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Basaloid squamous cell carcinoma of the lung: A rare tumour with a rare clinical presentation
Lung Cancer (2007) 57, 109—111
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/lungcan
CASE REPORT
Basaloid squamous cell carcinoma of the lung: A rare tumour with a rare clinical presentation Ebru Cakır a,∗, Funda Demirag a, Gulnur Onde Ucoluk b, Sadi Kaya c, Leyla Memıs d a
Ataturk Center for Chest Disease and Thoracic Surgery, Department of Pathology, Ankara, Turkey Ataturk Center for Chest Disease and Thoracic Surgery, Department of Chest Disease, Ankara, Turkey c Ataturk Center for Chest Disease and Thoracic Surgery, Department of Thoracic Surgery, Ankara, Turkey d Gazi University, Faculty of Medicine, Department of Pathology, Ankara, Turkey b
Received 12 November 2006; received in revised form 9 January 2007; accepted 25 January 2007
KEYWORDS Basaloid squamous cell carcinoma; Young age; Female
Summary Basaloid squamous cell carcinoma of the lung, an uncommon subtype of non-small cell carcinomas was introduced as a distinct entity in the recently revised World Health Organization (WHO) classification of lung tumours. This rare tumour most commonly develops in males older than 60 years. We report a 23-years-old female patient with basaloid squamous cell carcinoma of the lung who was stage IIB post-operatively. The patient is still alive and healthy 18 months after the operation. This is one of the youngest patient reported with this rare type of tumour. © 2007 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Basaloid carcinoma of the lung, a rare neoplasm with distinct histopathological features, was first described by Brambilla and colleagues in 1992 [1—5]. Basaloid carcinomas were defined as a subtype of squamous cell carcinoma, referred to as squamous cell carcinoma of basaloid subtype in the World Health Organization (WHO) classification 1999 or as a variant of large cell carcinoma depending on the presence or absence of squamous cell carcinoma component [5].
∗
Corresponding author. Tel.: +90 3123269310; fax: +90 3123553430. E-mail addresses: [email protected], [email protected] (E. Cakır).
There are some controversy about the clinical behavior and prognosis of this rare neoplasm [1,2,4]. Some of the recent studies concluded that basaloid squamous cell carcinomas had a poorer prognosis than other non-small cell carcinomas [1,2]. But some authors reported that the postoperative survival and recurrence were not different from other non-small lung cancers [4]. Like other types of bronchogenic carcinomas, basaloid carcinoma usually develops in males older than 60 years [4]. Present case is a 23-yearsold female with basaloid squamous cell carcinoma of the lung.
2. Case report A 23-years-old female was admitted to the hospital with persistent and productive cough, dyspnea and hemoptysis
0169-5002/$ — see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.lungcan.2007.01.021
110
Fig. 1 Chest computed tomography showing a heterogen mass extending from hilus to pleura in the left lung.
for 2 years. She had a pneumonia history 17 years ago. She had never smoked. Physical examination revealed decreased respiratory sounds in the left lung. Chest radiogram and computed tomography scan identified a dense heterogen soft tissue mass with lobular contours extending from hilus to the pleura in the left lung (Fig. 1). Broncoscopy provided endobronchial lesion localized in the inferior lobe. Broncoscopic biopsy diagnosed as non-small cell carcinoma. Abdominal USG, cranial CT, bone sintigraphy and the cytologic examination of the pleural effusion were normal. The patient underwent thoracotomy and resection of the inferior lobe. Macroscopic examination of the lobe revealed a 9 cm × 8.5 cm × 6 cm tumour with heterogen and necrotic cut surface, invading the pleura. Histologically the tumour had a solid and anastomotic trabecular pattern with centrolobular necrosis. Peripheral palisading with radially arranged cells at the periphery of lobules was evident (Fig. 2). The tumour cells had scant but visible cytoplasm, with hyperchromatic nuclei, high mitotic rate (20/10 HPF) and without prominent nucleoli. The tumour exhibited focal
Fig. 2 H&E stain 40×: anastomotic trabecular pattern with prominent peripheral palisading.
