Adenosquamous carcinoma of the skin: a report of 10 cases

Abstract

Cutaneous squamous carcinoma with true glandular differentiation has only rarely been documented. Ten patients with such tumors are presented. There were six men and four women, aged 48 to 87 years. The tumors were located on the central face (eight), scalp (one), and hand (one) and consisted of minimally elevated, indurated, keratotic plaques, up to 6 cm in size. Microscopically, the neoplasms exhibited multifocal origin from the epidermis; deep, dispersed, infiltrative growth; perineural invasion; and stromal desmoplasia. Squamous differentiation was most marked superficially. Glandular differentiation was more obvious in deeper areas. Lumens typically developed within squamous nests and were often lined by cells with cytoplasmic vacuoles, some of which contained mucin. The neoplastic cells had obvious cytologic atypia and easily identified mitotic figures. Immunohistochemically, nine neoplasms studied contained carcinoembryonic antigen in glandular foci. Each patient had one or more surgical resections, and six also received radiation and/or chemotherapy. Five patients died with uncontrolled local recurrence, and two are alive with extensive disease and clinical evidence of regional lymph node involvement. Two individuals with small, superficial neoplasms that could be completely removed are disease free. One patient died of unrelated causes shortly after diagnosis. Cutaneous adenosquamous carcinoma is more aggressive than the usual carcinoma of the skin. It must be distinguished from the cytologically bland, microcystic adnexal (sclerosing sweat duct) carcinoma which is capable of recurring but rarely, if ever, proves fatal. The question of whether adenosquamous carcinoma is an epidermally derived squamous tumor with divergent differentiation or should be viewed as a newly recognized adnexal carcinoma remains to be resolved.

A clinicopathologic review of lethal nonmelanoma skin cancers in Western Australia

“…The third most common neoplasm diagnosed was the relatively recently recognized ASC, 27,28 a neoplasm noted to be more aggressive than SCC 28,29 with frequent local recurrence and metastasis. 29 The diagnosis of ASC requires the detection of ductal differentiation within a neoplasm also showing prominent squamous differentiation, often with periodic acid-Schiffepositive glandular mucin and carcinoembryonic antigenepositive epithelial lining cells.…”

“…Most ASCs were originally diagnosed as SCC and no ASCs were diagnosed before death, probably because of its relatively recent description as a distinct entitiy. [27][28][29] Other less common cancers caused death in the following ways. The hidradenocarcinoma was a completely excised 2-cm ulcerated calf lesion that metastasized to inguinal lymph nodes.…”

Skin adnexal tumours

“…6 Although there are relatively few cases with long-term follow-up, ASC appears to have a high risk of destructive local recurrence and regional lymph node metastases, with 50% of cases in one series dying with uncontrollable local disease. 1 Tumour thickness and perineural invasion are important prognostic factors. Wide local excision or Mohs micrographic surgery are currently the treatment of choice.…”

High-risk Cutaneous Squamous Cell Carcinoma

“…24 Specific histopathological subtypes are also identified as high-risk features in NCCN guidelines, including acantholytic, adenosquamous, desmoplastic, and basosquamous subtypes. [25][26][27][28][29][30][31] Invasive Bowen's disease has 10 The presence of one of the above factors signifies high risk; Area H refers to areas at high risk for recurrence, including mask areas of the face (central face, eyelids, eyebrows, periorbital area, nose, lips, chin, ears, genitalia, hands, and feet). Area M refers to middle-risk areas for recurrence, including cheeks, forehead, neck, and scalp.…”