Autopsy and Case Reports
https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2023.450
Autopsy and Case Reports
Clinical Case Report

Acantholytic oral squamous cell carcinoma with clear cell change - a rare amalgamated variant

Gitika Sharma; Anju Devi; Mala Kamboj; Anjali Narwal

Downloads: 0
Views: 281

Abstract

Background: Acantholytic squamous cell carcinoma (ASCC) is an uncommon histological variation of oral squamous cell carcinoma (OSCC), accounting for fewer than 4% of all occurrences. The tumor shows a slight masculine predisposition, with the lower lip being the most commonly affected location. ASCC is reported to have a diverse biologic behavior, which explains its ability to metastasize to distant places and, thus, its poor prognosis. Similarly, clear cell change in OSCC is a rare occurrence with an unknown etiology that suggests its aggressive nature.

Method and Results: Histopathology reveals central acantholytic cells with numerous duct-like features. The presence of distinct cytological atypia contributes to the diagnosis of SCC. Special stains and IHC aid in distinguishing tumor from other histopathologically similar entities.

Conclusion: The case of a 29-year-old male presented here with an updated literature review highlights the need for histological study of the unique and seldom seen oral ASCC with clear cell change, which can be ignored because of similarities with other entities. Because recurrence rates are so high for ASCC, amalgamated clear cell change makes it critical for proper treatment initiation with a definite diagnosis. To the best of our knowledge, this is the first documented occurrence. Our experience with the present case suspected a more aggressive behavior due to a high Ki-67 index, anticipating a poorer prognosis in the oral cavity considering the patient's young age.

Keywords

Oral Squamous Cell Carcinoma, Acantholytic Squamous Cell Carcinoma, Clear Cells, immunohistochemistry

References

1 Sharma G, Kamboj M, Narwal A, Bhardwaj R, Yadav P. Cytotoxic role of chlorogenic acid on oral squamous cell carcinoma cell line. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 3):5773-81. http://dx.doi.org/10.1007/s12070-021-02395-1. PMid:36742612.

2 Sankaranarayanan R, Ramadas K, Amarasinghe H, Subramanian S, Johnson N. Oral cancer: prevention, early detection, and treatment. In: Gelband H, Jha P, Sankaranarayanan R, Horton S, editors. Cancer: disease control priorities. 3rd ed. Washington, DC: The International Bank for Reconstruction and Development/The World Bank; 2015. Chapter 5; Vol. 3; p. 85-99.

3 Pathak J, Swain N, Patel S, Poonja L. Histopathological variants of oral squamous cell carcinoma-institutional case reports. J Oral Maxillofac Pathol. 2014;18(1):143-5. http://dx.doi.org/10.4103/0973-029X.131945. PMid:24959057.

4 Perez-Ordoñez B, Beauchemin M, Jordan RC. Molecular biology of squamous cell carcinoma of the head and neck. J Clin Pathol. 2006;59(5):445-53. http://dx.doi.org/10.1136/jcp.2003.007641. PMid:16644882.

5 LeBoit PE, Weedon D, Sarasain A. Pathology and genetics of skin tumours. World Health Organization classification of tumours. Lyon: IARC Press; 2006.

6 Goldman RL, Klein HZ, Sung M. Adenoid squamous cell carcinoma of the oral cavity: report of the first case arising in the tongue. Arch Otolaryngol. 1977;103(8):496-8. http://dx.doi.org/10.1001/archotol.1977.00780250090012. PMid:880122.

7 Driemel O, Müller-Richter UD, Hakim SG, et al. Oral acantholytic squamous cell carcinoma shares clinical and histological features with angiosarcoma. Head Face Med. 2008;4(1):17. http://dx.doi.org/10.1186/1746-160X-4-17. PMid:18671846.

8 Kuo T. Clear cell carcinoma of the skin. A variant of the squamous cell carcinoma that simulates sebaceous carcinoma. Am J Surg Pathol. 1980;4(6):573-84. http://dx.doi.org/10.1097/00000478-198012000-00008. PMid:6163367.

9 Premalatha BR, Rao RS, Patil S, Neethi H. Clear cell tumours of the head and neck: an overview. World J Dent. 2012;3(4):344-9. http://dx.doi.org/10.5005/jp-journals-10015-1187.

10 Kakoti LM, Mahanta D, Sharma JD, Chowdhury Z. Clear-cell squamous cell carcinoma: an uncommon variant of very common malignancy in the head and neck. Int J Oral Health Sci. 2018;8(2):136. http://dx.doi.org/10.4103/ijohs.ijohs_23_18.

11 Taghibakhsh M, Farhadi S, Babaee A, Sheikhi M. The effect of hookah use on buccal mucosa: evaluation of repair index. Asian Pac J Cancer Prev. 2019;20(4):1109-12. http://dx.doi.org/10.31557/APJCP.2019.20.4.1109. PMid:31030482.

