Cutaneous Squamous Cell Carcinoma With Mucinous Metaplasia on the Sole Associated With High-Risk Human Papillomavirus Type 18

Abstract

A case of superficially invasive cutaneous squamous cell carcinoma (SCC) of the sole containing numerous mucin-producing vacuolated cells resembling "signet-ring" cells is reported. The 2 cellular components of the tumor, both squamous and mucinous, were atypical with pleomorphic nuclei, and expressed the same immunophenotype, consistent in weak and focal positivity for cytokeratin 5/6 and epithelial membrane antigen (EMA) and weak cytoplasmic and nuclear positivity for p16. Real-time PCR genotyping demonstrated the presence of high-risk human papillomavirus (HPV) type 18. We diagnose our case as "cutaneous SCC with mucinous metaplasia" and discuss the differential diagnoses with other skin tumors exhibiting mucin-containing cells, in particular with adenosquamous carcinoma and mucoepidermoid carcinoma. Although HPV 18 is not uncommon in cervico-vaginal pathology, where is often associated with mucinous adenocarcinoma or adenosquamous carcinoma of the cervix, its detection has been rarely reported in cutaneous SCC. In our case, the association of mucinous metaplasia and oncogenic high-risk HPV 18 in a cutaneous SCC may be of interest to the dermatopathologist. Further observations need to confirm whether the histopathologic finding of mucinous metaplasia in an atypical squamous cell proliferation could be a clue for investigating the presence of oncogenic high-risk HPV infection, with particular regard to HPV 18 subtype.

Low Rate of Detection of Mucosal High-Risk-Type Human Papillomavirus in Korean Patients with Extragenital Bowen's Disease and Squamous Cell Carcinoma, Especially in Digital Cases

“…In this study, patients with digital squamous cell carcinoma ( n = 3) did not show any mucosal high-risk HPV, and all patients were immunocompetent. These results are in contrast with those of a previous report which indicated relatively high prevalences of mucosal high-risk HPVs in digital squamous cell carcinoma [17, 18]. This discrepancy may be due to differences in patient immunocompetence or sexual behavior, including possible finger-genital transmission.…”

Benign mucinous metaplasia of the genital mucosa: histomorphological and immunohistochemical features and criteria for differentiation from extramammary Paget disease

“…Apart from mucinous metaplasia in the setting of chronic inflammation, mucinous cells in squamous epithelium have also been reported in VIN 11 and very recently in a case of squamous cell carcinoma 23 . In the latter two situations, lesions were proven to be induced by high‐risk HPVs (types 16 and 18, respectively), that being the reason for us to investigate the presence of HPV in BMM.…”

Penile Analogue of Stratified Mucin-Producing Intraepithelial Lesion of the Cervix

“…Notably, HPV has been detected in squamous cell carcinoma with mucinous metaplasia occurring outside the anogenital area. 16 In summary, we have described a lesion which we believe represents the first case of the penile analogue of cervical SMILE. The lesion is HPV induced.…”