E. Cakır et al.
Fig. 3 H&E stain 200×: tumour cells with squamous differentiation, high mitotic rate and palisading pattern.
areas of squamous differantiation (Fig. 3) and invaded the parietal pleura. Immunohistochemical analysis showed diffuse strong positivity with 34ßE12 but TTF-1, LMW-CK, chromogranin, NSE, PGP9.5, actin, S-100 and CD56 were negative and the final diagnosis was basaloid squamous cell carcinoma. Post-operatively the patient was uncomplicated and the post-operative (p) TNM stage was T3N0M0. She had no chemotherapy or radiotherapy. She is still alive and healthy 18 months after the operation.
3. Discussion Basaloid squamous cell carcinoma was introduced as a distinct entity in the recently revised WHO classification of lung tumours [6]. It is mainly located in the major or moderate bronchi and usually develops in males older than 60 years [1—3]. There are conflicting data’s about the prognosis of this unique tumour [3,4]. Histological differential diagnosis from small cell carcinoma, large cell neuroendocrine carcinoma and sometimes adenoid cystic carcinoma is difficult especially in preoperative small bronchial biopsies [7—9]. Immunohistochemical expression of CK34ßE12 usually rules out the neuroendocrine differentiation of the tumours. Moreover, basaloid squamous cell carcinomas never express three neuroendocrine markers [2,9]. Actin, desmin and S100 immunostains may be also useful in differentiating from adenoid cystic carcinoma [7]. The typical histological findings of basaloid squamous cell carcinoma like lobular or anastomotic trabecular pattern, peripheral palisading, small cuboidal to fusiform cells without prominent nucleoli and high rate of mitoses are also important clues in differential diagnosis [1]. The present case has all the histological and immunohistochemical characteristic features of basaloid squamous cell carcinoma. Bronchogenic carcinomas are generally considered a disease that predominantly affects middle-aged or elderly smoker men and uncommon in patients aged 40 years or less [10—13]. Basaloid squamous cell carcinomas are also develop in males older than 60 years [4]. The youngest
Basaloid squamous cell carcinoma of the lung patient with basaloid squamous cell carcinoma is an 18years-old Japanese female who had a clinical stage of T4N2M1 and died 2 months after the start of chemotherapy [14]. Lung cancer in young patients has different features like higher incidence of adenocarcinoma, stages III—IV disease and lower male-to-female ratio [10—13]. Some investigators have also suggested that lung cancer in this population is more aggressive and more rapidly fatal than in older patients [10,15]. Our patient has stage II disease and still healthy 18 months after the operation. This case seems unusual for the young age, female sex and rare type of tumour. In conclusion, a 23-years-old woman with basaloid squamous cell carcinoma of the lung was reported. This is the second youngest patient reported with this rare type of tumour. The follow-up information of this patient should provide some additional knowledge about the prognosis of this rare tumour in young population.
References [1] Brambilla E, Moro D, Veale D, Brichon PY, Stoebner P, Paramelle B, et al. Basal cell (basaloid) carcinoma of the lung: a new morphologic and phenotypic entity with seperate prognostic significance. Hum Pathol 1992;23:993—1003. [2] Moro D, Brichon P, Brambilla E, Veale D, Labat F, Brambilla C. Basaloid bronchial carcinoma A histologic group with a poor prognosis. Cancer 1994;73:2734—9. [3] Foroulis CN, Iliadis KH, Mauroudis PM, Kosmidis PA. Case report: basaloid carcinoma, a rare primary lung neoplasm: report of a case and review of the literature. Lung Cancer 2002;35:335—8. [4] Kim DJ, Kim KD, Shin DH, Ro JY, Chung KY. Basaloid carcinoma of the lung: a really dismal histologic variant? Ann Thorac Surg 2003;76:1833—7.
