Adenosquamous carcinoma (ASC) is not only a rare variant of squamous cell carcinoma (SCC) but it is also an aggressive and highly infiltrating neoplasm with distinct histomorphology. Histogenetic concept in the pathogenesis of the tumor would eradicate controversies regarding the resemblance of ASC with mucoepidermoid carcinoma and adenoid SCC. Hence, we intend to present a case series of four cases of ASC in the head-and-neck region reported in a single institution in the past 10 years. Head-and-neck ASC lesions have been reported in the thyroid gland, nasal cavity, oral cavity, pharynx, and larynx. Intraoral lesions are mostly seen in the tongue and floor of the mouth, but in our case series, the most common site was the maxillary alveolus. Therapeutic approach toward nonconventional malignancies of epithelial origin should include proper analysis of the biological behavior of disease, the anatomical site, sensitivity of lesion to radiation, and systemic treatment modality. Hence, for better understanding of the behavior of lesions such as ASC, immunohistochemical analysis plays a significant role as it provides an insight into the origin and also accentuates the chances of enhanced therapeutic model for treating any such variant of SCC.

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Background: IFN-gamma and natural killer (NK) cells have been considered the most effective cells in the combat of cancer, contributing to better prognosis and longer survival. The aim of the study was to analyze and correlate the CD 57 immunopositive NK cell-mediated Interferon-γ pathway in regulating immune mechanisms in Oral Squamous Cell Carcinoma. Materials and Methodology: The study sample was composed of a total of 40 cases of histopathologically confirmed cases of Oral Squamous cell carcinoma (OSCC). Clinical data such as age, gender, habit history, signs and symptoms, and TNM staging were obtained for each case. The biopsy specimens of the cases obtained were fixed with 10% neutral buffered formalin and processed and embedded in paraffin wax. 3-4 μ thick sections were taken for hematoxylin and eosin staining and immunohistochemistry procedure. A saliva sample was collected from each patient and stored at 20 degree Celsius for estimation of salivary interferon-gamma levels using the sandwich ELISA technique. Results: CD 57 NK cells quantitative assessment was significantly associated with tumor budding, cell nest size, the pattern of invasion, lymphocytic host response, NK cell morphology, Depth of invasion, and Tumor thickness. The ratio of CD 57 immunopositive NK cells to salivary IFN-γ levels showed a significant association with histopathological grades, tumor size, and lymph node status. Conclusion: Adoptive cellular transfer therapy with NK cells has been advocated in both experimental models and clinical trials in treating hematopoietic malignancies. The strategy is based on reviving the patient innate immune surveillance and control of tumor invasion by the infusion of activated NK cells. The IFN-gamma and NK cell infiltration in oral squamous cell carcinoma might show a distinctive tumor microenvironment with a favorable local cytotoxic immune response against neoplastic cells.

The presence of clear cells is associated with the aggressiveness of the lesion and also poses a diagnostic dilemma. Hence, specific categorization of the lesion is of the utmost importance for therapeutic intervention. A 70-year-old male patient reported with a chief complaint of discomfort and swelling in the left mandibular alveolar region. Biopsy from the lesion was suggestive of ameloblastic carcinoma (AC) with clear-cell differentiation. The differential diagnosis of clear-cell components can be clear-cell odontogenic carcinoma, clear-cell adenocarcinoma of the salivary gland, mucoepidermoid carcinoma, and metastatic neoplasm. In the present case, the pathogenesis of this rare tumor is studied with the help of molecular markers such as p53, proliferating cell nuclear antigen, alpha-smooth muscle actin, vimentin, and p63 along with special stains such as periodic acid-Schiff, mucicarmine, and alcian blue. The clinical and biological behavior of these lesser-known variants has not been established due to the scarcity of meta-analysis and systematic reviews. Thus, this rare case of AC with clear-cell differentiation would highlight the pathogenesis, prognosis, and outcome of the disease with unusual histological presentation than conventional AC.