Adenosquamous carcinoma of skin appendages (adenoid squamous cell carcinoma, pseudoglandular squamous cell carcinoma, adenoacanthoma of sweat gland of lever) of the vulva.A clinical and ultrastructural study

Abstract

History and clinical findings of 18 cases of adenosquamous carcinoma of the skin appendages found among 135 cases of primary carcinoma of the vulva seen at the University of Minnesota Hospital between 1951 and 1970 were analyzed. In addition, two recent cases of this tumor were studied with conventional transmission electron microscopy. Adenosquamous carcinoma of the vulva showed poorer survival and a higher rate of lymph node metastases than squamous cell carcinoma of the corresponding stages (carcinoma in situ excluded). In four out of thirteen cases, the metastatic lesions in the lymph nodes retained glandular pattern. The ultrastructure showed mucin-producing columnar cells lining glandular lumina, and poorly differentiated squamous cells elsewhere; further, cells of the intermediate type between the two were present. This study indicates that adenosquamous carcinoma of the vulva is a distinctively separate entity from squamous cell carcinoma of the vulva, and possibly arises from mucin-producing cells of the skin appendages as suggested by Johnson and Helwig.

A Case of Acantholytic Squamous Cell Carcinoma

“…It was also known as adenoid SCC, lobular SCC, or pseudoglandular SCC [4][5][6][7] . As can be guessed by the name, it was previously thought to be a tumor of a sweat gland origin because of gland-like and solid epithelial proliferations extending into the dermis 3 .…”

“…Slightly basophilic amorphous material can sometimes be seen within the central spaces, and this material has a suspected glandular origin. But the tumor is negative on both dPAS and mucicarmine staining, and this is unlike other eccrine neoplasms 1,[5][6][7]14 . The overlying epidermis may show hyperkeratosis and parakeratosis, and the connection to the underlying tumor can be seen in most cases 1,2 .…”

“…Some authors have suggested the hypothesis that A-SCC originates from premalignant acantholytic actinic keratosis 5 . However, clinically it can occur on sun-protected areas and histologically there may be no sign of solar damage 5,7,8,15 . In addition, Nappi et al 14 did not find the exact association between A-SCC and acantholytic actinic keratosis in their 55 cases.…”

“…It has been documented to arise in areas of pre-existing scarring and in patients with chronic lymphocytic leukemia 8,10,14 . The histopathologic differential diagnosis includes adenoid basal cell carcinoma (BCC), eccrine adenocarcinomas, metastatic adenocarcinomas, and epithelioid angiosarcomas [5][6][7]14 . BCC must show, at least in part, the typical peripheral palisading, peritumoral lacunae, and stromal mucin.…”

“…Second, most of the reported lesions located on mucosa to have a high malignant potential. Third, many patients have predisposing factors associated with metastasis (i.e., immunosuppression) 3,[5][6][7][8][9][10][11][12][13][14] . Although various reports have shown controversial results, the overall malignant potential of A-SCC seems not to be higher than that of typical invasive SCC 1,2 .…”