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LETTER TO EDITOR  
Year : 2015  |  Volume : 58  |  Issue : 1  |  Page : 121-122
A rare case of squamous cell carcinoma with rhabdoid differentiation of oral cavity


Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra, India

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Date of Web Publication11-Feb-2015
 

How to cite this article:
Kulkarni MM, Joshi AR, Khandeparkar S, Gaurish S, Suryavanshi M. A rare case of squamous cell carcinoma with rhabdoid differentiation of oral cavity. Indian J Pathol Microbiol 2015;58:121-2

How to cite this URL:
Kulkarni MM, Joshi AR, Khandeparkar S, Gaurish S, Suryavanshi M. A rare case of squamous cell carcinoma with rhabdoid differentiation of oral cavity. Indian J Pathol Microbiol [serial online] 2015 [cited 2020 Apr 9];58:121-2. Available from: http://www.ijpmonline.org/text.asp?2015/58/1/121/151210


Editor,

Malignant rhabdoid tumors were originally described in the kidneys of children, as a subset of the first national Wilms's tumor study. [1] Recently, "composite" extrarenal malignant rhabdoid tumors in which a recognizable parent neoplasm is admixed with a malignant rhabdoid tumor have been observed. [2] Such tumors suggest that the rhabdoid morphology might be a common endpoint in the clonal evolution of tumors of different origins. The recognition of the rhabdoid morphology in a pure or composite tumor is important, because it appears to be associated with aggressive biological behavior, rapid dissemination, and poor response to adjuvant treatment. [2],[3] Squamous cell carcinoma with rhabdoid features (SCCRF) shows noncohesive growth of ovoid carcinoma cells without duct like structures. SCCRF is the extreme phenotype of acantholytic squamous cell carcinoma (SCC), which is composed of noncohesive large ovoid carcinoma cells with eosinophilic cytoplasm and eccentric nuclei. [4] We describe the clinicopathological and immunohistochemical (IHC) features of oral SCCRF. To the best of our knowledge, this case is the third report of oral SCCRF published in English literature.

A 26-year-old female, presented with tumor involving the left gingivo-buccal sulcus and reaching upto the overlying skin causing ulceration covered with necro-inflammatory slough. Left hemi-mandibulectomy was done with left radical neck dissection. An ulcero-infiltrative growth measuring 8 cm × 7 cm × 6 cm was seen in the gingivobuccal sulcus. Cut surface of the tumor was grayish white in color and firm in consistency. Microscopically, it was composed of an ill circumscribed tumor made up of sheets of discohesive round to oval cells with eccentric pleomorphic, hyperchromatic nuclei, and abundant eosinophilic cytoplasm showing rhabdoid differentiation [[Figure 1]a, inset]. Cytoplasmic hyaline globules were seen. Also seen were areas showing moderately differentiated SCC and carcinoma in situ [[Figure 1]a]. The surface epithelium showed koilocytic change. Few areas showed spindle cells with pleomorphic, hyperchromatic nuclei and moderate amount of cytoplasm. Two out of six lymph nodes showed tumor metastasis. Metastatic tumor revealed composite tumor with rhabdoid differentiation.
Figure 1: (a) Photomicrograph of tumor showing carcinoma in situ and squamous cell carcinoma with rhabdoid differentiation (H and E, ×100). (a, inset) Tumor showing numerous rhabdoid cells with eccentric, vesicular nucleus and moderate amount of cytoplasm (H and E, ×400). (b) The tumor cells showing strong cytoplasmic immunoreactivity for pan cytokeratin and (c) vimentin, (d) Ki-67 labeling index was 90%


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Immunohistochemical analysis was performed with the following panel of antibodies viz. pancytokeratin (CK) (AE/AE3, Dako), vimentin (V9, Dako), S-100 (Leica), epithelial membrane antigen (EMA) (clone E29, Dako) and cell proliferative marker like Ki-67 (clone MIB-1, Dako). The tumor cells showed strong cytoplasmic immunoreactivity for pan CK [[Figure 1]b] and vimentin [[Figure 1]c]. The tumor cells were negative for EMA and S-100. Ki-67 labeling index was 90% [[Figure 1]d]. Diagnosis of SCCRF was confirmed.

Beckwith and Palmar first identified tumors with rhabdoid morphology within the kidneys of children in 1978. [1] These tumors occur most often in children and are associated with fatal outcome. Malignant tumors with rhabdoid morphology rarely occur in adults. Such tumors show areas of the primary tumor or metastatic deposits having rhabdoid morphology along with the morphology of the parent neoplasm, such as carcinoma, melanoma, or sarcoma. [2],[3] Recognition of the rhabdoid morphology is important histopathologically, because there is evidence that they have the same aggressive biological behavior as those tumors seen in children. Furthermore, they do not appear to respond to any currently available adjuvant chemoradiotherapy. [3] In our case, the tumor was bulky with skin involvement, showing its aggressive nature.

Malignant rhabdoid tumor of oral cavity is rarely documented. The first report of SCCRF was described in 1996.[5] The second report was documented in 2013. [4] In our case, adjacent epithelium showed changes of carcinoma in situ. To the best of our knowledge, this is the third case of oral composite malignant rhabdoid tumor showing clear squamous histogenesis. Cutaneous malignant rhabdoid tumor with squamous histogenesis was similarly described. [3] Our case was a young female and she had no history of tobacco, smoking, gutaka or betel nut abuse. The surface epithelium showed koilocytic change suggesting possible human papillomavirus (HPV) etiology. Oropharyngeal site and younger patient age were strongly associated with presence of HPV 16 in one study. [6] Our experience with the present case highlights the rarity of the lesion and importance of recognition of this entity in predicting clinical outcome. Detailed IHC analysis helps in identification of this distinct histological type of tumor.

 
   References Top

1.
Beckwith JB, Palmer NF. Histopathology and prognosis of Wilms tumors: Results from the First National Wilms' Tumor Study. Cancer 1978;41:1937-48.  Back to cited text no. 1
[PUBMED]    
2.
Wick MR, Ritter JH, Dehner LP. Malignant rhabdoid tumors: A clinicopathologic review and conceptual discussion. Semin Diagn Pathol 1995;12:233-48.  Back to cited text no. 2
    
3.
Mathers ME, O'Donnell M. Squamous cell carcinoma of skin with a rhabdoid phenotype: A case report. J Clin Pathol 2000;53:868-70.  Back to cited text no. 3
    
4.
Kusafuka K, Onitsuka T, Miki T, Murai C, Suda T, Fuke T, et al. Squamous cell carcinoma with rhabdoid features of the gingiva: A case report with unusual histology. Med Mol Morphol 2013.  Back to cited text no. 4
    
5.
Pai SA, Vege DS, Borges AM, Soman CS. Rhabdoid phenotype in squamous carcinoma. A report of two cases. Indian J Cancer 1996;33:161-4.  Back to cited text no. 5
[PUBMED]    
6.
Soria-Céspedes D, Canchola Aguilar G, Lara-Torres CO, Sánchez-Marle JF, Hernández-Peña RE, Ortiz-Hidalgo C. Metastatic oropharyngeal squamous cell carcinoma in cervical lymph nodes associated to HPV infection type 16 and 45; clinical, morphological and molecular study of two cases. Gac Med Mex 2013;149:673-9.  Back to cited text no. 6
    

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Correspondence Address:
Dr. Maithili M Kulkarni
Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.151210

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