111 [5] Brambilla E, Travis WD, Colby TV, Corrin B, Shimosato Y. The new World Health Organization classification of lung tumours. Eur Respir J 2001;18:1059—68. [6] Travis WD, Colby TV, Corrin B, Shimosato Y, Brambilla E. In Collaboration with Sobin LH and Pathologists from 14 Coutries. In: Histological typing of lung and pleural tumours. World Health Organization. International histological classification of tumours. 3rd ed. Berlin: Springer; 1999. [7] Morice WG, Ferreıro JA. Distinction of basaloid squamous cell carcinoma from adenoid cystic and small cell undifferentiated carcioma by immunohistochemistry. Hum Pathol 1998;29:609—12. [8] Sturm N, Lantuejoul S, Laverrıere M-H, Papotti M, Brichon P-Y, Brambilla C, et al. Thyroid transcription factor 1 and cytokeratins 1,5,10,14 (34ßE12) expression in basaloid and large-cell neuroendocrine carcinomas of the lung. Hum Pathol 2001;32:918—25. [9] Sturm N, Rossi G, Lantuejoul S, Laverriere M-H, Papotti M, Brihon P-Y, et al. 34ßE12 expression along the whole spectrum of neuroendocrine proliferations of the lung, from neuroendocrine cell hyperplasia to small cell carcinoma. Histopathology 2003;42:156—66. [10] Jubelirer SJ, Wilson RA. Lung cancer in patients younger than 40 years of age. Cancer 1991;67:1436—8. [11] Sekine I, Nishiwaki Y, Yokose T, Nagai K, Suzuki K, Kodama T. Young lung cancer patients in japan: different characteristics between the sexes. Ann Thorac Surg 1999;67:1451—5. [12] Antkowiak JG, Regal AM, Takita H. Bronchogenic carcinoma in patients under age 40. Ann Thorac Surg 1989;47:391—3. [13] Maruyama R, Yoshino I, Yohena T, Uehara T, Kanematsu T, Kitajima M, et al. Lung cancer in patients younger than 40 years of age. J Surg Oncol 2001;77:208—12. [14] Nagakawa H, Hiroshima K, Takiguchi Y, Yatomi M, Takahashi Y, Mikami M, et al. Basaloid squamous cell carcinoma of the lung in a young woman. Int J Clin Oncol 2006;11:66—8. [15] DeCaro L, Benfield JR. Lung cancer in young persons. J Thorac Cardiovasc Surg 1982;83:372—6.
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/lungcan
CASE REPORT
Basaloid squamous cell carcinoma of the lung: A rare tumour with a rare clinical presentation Ebru Cakır a,∗, Funda Demirag a, Gulnur Onde Ucoluk b, Sadi Kaya c, Leyla Memıs d a
Ataturk Center for Chest Disease and Thoracic Surgery, Department of Pathology, Ankara, Turkey Ataturk Center for Chest Disease and Thoracic Surgery, Department of Chest Disease, Ankara, Turkey c Ataturk Center for Chest Disease and Thoracic Surgery, Department of Thoracic Surgery, Ankara, Turkey d Gazi University, Faculty of Medicine, Department of Pathology, Ankara, Turkey b
Received 12 November 2006; received in revised form 9 January 2007; accepted 25 January 2007
KEYWORDS Basaloid squamous cell carcinoma; Young age; Female
Summary Basaloid squamous cell carcinoma of the lung, an uncommon subtype of non-small cell carcinomas was introduced as a distinct entity in the recently revised World Health Organization (WHO) classification of lung tumours. This rare tumour most commonly develops in males older than 60 years. We report a 23-years-old female patient with basaloid squamous cell carcinoma of the lung who was stage IIB post-operatively. The patient is still alive and healthy 18 months after the operation. This is one of the youngest patient reported with this rare type of tumour. © 2007 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Basaloid carcinoma of the lung, a rare neoplasm with distinct histopathological features, was first described by Brambilla and colleagues in 1992 [1—5]. Basaloid carcinomas were defined as a subtype of squamous cell carcinoma, referred to as squamous cell carcinoma of basaloid subtype in the World Health Organization (WHO) classification 1999 or as a variant of large cell carcinoma depending on the presence or absence of squamous cell carcinoma component [5].
∗
Corresponding author. Tel.: +90 3123269310; fax: +90 3123553430. E-mail addresses: [email protected], [email protected] (E. Cakır).
