Basaloid carcinoma: a study.
OBSERVATION: A total of 79 cases of Squamous cell carcinoma were reported in the Department of Pathology, Rajah Muthiah Medical College and Hospital, during January 2010 to December 2012.
Among these, 18 (23%) cases were basaloid variant of squamous cell carcinoma involving Cervix (13), Penis (2), Tonsil (2) and Esophagus (1).
DISCUSSION: Basaloid carcinoma is a high grade variant of squamous cell carcinoma(SCC) that has a predilection for occurrence in the hypopharynx (pyriform sinus), supraglottic larynx, oral cavity, tongue, tonsil and palate. (1,2,3) Less frequently they occur in sinonasal tract, external ear, submandibular region, oesophagus, lung, penis, cervix, vulva, vagina and anus. (4,5) Basaloid squamous cell carcinoma of upper aero digestive tract are aggressive high grade tumors with an increased tendency to be multifocal, deeply invasive and metastatic even at the initial presentation. (1)
Specific etiological factors for basaloid variant of squamous cell carcinoma have not been found (6) But factors linked to non-sinonasal tract include excessive alcohol consumption and tobacco use (2,7). Basaloid carcinoma is an HPV (type 16 and 18) related carcinoma in genital sites, that is deeply invasive with a high frequency of recurrence, vascular invasion and lymph node metastasis. The cell of origin has not been definitely identified but in all probability is a single totipotential cell capable of divergent differentiation located in the basal layer. (8) Patients range in age from 33 to 84 years (mean 51 years). Most of the patients presents with metastasis to lymphnodes. (9)
In the present study among the 79 SCC cases, 18 (22.8%) were basaloid variant of squamous cell carcinoma(BSCC).17 BSCC cases were reported from cervix, penis, esophagus and 1 case reported from tonsil. All BSCC patients in the study lie between 50-70 age group, which correlates with usual occurrence. In this study basaloid cell carcinoma of penis, esophagus and tonsil were found to be associated with alcohol and tobacco use. HPV association was not identified in our cases of cervical lesions. Associated lymph node enlargement was noticed in basaloid cell carcinoma of penis.
Macroscopically the lesions are firm to hard, tan-white masses with central necrosis and measure up to 6cm in greatest dimension. Infrequently they may be exophytic in appearance. Microscopic picture of basaloid carcinoma is characteristic. The small basaloid cells arranged in nests, lobules and trabeculae are the hallmark of the tumor. Peripheral palisading around individual lobules also can be prominent in most areas. (4,6,10) The pattern of comedo type of necrosis is a more frequent companion of the lesion, to the extent that some authors consider it to be "one of the main characteristics of the lesion". (6,10)
The abrupt keratinization seen within islands of basaloid cells has also been noted. (6,11) Most authorities believe that the tumors with histological architecture that also contain foci of more typical SCC are associated with overlying squamous dysplasia and those lesions with pleomorphic nuclei, abundant mitoses and evidence of lymphnode metastases should be considered as basaloid variant of SCC. (13,14,15) Metastases include both basaloid and squamous cell components. Electron microscopy shows the basaloid component to have desmosomes, rare tonofilaments and loose stellate granules or replicated basal lamina within the cystic spaces. (1)
The differential diagnosis of BSCC include adenoid cystic carcinoma, adenosquamous carcinoma, spindle cell squamous carcinoma, mucoepidermoid carcinoma, adenoid squamous carcinoma, small cell neuroendocrine carcinoma, and basosquamous cell carcinoma. (5,6,12) Basaloid squamous cell carcinoma is a rapidly fatal neoplasm associated with high mortality rate within the first year after diagnosis. The treatment of choice for basaloid carcinoma is complete surgical resection of the tumor. Lymph node dissection with supplemental radiotherapy and chemotherapy may be included in the initial management protocol.
CONCLUSION: Basaloid carcinoma is an uncommon aggressive variant of squamous cell carcinoma believed to carry dismal prognosis. The increasing incidence of basaloid carcinoma in rare sites is being observed as noted in the present study. Hence utmost care should be taken for early detection and thus improve the prognosis.
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(9.) Cubilla AL, Reuter VE, Gregoire L, Ayala G, Ocampos S, Lancaster WD, Fair W. Basaloid squamous cell carcinoma: a distinctive human papilloma virus-related penile neoplasm: a report of 20 cases. Am J SurgPathol 1998; 22:755-61.
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(14.) Abe K, Sasano H, Itakura Y, et al: Basaloid-squamous carcinoma of the esophagus. A clinicopathologic, DNA ploidy, and immunohistochemical study of seven cases. Am J Surg Pathol 20:453-461, 1996.
(15.) Sarbia M, Verreet P, Bittinger F, et al: Basaloid squamous cell carcinoma of the esophagus: diagnosis and prognosis. Cancer 79: 1871-1878, 1997.
[FIGURE 1 OMITTED]
[FIGURE 2 OMITTED]
Nests of basaloid tumour cell with peripheral pallisading. Central area shows pallor.
[FIGURE 3 OMITTED]
Tumor cells show cellular and nuclear pleomorphism with hyperchromatism.
Nimmy Venu , K. V. Hariprasad , P. Viswanathan , Rehana Tippo , L. Lakshmana Rao  B. Krishnaswamy , U. Manohar , K. R. Gopalakrishnan 
[1.] Nimmy Venu
[2.] K. V. Hariprasad
[3.] P. Viswanathan
[4.] Rehana Tippo
[5.] L. Lakshmana Rao
[6.] B. Krishnaswamy
[7.] U. Manohar
[8.] K. R. Gopalakrishnan
PARTICULARS OF CONTRIBUTORS:
[1.] 3rd Year Post Graduate, Department of Pathology, Rajah Muthiah Medical College, Annamalai University.
[2.] 3rd Year Post Graduate, Department of Pathology, Rajah Muthiah Medical College, Annamalai University.
[3.] Professor, Department of Pathology, Rajah Muthiah Medical College, Annamalai University.
[4.] Professor, Department of Pathology, Rajah Muthiah Medical College, Annamalai University.
[5.] Professor, Department of Pathology, Rajah Muthiah Medical College, Annamalai University.
[6.] Professor, Department of Pathology, Rajah Muthiah Medical College, Annamalai University.
[7.] Professor, Department of Pathology, Rajah Muthiah Medical College, Annamalai University.
[8.] Professor, Department of Pathology, Rajah Muthiah Medical College, Annamalai University.
NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:
Dr. P. Viswanathan, Professor, Department of Pathology, Faculty of medicine, Rajah Muthiah Medical College, Annamalai University, Chidambaram-608002 Tamil Nadu, India. Email: email@example.com
Date of Submission: 12/09/2014.
Date of Peer Review: 13/09/2014.
Date of Acceptance: 06/10/2014.
Date of Publishing: 10/10/2014.
Table 1: AGE DISTRIBUTION IN STUDY ORGANS SQUAMOUS CELL BASALOID INVOLVED CARCINOMA CARCINOMA (Age in years) (Age in years) CERVIX 50-70 50-70 PENIS 50-70 50-55 ESOPHAGUS 50-60 50-55 TONSIL 58 58 Figure 1 No. of Cases CERVIX PENIS ESOPHAGUS TONSIL SQUAMOUS CELL CARCINOMA 35 29 14 1 BASALOID CARCINOMA 13 2 2 1
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|Title Annotation:||ORIGINAL ARTICLE|
|Author:||Venu, Nimmy; Hariprasad, K.V.; Viswanathan, P.; Tippo, Rehana; Rao, L. Lakshmana; Krishnaswamy, B.;|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Date:||Oct 13, 2014|
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