Basal Cell Adenocarcinoma in the Tongue: An Unusual Presentation

Abstract

We present a case of basal cell adenocarcinoma (BCAC) in the tongue in a 65-year old male. This is an extremely rare presentation. BCAC generally occurs in the parotid gland and rarely involves the minor salivary glands. Few cases have been reported in literature with a variable presentation. The biopsy was formalin-fixed and paraffin-embedded. The sections were stained with routine Hematoxylin and Eosin. Immunohistochemistry was performed. Hematoxylin and eosin staining showed tumour composed of variable sized and shaped, nests and sheets of basaloid epithelial cells having hyperchromatic to vesicular nuclei. Immunohistochemistry was positive for Pancytokeratin, Epithelial membrane antigen and p53. The clinicopathological features and the cellular immunophenotype addressed the diagnosis towards BCAC of the tongue. The goal of this report is to increase awareness of this rare disease and to review and discuss the differential diagnosis and important considerations in treatment.

Basal cell adenocarcinoma of the tongue- A rarity Case report

“…Andraedis et al found that both BCA and BCAC had similar architectural and cytologic factors and were not differentiable by ultrastructural or immunohistochemical examinations [8]. However, other researchers have found certain immunohistochemical markers that may play a role in the diagnosis of BCAC (Table I) [3,4,5]. It is important to distinguish BCAC from other lesions such as basal cell adenoma, basaloid squamous cell carcinoma, myoepithelial lesions, Warthin tumour, pleomorphic adenoma, small cell undifferentiated carcinoma, metastatic adenocarcinoma and adenoid cystic carcinoma due to the difference in treatment and prognosis among these lesions [3,4,5,9].…”

“…The membranous type is characterised by large amount of PAS positive, hyalinised eosinophilic basal lamina that forms the peripheral membrane and intercellular droplets. The trabecular type contains basaloid cells that form interconnecting bands [5]. Andraedis et al found that both BCA and BCAC had similar architectural and cytologic factors and were not differentiable by ultrastructural or immunohistochemical examinations [8].…”

“…Later in 1990 Ellis and Wiscivitch described the clinical and pathological features of the lesion [5,7]. BCAC is a rare salivary gland neoplasm with an unknown etiology, although some researchers claim that the tumour arises from pluripotent ductal epithelial cells or from reserve cells [1,5,6].…”

“…Diagnostic criteria include the pattern of growth and the presence of perivascular or perineural infiltration of the tumour [5]. The lesion is diagnosed as BCAC in the presence of infiltration into periglandular fat, muscle, parotid parenchyma or dermis, cellular atypia, necrosis and mitosis [1,2].…”

“…BCAC constitutes 1.6% of these salivary gland tumours and 29% of all malignant salivary gland tumours. A vast majority (90%) of BCAC originate from the parotid glands while submandibular and minor salivary gland BCAC make up a small percentage [1,5,6]. When the parotid is involved, it is usually seen in the superficial lobe of the gland [7].…”