Acantholytic squamous cell carcinoma of the lung with marked lymphogenous metastases and high titers of myeloperoxidase-antineutrophil cytoplasmic antibodies: a case report

Abstract

BackgroundAcantholytic squamous cell carcinoma (ASQCC), histologically characterized by intercellular bridge loosening, is recognized as a rare variant of squamous cell carcinoma (SQCC). ASQCC may demonstrate a worse prognosis than conventional SQCC. Pulmonary ASQCC is particularly rare; its biological behavior and prognostic data have not been reported.Case presentationWe report the clinical and autopsy findings of a 71-year-old Japanese man with pulmonary ASQCC. Pulmonary lesions, suggestive of idiopathic interstitial pneumonia, were radiologically observed 3 and 6 years prior to the patient’s most recent hospitalization; however, the patient did not undergo further medical examinations. Upon being discovered unconscious, the patient was admitted to our hospital. Dehydration and lower limb muscle weakness were noted, as were laboratory findings of coagulation abnormalities and renal dysfunction. Computed tomography helped confirm a 21-mm peripheral nodule in the upper left lobe of the lung, with associated swollen lymph nodes in the bilateral hilar, mediastinal, and para-aortic regions. Brain and spinal lesions, suggestive of neurological disturbances, were not found. Small cell lung carcinoma was suspected, upon admission, but high serum levels of squamous cell carcinoma antigen and cytokeratin-19 fragments were present. Therefore, advanced lung cancer, possibly SQCC, was diagnosed. The patient was treated with best supportive therapy, and died one month after admission. Hypercalcemia and high serum levels of parathyroid hormone-related protein (PTHrP) and myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers were observed. Progressive renal insufficiency was absent due to improved renal function subsequent to hydration. An autopsy helped confirm the left lung tumor as an ASQCC associated with pulmonary lymphangitic carcinomatosis and multiple metastases in the lungs and lymph nodes. Skin lesions suggesting malignant tumors were absent. The metastatic lesions consisted largely of acantholytic tumor cells, and the lungs showed usual interstitial pneumonia pattern; vasculitis was absent.ConclusionsThis is the first reported case of pulmonary ASQCC resulting in an aggressive clinical course, with marked lymphogenous metastases and PTHrP-associated hypercalcemia. The high serum MPO-ANCA titers were clinicopathologically insignificant, but may have been related to the pulmonary interstitial lesion. Pulmonary ASQCC represents a highly malignant subset of lung cancer.

Clinical and Pathologic Presentation of Primary Ocular Surface Tumors among Zambians

“…Acantholytic SCC is a rare histologic variant of SCC that is characterized by acantholysis and dyskeratosis of the tumor cells due to loss of desmosome adhesion proteins [31][32][33]. It is classically seen in sun-exposed areas such as the skin and lip though other rare sites are reported, and it may have a poorer prognosis [31][32][33].…”

“…Acantholytic SCC is a rare histologic variant of SCC that is characterized by acantholysis and dyskeratosis of the tumor cells due to loss of desmosome adhesion proteins [31][32][33]. It is classically seen in sun-exposed areas such as the skin and lip though other rare sites are reported, and it may have a poorer prognosis [31][32][33]. Hybrid SCC is characterized by focal partial squamous maturation (mature squamous cells with eosinophilic cytoplasm and distinct cell borders) in an otherwise poorly differentiated tumor, comprised of cellular areas with hyperchromatic nuclei and high nuclear: cytoplasm ratio [34,35].…”

Acantholytic squamous cell carcinoma mimicking epithelioid angiosarcoma: A diagnostic challenge by cytology

“…No conclusion was reached regarding their nature by most authors reporting this finding. 9,13,15,[24][25][26][27] The lack of positive staining by mucin and PAS stains suggests they are not metabolic or storage material. There is only a single report that performed electron microscopy, concluding that the vacuoles were dilated endoplasmic reticulum containing proteinaceous and filamentous material.…”

“…The arrangement of such cells can be single or in groups (closely packed and/or loosely cohesive) as well as forming a linear pattern 12 . An unusual feature was the presence of intracytoplasmic vacuoles, but which have been reported in cases of acantholytic SCC 9,13–15 . These vacuoles have been the source of diagnostic confusion since their presence raises the possibility of other diagnoses such as signet ring cell adenocarcinoma and mesothelioma.…”

The Effect of Lymphangitis Carcinomatosa on the Stage, and Survival in the Primary Lung Cancers

“…Skuamöz hüceli karsinomun nadir görülen farklı bir alt türü olan akantolizli skuamöz hücreli karsinomlarda görülen LK ile ilgili literatürde 9 olgu bildirilmiş ve bu olgularda prognozun kötü olduğu belirtilmiştir. [24][25][26][27][28][29][30] Bizim serimizde en sık LK'ya neden olan histopatolojik tip skuamöz hücreli kanserlerdi. Literatürde primer akciğer skuamöz hücreli kanser tanısı alıp LK tespit edilen bir olguya ulaşıldı.…”