There are some controversy about the clinical behavior and prognosis of this rare neoplasm [1,2,4]. Some of the recent studies concluded that basaloid squamous cell carcinomas had a poorer prognosis than other non-small cell carcinomas [1,2]. But some authors reported that the postoperative survival and recurrence were not different from other non-small lung cancers [4]. Like other types of bronchogenic carcinomas, basaloid carcinoma usually develops in males older than 60 years [4]. Present case is a 23-yearsold female with basaloid squamous cell carcinoma of the lung.
2. Case report A 23-years-old female was admitted to the hospital with persistent and productive cough, dyspnea and hemoptysis
0169-5002/$ — see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.lungcan.2007.01.021
110
Fig. 1 Chest computed tomography showing a heterogen mass extending from hilus to pleura in the left lung.
for 2 years. She had a pneumonia history 17 years ago. She had never smoked. Physical examination revealed decreased respiratory sounds in the left lung. Chest radiogram and computed tomography scan identified a dense heterogen soft tissue mass with lobular contours extending from hilus to the pleura in the left lung (Fig. 1). Broncoscopy provided endobronchial lesion localized in the inferior lobe. Broncoscopic biopsy diagnosed as non-small cell carcinoma. Abdominal USG, cranial CT, bone sintigraphy and the cytologic examination of the pleural effusion were normal. The patient underwent thoracotomy and resection of the inferior lobe. Macroscopic examination of the lobe revealed a 9 cm × 8.5 cm × 6 cm tumour with heterogen and necrotic cut surface, invading the pleura. Histologically the tumour had a solid and anastomotic trabecular pattern with centrolobular necrosis. Peripheral palisading with radially arranged cells at the periphery of lobules was evident (Fig. 2). The tumour cells had scant but visible cytoplasm, with hyperchromatic nuclei, high mitotic rate (20/10 HPF) and without prominent nucleoli. The tumour exhibited focal
Fig. 2 H&E stain 40×: anastomotic trabecular pattern with prominent peripheral palisading.
E. Cakır et al.
Fig. 3 H&E stain 200×: tumour cells with squamous differentiation, high mitotic rate and palisading pattern.
areas of squamous differantiation (Fig. 3) and invaded the parietal pleura. Immunohistochemical analysis showed diffuse strong positivity with 34ßE12 but TTF-1, LMW-CK, chromogranin, NSE, PGP9.5, actin, S-100 and CD56 were negative and the final diagnosis was basaloid squamous cell carcinoma. Post-operatively the patient was uncomplicated and the post-operative (p) TNM stage was T3N0M0. She had no chemotherapy or radiotherapy. She is still alive and healthy 18 months after the operation.
3. Discussion Basaloid squamous cell carcinoma was introduced as a distinct entity in the recently revised WHO classification of lung tumours [6]. It is mainly located in the major or moderate bronchi and usually develops in males older than 60 years [1—3]. There are conflicting data’s about the prognosis of this unique tumour [3,4]. Histological differential diagnosis from small cell carcinoma, large cell neuroendocrine carcinoma and sometimes adenoid cystic carcinoma is difficult especially in preoperative small bronchial biopsies [7—9]. Immunohistochemical expression of CK34ßE12 usually rules out the neuroendocrine differentiation of the tumours. Moreover, basaloid squamous cell carcinomas never express three neuroendocrine markers [2,9]. Actin, desmin and S100 immunostains may be also useful in differentiating from adenoid cystic carcinoma [7]. The typical histological findings of basaloid squamous cell carcinoma like lobular or anastomotic trabecular pattern, peripheral palisading, small cuboidal to fusiform cells without prominent nucleoli and high rate of mitoses are also important clues in differential diagnosis [1]. The present case has all the histological and immunohistochemical characteristic features of basaloid squamous cell carcinoma. Bronchogenic carcinomas are generally considered a disease that predominantly affects middle-aged or elderly smoker men and uncommon in patients aged 40 years or less [10—13]. Basaloid squamous cell carcinomas are also develop in males older than 60 years [4]. The youngest
Basaloid squamous cell carcinoma of the lung patient with basaloid squamous cell carcinoma is an 18years-old Japanese female who had a clinical stage of T4N2M1 and died 2 months after the start of chemotherapy [14]. Lung cancer in young patients has different features like higher incidence of adenocarcinoma, stages III—IV disease and lower male-to-female ratio [10—13]. Some investigators have also suggested that lung cancer in this population is more aggressive and more rapidly fatal than in older patients [10,15]. Our patient has stage II disease and still healthy 18 months after the operation. This case seems unusual for the young age, female sex and rare type of tumour. In conclusion, a 23-years-old woman with basaloid squamous cell carcinoma of the lung was reported. This is the second youngest patient reported with this rare type of tumour. The follow-up information of this patient should provide some additional knowledge about the prognosis of this rare tumour in young population.
