carcinomas of the skin, it is important to understand the natural history and proper treatment of this aggressive neoplasm.

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keywords = neoplasm
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10/18. Basosquamous (transitional cloacogenic) carcinoma of the sigmoid colon.

A case of basosquamous or so-called transitional cloacogenic carcinoma of the sigmoid colon, which arose above the pelvic brim at the peritoneal reflection, is reported. We were not able to find a report of this histologic type of tumor arising this far from the pectinate line of the anus, which is the most common primary site of this neoplasm. Possibilities as to the histogenesis of this tumor at this site are stated. The neoplasm also produced parathyroid hormone (PTH) and also possibly adrenal corticotrophic hormone (ACTH), which had not been previously reported for this specific neoplasm.

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