Letter to the editor
A third case of cutaneous papillary squamous cell carcinoma We read with inferest the article by I.andman et al. (j Cujtan Pathol 1990: 17:105) which describes 2 cases of a |)apillary variant of ciilaiieous squamous cell carcinoma. We agree with the authors' opinion that these tumors exhibit distinctive clinical and histological features. We had the privilege of following a similar case of this unusual cutaneous neoplasia. An 85-year-old woman developed, over a few months, an exophytie, fungating, red-tan tumor on her right flatik. The lesion was removed surgically. I he patient died of eardiae failure one year later; there was no evidence of recurrence or metastasis of the cutaneous neoplasm. Gross examination of the excised tumor revealed an exophytic papillomatous proliferation measuring 7 X 5 X 3.5 cm (Fig. 1). Histologically, the exophytic papillary structures c()n,sislccl of an acanthotic epidermal growth lying over well-developed fibrovascular cores (Fig. 2). Two cell components were idenlifled. In the lower portion of (he epidermis, the keralinocytes showed eosinophilic cytoplasm, large basophilie nuclei wilh
severe atypia, and mitotic activity; intercellular bridges were present, and small squamous eddies were seen oecasionally. In the upper layers, the epidermal cells had basophilic and atypical nuclei that were larger than the preceding and possessed abundant clear cytoplasm (Fig. 3). The stratum corneum was parakeratotie and often missing, and the surface was lined by neutrophilic aggregates. The fibrovascular projections were edematous and infiltrated by numerous lymphocytes, histiocytes, and plasma cells. Staining with anti-HPV antibody (DAKO) by a standard immunofluorescent method was negative. The 2 cases reported by Landman et al. and our patient share common clinical features: the tumor was exophytic and lobulate, occurred in elderly patients, grew rapidly, and reached a large size. However, in our patient, the lesion was not localized in a sun-exposed area. Histologically, all 3 cases were characterized by an exophytic growth pattern, large fibrovascular projections overlayed by thickened epidermis, presence of atypia, and numerous mitotic
', /, Transverse ,seetion of excised tumor.
142
Letter to the Editor /'/;', 2. L o w n i a i ; n i l i c a t i o n demonstratins; the papillaty exophytie growth |)attein
with
wc'll-de\('lo|)ed libiovasc tilar c o t e s
(H&E),
/'/;', ,7, ()\c'rlyitii^ e p u l e i i n i s s h o w i n g scN'etc nuelc-ar aty|)ia ancl a clear cell c o m p o n e n t in the u p | ) e r l a y e r s ( H & l ' . ) ,
ligures. Dee|) inxasion was lacking, and staining for HPV remained negatixc in all cas(\s. In addition, 2 of the 3 cases had a superlicial clear cell component. The lack of dermal invasion, desjjite the very large size reached by the tumoi' in otu" cas(\ supports the non-aggressive course ol' this rare \arianl of cutaneous squamous cell carcinoma.
I.sabclle .Ma.sotnuK Yu.Kuf Kap(uui CMitiiciue d e D e i i i i a t o l o g i e , I n s t i t u t dc- P a t h o l o g i c - C l i n i c i u e ital C a n t o t i a l l ' m \ c-tsitaitc d e (;etu~-\c\ C M 1 - I 2 1 1 C c - n Sw it/ei land
143
A third case of cutaneous papillary squamous cell carcinoma We read with inferest the article by I.andman et al. (j Cujtan Pathol 1990: 17:105) which describes 2 cases of a |)apillary variant of ciilaiieous squamous cell carcinoma. We agree with the authors' opinion that these tumors exhibit distinctive clinical and histological features. We had the privilege of following a similar case of this unusual cutaneous neoplasia. An 85-year-old woman developed, over a few months, an exophytie, fungating, red-tan tumor on her right flatik. The lesion was removed surgically. I he patient died of eardiae failure one year later; there was no evidence of recurrence or metastasis of the cutaneous neoplasm. Gross examination of the excised tumor revealed an exophytic papillomatous proliferation measuring 7 X 5 X 3.5 cm (Fig. 1). Histologically, the exophytic papillary structures c()n,sislccl of an acanthotic epidermal growth lying over well-developed fibrovascular cores (Fig. 2). Two cell components were idenlifled. In the lower portion of (he epidermis, the keralinocytes showed eosinophilic cytoplasm, large basophilie nuclei wilh
severe atypia, and mitotic activity; intercellular bridges were present, and small squamous eddies were seen oecasionally. In the upper layers, the epidermal cells had basophilic and atypical nuclei that were larger than the preceding and possessed abundant clear cytoplasm (Fig. 3). The stratum corneum was parakeratotie and often missing, and the surface was lined by neutrophilic aggregates. The fibrovascular projections were edematous and infiltrated by numerous lymphocytes, histiocytes, and plasma cells. Staining with anti-HPV antibody (DAKO) by a standard immunofluorescent method was negative. The 2 cases reported by Landman et al. and our patient share common clinical features: the tumor was exophytic and lobulate, occurred in elderly patients, grew rapidly, and reached a large size. However, in our patient, the lesion was not localized in a sun-exposed area. Histologically, all 3 cases were characterized by an exophytic growth pattern, large fibrovascular projections overlayed by thickened epidermis, presence of atypia, and numerous mitotic
', /, Transverse ,seetion of excised tumor.
142
Letter to the Editor /'/;', 2. L o w n i a i ; n i l i c a t i o n demonstratins; the papillaty exophytie growth |)attein
with
wc'll-de\('lo|)ed libiovasc tilar c o t e s
(H&E),
/'/;', ,7, ()\c'rlyitii^ e p u l e i i n i s s h o w i n g scN'etc nuelc-ar aty|)ia ancl a clear cell c o m p o n e n t in the u p | ) e r l a y e r s ( H & l ' . ) ,
ligures. Dee|) inxasion was lacking, and staining for HPV remained negatixc in all cas(\s. In addition, 2 of the 3 cases had a superlicial clear cell component. The lack of dermal invasion, desjjite the very large size reached by the tumoi' in otu" cas(\ supports the non-aggressive course ol' this rare \arianl of cutaneous squamous cell carcinoma.
I.sabclle .Ma.sotnuK Yu.Kuf Kap(uui CMitiiciue d e D e i i i i a t o l o g i e , I n s t i t u t dc- P a t h o l o g i c - C l i n i c i u e ital C a n t o t i a l l ' m \ c-tsitaitc d e (;etu~-\c\ C M 1 - I 2 1 1 C c - n Sw it/ei land
143
