cells undergo a second genetic mutation and transform into cells with SMA phenotype. 4,5 In our cases, the expression of 34betaE12 and p63 supported the notion that the spindle cells derived from epithelium with fibroblastic or myofibroblastic differentiation rather than mesenchyme origin.Cytokeratin immunostains used in our research include AE1/AE3, 34betaE12, and CK5/6. Except for 34betaE12, other keratin markers (AE1/AE3 and CK5/6) are lost. Goldblum et al 6 conducted a cytokeratin expression study in 16 cases of SSCC, with only 6 expressing AE1/AE3 (38%), 8 expressing 34betaE12 (50%), and 11 (69%) expressing CK5/6, which showed CK5/6 with highest sensitivity. The study conducted by Glusac et al 7 showed greatest sensitivity for 34betaE12 (100%) and p63 (100%). The study conducted by Morgan et al 3 showed that 34betaE12 is the most sensitive (12/12, 100%) marker for SSCC compared with p63 (10/12, 80%), AE1/ AE3 (8/12, 67%), CAM 5.2 (7/12, 58%), and Pan KER (4/12, 33%). Our study demonstrated general agreement with the studies conducted by Glusac et al and Morgan et al. Based on the above results, we recommend using 34betaE12 and p63 in the panel for working up the differential diagnosis so as not to miss the diagnosis of SSCC.
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