Pseudovascular adenoid squamous cell carcinoma of oral cavity: A mimicker of angiosarcoma

Abstract

Pseudovascular adenoid squamous cell carcinoma (PASCC) is an uncommon histological variant of squamous cell carcinoma that can mimic vascular neoplasms, particularly angiosarcoma, in its morphologic characteristics. PASCC has been reported in the head and neck, as well as in the other organs such as the breast, lungs, urinary bladder, vulva, and uterine cervix. Only two cases of PASCC arising from the upper aerodigestive tract have been reported so far. We report a case of PASCC of oral cavity in a 40-year-old man, which mimicked an angiosarcoma initially. Immunohistochemical analysis led to a conclusive diagnosis of PASCC.

Primary angiosarcoma of the oral cavity in a young adult

“…6 Pseudovascular adenoid or acantholytic squamous cell carcinoma can mimic angiosarcoma in the oral cavity on histology. 10 Histopathological features, which are helpful in distinguishing epithelioid angiosarcoma from poorly differentiated metastatic/primary carcinoma, include occasional intracytoplasmic vacuoles with or without red blood cells, anastomosing vascular channels, and the lack of a desmoplastic reaction encountered in the former. Furthermore, strong immunoreactivity for vimentin, coupled with endothelial cell markers (Factor VIII, CD31, CD34) positivity, renders the diagnosis of metastatic carcinoma unlikely.…”

Acantholytic Squamous Cell Carcinoma of Oral Cavity, Mimicker of Angiosarcoma: A Rare Case Report

“…It is known to cause diagnostic difficulties to the pathologist due to discohesive pattern it generates. Hence, there is a multitude of terminologies associated with this entity such as adenoid SCC, pseudoglandular SCC, SCC with gland-like features, angiosarcoma-like SCC [8], and pseudovascular adenoid SCC [9]. ASCC differs from common SCC not only histologically but also by its aggressive behavior.…”

Meticulous diagnosis of adenoid squamous cell carcinoma: A sine qua non

“…Apart from giving the appearance of pseudovascular spaces, the epithelial cells lining the pseudolumens may have a hobnail pattern [2] and hence the synonymns angiosarcoma-like SCC, pseudo-angiosarcomatous carcinoma or pseudovascular ASCC. [7] Nappi et al [12] in their case series, noted that six acantholytic cutaneous squamous cell carcinomas, closely resembled angiosarcomas on conventional histologic examination. However, none of them were immunoreactive for factor VIII antigen, and two out of three cases studied were CD 34 negative.…”

“…[5] Our intention, in this short commentary, is to reiterate the importance of diagnosing this entity, as there is a repeated tendency by the pathologist to misdiagnose the same as mucoepidermoid carcinoma, vascular neoplasms, specially angiosarcoma and adeno squamous carcinoma (ASC). [6,7] Pitfalls in Diagnosis of ASCC ASCC, arising due to sun damage, most commonly manifests near the lips at the vermillion border [8] and less frequently in the mucosal sites of the upper aerodigestive tract including, oral cavity, tongue and nasopharynx, [9] as ulcerations or exophytic growths. [10] Jacoway et al [11] described 15 cases of oral labial ASCCs affecting males predominantly with a mean age of 56.1 years.…”