12 O’Shea C, Fitzpatrick JE, Koch PJ. Desmosomal defects in acantholytic squamous cell carcinomas. J Cutan Pathol. 2014;41(11):873-9. http://dx.doi.org/10.1111/cup.12390. PMid:25264142.

13 Arron ST, Ruby JG, Dybbro E, Ganem D, Derisi JL. Transcriptome sequencing demonstrates that human papillomavirus is not active in cutaneous squamous cell carcinoma. J Invest Dermatol. 2011;131(8):1745-53. http://dx.doi.org/10.1038/jid.2011.91. PMid:21490616.

14 Ratushny V, Gober MD, Hick R, Ridky TW, Seykora JT. From keratinocyte to cancer: the pathogenesis and modeling of cutaneous squamous cell carcinoma. J Clin Invest. 2012;122(2):464-72. http://dx.doi.org/10.1172/JCI57415. PMid:22293185.

15 Raut T, Keshwar S, Jaisani MR, Shrestha A. Adenoid (acantholytic) squamous cell carcinoma of mandibular gingiva. Case Rep Dent. 2021;2021:5570092. http://dx.doi.org/10.1155/2021/5570092. PMid:34336306.

16 Corbalán-Vélez R, Ruiz-Macia JA, Brufau C, López-Lozano JM, Martínez-Barba E, Carapeto FJ. Las células claras en el carcinoma espinocelular cutáneo. Actas Dermosifiliogr. 2009;100(4):307-16. http://dx.doi.org/10.1016/S0001-7310(09)70825-7. PMid:19463234.

17 Ishikawa S, Ishikawa H, Kato T, et al. Acantholytic squamous cell carcinoma of the maxillary gingiva: case report and literature review. J Oral Maxillofac Surg Med Pathol. 2014;26(4):488-91. http://dx.doi.org/10.1016/j.ajoms.2013.04.008.

18 Takagi M, Sakota Y, Takayama S, Ishikawa G. Adenoid squamous cell carcinoma of the oral mucosa: report of two autopsy cases. Cancer. 1977;40(5):2250-5. http://dx.doi.org/10.1002/1097-0142(197711)40:5<2250::AID-CNCR2820400535>3.0.CO;2-M. PMid:922664.

19 Jones AC, Freedman PD, Kerpel SM. Oral adenoid squamous cell carcinoma: a report of three cases and review of the literature. J Oral Maxillofac Surg. 1993;51(6):676-81. http://dx.doi.org/10.1016/S0278-2391(10)80269-1. PMid:8492207.

20 Kusafuka K, Ebihara M, Ishiki H, et al. Primary adenoid squamous cell carcinoma of the oral cavity. Pathol Int. 2006;56(2):78-83. http://dx.doi.org/10.1111/j.1440-1827.2006.01927.x. PMid:16445819.

21 Kerawala CJ. Acantholytic squamous cell carcinoma of the oral cavity: a more aggressive entity? Br J Oral Maxillofac Surg. 2009;47(2):123-5. http://dx.doi.org/10.1016/j.bjoms.2008.04.018. PMid:18565630.

22 Papadopoulou E, Tosios KI, Nikitakis N, Papadogeorgakis N, Sklavounou-Andrikopoulou A. Acantholytic squamous cell carcinoma of the gingiva: report of a case and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(6):e67-71. http://dx.doi.org/10.1016/j.tripleo.2010.01.019. PMid:20451835.

23 Prasad KK, Kaur S. Acantholytic squamous cell carcinoma of the oral cavity: an uncommon histological variant of squamous cell carcinoma. Minerva Stomatol. 2010;59(6):377-80. PMid:20588225.

24 Yeoh MS, Kim DD, Ghali GE. Acantholytic squamous cell carcinoma of the buccal mucosa: report of a case. J Oral Maxillofac Surg. 2012;70(7):1733-8. http://dx.doi.org/10.1016/j.joms.2011.07.030. PMid:22014937.

25 Nayak SD, Jose M, Sequeira J. Oral adenoid/acantholytic squamous cell carcinoma: a report of two cases with review of literature. Kathmandu Univ Med J. 2012;10(39):83-7. http://dx.doi.org/10.3126/kumj.v10i3.8028. PMid:23434971.

26 Ozgursoy OB, Tulunay O, Muz SE, Aslan G, Kucuk B. Acantholytic squamous cell carcinoma of the maxilla: unusual location and aggressive behavior of a rare histologic variant. Ear Nose Throat J. 2013;92(9):E22-4. PMid:24057911.

27 Mardi K, Singh N. Acantholytic squamous cell carcinoma of the oral cavity: a rare entity. J Oral Maxillofac Pathol. 2014;18(4, Suppl 1):S128-30. http://dx.doi.org/10.4103/0973-029X.141359. PMid:25364162.

28 Lin JS, Lin HP, Liu CJ. Acantholytic squamous cell carcinoma of soft palate-case report and literature review. J Dent Sci. 2016;11(2):207-9. http://dx.doi.org/10.1016/j.jds.2015.10.003. PMid:30894973.

