Adenoid (Acantholytic) Squamous Cell Carcinoma of Mandibular Gingiva

Abstract

Introduction. Adenoid (acantholytic) squamous cell carcinoma (ASCC) is a histological variant of squamous cell carcinoma which occurs mainly in the sun-exposed areas of the head and neck region. It is commonly seen among males which mainly occurs in the sixth and seventh decade of life with lip being predominately affected. Limited scientific literature is documenting the intraoral presentation of ASCC in contrast to its usual extraoral lesions associated with the skin. Characteristic pseudo glandular alveolar space formation seen in ASCC often mimics carcinoma of salivary gland origin. In-depth knowledge of histopathological features of ASCC is important to diagnose this uncommon variant. Case Description. An 80-year-old female presented with the chief complaint of the nonhealing lesion in the right lower back region of the jaw for 2 months, associated with pain. A provisional diagnosis of oral cancer was considered, and an incisional biopsy was done. Histopathological presentation of the epithelial tumor island, pseudo glandular duct-like structures, and neoplastic cells showing features of dysplasia and keratin pearl formation confirmed the diagnosis as adenoid (acantholytic) squamous cell carcinoma. Conclusion. The histopathological presentation of adenoid (acantholytic) squamous cell carcinoma reflects the prognosis and metastatic behavior of the diseases. The knowledge of histopathological features of ASCC would be a guide to the untrained eye for the diagnosis and management of this uncommon variant to minimize the rate of metastasis or reoccurrence.

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

“…Ancillary approaches, such as IHC, revealed substantial diffuse positivity for p40 and decreased expression of E cadherin within these dysplastic islands with acantholytic cells, assisting us in reaching a conclusive diagnosis. 15 A high Ki-67 proliferative index (65%) was observed in the present case. Ki-67 has been used to assess the aggressiveness of a tumor and forecast its survival and prognosis due to its high sensitivity and specificity in labeling cell proliferation in malignant tissues.…”

“…Higher Ki-67 expression is an indicator of tumor cells with higher proliferation and locally invasive potential and, thus providing one of the best markers for the evaluation of the biological aggressiveness of tumors. 15 …”

Adenoid (Acantholytic) squamous cell carcinoma of the alveolar ridge: A rare case report

“…9 Around 50 cases of ASCC affecting the oral cavity have been reported till now with lower lip being the most affected site and with more male predilection. 4,10 However in our case, the affected was a female with alveolar ridge being the site of occurrence.…”

“…12 The histological differential diagnosis of ASCC include conventional SCC, adenosquamous cell carcinoma (ASC), adenocarcinoma of salivary gland and angiosarcoma. 10 The conventional SCC lacks the duct-like structures with central acantholysis, ASC on the other hand shows true glandular differentiation with positivity for mucin seen in special stains like PAS, mucicarmine and alcian blue. Although, salivary gland tumours like adenocarcinoma and mucoepidermoid carcinoma can be confused with ASCC but presence of mucinous material helps in differentiation.…”

“…6 Despite the less number of cases available, owing to the aggressive behaviour, radical surgery along with adjuvant therapies is the treatment of choice. 10…”