References [1] Brambilla E, Moro D, Veale D, Brichon PY, Stoebner P, Paramelle B, et al. Basal cell (basaloid) carcinoma of the lung: a new morphologic and phenotypic entity with seperate prognostic significance. Hum Pathol 1992;23:993—1003. [2] Moro D, Brichon P, Brambilla E, Veale D, Labat F, Brambilla C. Basaloid bronchial carcinoma A histologic group with a poor prognosis. Cancer 1994;73:2734—9. [3] Foroulis CN, Iliadis KH, Mauroudis PM, Kosmidis PA. Case report: basaloid carcinoma, a rare primary lung neoplasm: report of a case and review of the literature. Lung Cancer 2002;35:335—8. [4] Kim DJ, Kim KD, Shin DH, Ro JY, Chung KY. Basaloid carcinoma of the lung: a really dismal histologic variant? Ann Thorac Surg 2003;76:1833—7.
111 [5] Brambilla E, Travis WD, Colby TV, Corrin B, Shimosato Y. The new World Health Organization classification of lung tumours. Eur Respir J 2001;18:1059—68. [6] Travis WD, Colby TV, Corrin B, Shimosato Y, Brambilla E. In Collaboration with Sobin LH and Pathologists from 14 Coutries. In: Histological typing of lung and pleural tumours. World Health Organization. International histological classification of tumours. 3rd ed. Berlin: Springer; 1999. [7] Morice WG, Ferreıro JA. Distinction of basaloid squamous cell carcinoma from adenoid cystic and small cell undifferentiated carcioma by immunohistochemistry. Hum Pathol 1998;29:609—12. [8] Sturm N, Lantuejoul S, Laverrıere M-H, Papotti M, Brichon P-Y, Brambilla C, et al. Thyroid transcription factor 1 and cytokeratins 1,5,10,14 (34ßE12) expression in basaloid and large-cell neuroendocrine carcinomas of the lung. Hum Pathol 2001;32:918—25. [9] Sturm N, Rossi G, Lantuejoul S, Laverriere M-H, Papotti M, Brihon P-Y, et al. 34ßE12 expression along the whole spectrum of neuroendocrine proliferations of the lung, from neuroendocrine cell hyperplasia to small cell carcinoma. Histopathology 2003;42:156—66. [10] Jubelirer SJ, Wilson RA. Lung cancer in patients younger than 40 years of age. Cancer 1991;67:1436—8. [11] Sekine I, Nishiwaki Y, Yokose T, Nagai K, Suzuki K, Kodama T. Young lung cancer patients in japan: different characteristics between the sexes. Ann Thorac Surg 1999;67:1451—5. [12] Antkowiak JG, Regal AM, Takita H. Bronchogenic carcinoma in patients under age 40. Ann Thorac Surg 1989;47:391—3. [13] Maruyama R, Yoshino I, Yohena T, Uehara T, Kanematsu T, Kitajima M, et al. Lung cancer in patients younger than 40 years of age. J Surg Oncol 2001;77:208—12. [14] Nagakawa H, Hiroshima K, Takiguchi Y, Yatomi M, Takahashi Y, Mikami M, et al. Basaloid squamous cell carcinoma of the lung in a young woman. Int J Clin Oncol 2006;11:66—8. [15] DeCaro L, Benfield JR. Lung cancer in young persons. J Thorac Cardiovasc Surg 1982;83:372—6.