29 Kang JH, Seo YK, Lee SR, Oh SH, Choi YS, Hwang EH. Characteristic imaging findings of acantholytic squamous cell carcinoma: a case report. Oral Radiol. 2019;35(3):341-6. http://dx.doi.org/10.1007/s11282-019-00366-5. PMid:30798506.

30 Kim JE, Lee C, Oh KY, Huh KH. A rare acantholytic variant of squamous cell carcinoma of the maxilla: a case report and literature review. Medicine. 2020;99(32):e21631. http://dx.doi.org/10.1097/MD.0000000000021631. PMid:32769927.

31 Kulkarni M, Sahana NS, Suresh T, Renuga S, Khatoon H, Verghese R. Adenoid (acantholytic) squamous cellcarcinoma of the alveolar ridge: a rare case report. J Oral Med Oral Surg Oral Pathol Oral Radiol. 2022;8(3):163-6. http://dx.doi.org/10.18231/j.jooo.2022.034.

32 Frazier JJ, Sacks H, Freedman PD. Primary glycogen-rich clear cell squamous cell carcinoma of the mandibular gingiva. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(5):e47-51. http://dx.doi.org/10.1016/j.oooo.2012.01.033. PMid:23083485.

33 Nainani P, Singh HP, Paliwal A, Nagpal N. A rare case report of clear cell variant of oral squamous cell carcinoma. J Clin Diagn Res. 2014;8(12):QD07-9. http://dx.doi.org/10.7860/JCDR/2014/11536.5339. PMid:25654003.

34 Kaliamoorthy S, Sethuraman V, Ramalingam SM, Arunkumar S. A rare case of clear cell variant of oral squamous cell carcinoma. J Nat Sci Biol Med. 2015;6(1):245-7. http://dx.doi.org/10.4103/0976-9668.149209. PMid:25810675.

35 Devi A, Kamboj M, Singh V, Singh S. Clear-cell variant of squamous cell carcinoma in maxilla as primary lesion: a rare case. J Oral Maxillofac Pathol. 2017;21(3):425-8. http://dx.doi.org/10.4103/jomfp.JOMFP_180_16. PMid:29391719.

36 Khoury ZH, Bugshan A, Lubek JE, Papadimitriou JC, Basile JR, Younis RH. Glycogen-rich clear cell squamous cell carcinoma originating in the oral cavity. Head Neck Pathol. 2017;11(4):552-60. http://dx.doi.org/10.1007/s12105-017-0812-3. PMid:28342060.

37 Kamboj M, Sharma G, Narwal A, Gill PS, Devi A, Yadav J. Estimation of serum leptin, adiponectin, and malondialdehyde levels in tobacco-induced oral squamous cell carcinoma: ELISA-based study. South Asian J Cancer. 2023:1-6. Online. http://dx.doi.org/10.1055/s-0043-1768688.

38 Zaatari GS, Santoianni RA. Adenoid squamous cell carcinoma of the nasopharynx and neck region. Arch Pathol Lab Med. 1986;110(6):542-6. PMid:3518653.

39 Jacoway JR, Nelson JF, Boyers RC. Adenoid squamous-cell carcinoma (adenocanthoma) of the oral labial mucosa: a clinicopathologic study of fifteen cases. Oral Surg Oral Med Oral Pathol. 1971;32(3):444-9. http://dx.doi.org/10.1016/0030-4220(71)90205-2. PMid:5285191.

40 Goldman RL, Klein HZ, Sung M. Adenoid squamous cell carcinoma of the oral cavity: report of the first case arising in the tongue. Arch Otolaryngol. 1977;103(8):496-8. http://dx.doi.org/10.1001/archotol.1977.00780250090012. PMid:880122.

41 Kalele K, Deshmukh R, Alsi A. A sneak peep at adenoid/acantholytic variant of oral squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;4(3):128-30. http://dx.doi.org/10.18231/2395-6194.2018.0031.

42 Seshadri D, Kumaran MS, Kanwar AJ. Acantholysis revisited: back to basics. Indian J Dermatol Venereol Leprol. 2013;79(1):120-6. http://dx.doi.org/10.4103/0378-6323.104688. PMid:23254748.

43 Bhogavaram B, Sinha R, Rapolu K, Boggarapu BP. Adenoid squamous cell carcinoma of upper lip, a rare variant of squamous cell carcinoma: a case report. J Family Med Prim Care. 2020;9(11):5779-82. http://dx.doi.org/10.4103/jfmpc.jfmpc_850_20. PMid:33532433.

44 Krishnan RP, Ramani P, Pandiar D. Plausible mechanisms in the pathobiology of acantholytic squamous cell carcinoma: an evidence based hypothesis. Med Hypotheses. 2022;167:110946. http://dx.doi.org/10.1016/j.mehy.2022.110946.
 


Submitted date:
04/20/2023

Accepted date:
08/24/2023

Publication date:
10/11/2023

65268a92a953952c990e8f35 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections