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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 12  |  Issue : 2  |  Page : 61-63
 

Basaloid squamous cell carcinoma involving floor of the mouth


Department of Oral and Maxillofacial Pathology and Microbiology, Institute of Dental Sciences, KLE University, Belgaum, Karnataka, India

Correspondence Address:
Kunal Sah
Department of Oral and Maxillofacial Pathology and Microbiology, Institute of Dental Sciences, KLE University, Belgaum - 590 010
India
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DOI: 10.4103/0973-029X.44579

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   Abstract 

Basaloid squamous cell carcinomas of oral mucosa are uncommon. Majority of them can be differentiated from squamous cell carcinoma by their aggressive clinical course and their histopathological features. This case report presents a case of 70-year-old male with basaloid squamous cell carcinoma involving the floor of the mouth.


Keywords: Basaloid squamous cell carcinoma, squamous cell carcinoma


How to cite this article:
Sah K, Kale A, Hallikerimath S. Basaloid squamous cell carcinoma involving floor of the mouth. J Oral Maxillofac Pathol 2008;12:61-3

How to cite this URL:
Sah K, Kale A, Hallikerimath S. Basaloid squamous cell carcinoma involving floor of the mouth. J Oral Maxillofac Pathol [serial online] 2008 [cited 2014 Sep 23];12:61-3. Available from: http://www.jomfp.in/text.asp?2008/12/2/61/44579



   Introduction Top


Basaloid squamous cell carcinoma (BSCC) is an uncommon variant of squamous cell carcinoma. [1] It was initially introduced by Wain et al. in 1986 [2] and was included in the revised edition of WHO classification in 1991. [3] Since then, the reporting of this tumor is constantly increasing. It tends to have an aggressive clinical course as compared to age-, sex- and stage-matched conventional squamous cell carcinoma, with frequent local recurrence, regional and distant metastases. [4],[5],[6]

BSCC is biphasic, and the most striking characteristic feature is presence of solid malignant epithelial nests showing basaloid appearance with central comedo-type necrosis. Overlying epithelium shows presence of multiple foci of carcinomatous changes. The recommended treatment for this tumor is surgery followed by radiotherapy and chemotherapy. [2],[7] In this article, we describe a case of BSCC involving floor of the mouth with unusual clinical presentation and which has been diagnosed in its early clinical course.


   Case Report Top


A 70-year-old male patient reported with a chief complaint of a painful swelling in lower anterior region and floor of the mouth since two weeks. An year back the patient had a trauma to the lower jaw. The patient gave a history of extraction of 31, 41 and 42 a month back due to pain and caries. He had a history of cigarette smoking for the past 20 years.

Extraoral clinical examination revealed no significant findings. On intraoral examination, a large swelling reddish in color and measuring about 52 cm was seen involving the floor of the mouth, extending from 34 to 44 region. Swelling in the floor of the mouth was soft in consistency and extremely painful, and the patient was not cooperating for proper palpation. There were multiple carious teeth and root stumps in the posterior region. Mandibular canines and left lateral incisor had grade II mobility. Attrition in the incisal region and severe cervical abrasion were noted. The teeth were tender on percussion. Oral hygiene was poor, with generalized stains and calculus. Right submandibular lymph nodes were enlarged to a size of approximately 1 cm. They were tender and not adhering to the underlying structures.

A provisional clinical diagnosis of inflammatory swelling was given. This was thought to be originating from sublingual salivary gland. To rule out salivary duct blockage and presence of sialolith, mandibular occlusal radiograph was taken, which was noncontributory. As the patient was in severe discomfort, he was prescribed an antibiotic [Doxycycline: 200 mg for the first day followed by 100 mg once a day for 10 days] and analgesic [Ibuprofen 400 mg and paracetamol 325 mg twice a day for a week]. The patient was asked to report after a week.

The patient reported only after 15 to 20 days of the initial complaint. The swelling in the floor of the mouth had subsided considerably but was found to have appeared as an irregular, reddish, nodular growth measuring about 1 to 2 cm, located anterior to the opening of the salivary gland duct. The growth was firm in consistency [Figure 1]. Right submandibular lymph nodes were enlarged to a size of approximately 1 cm, firm in consistency, tender and mobile. At this stage, the clinical provisional diagnosis of salivary gland malignancy was given and was graded as T 2 N 1 M 0 . The patient was subjected to complete medical examination to rule out metastasis. The medical examination was noncontributory. After obtaining written consent from the patient, an incision biopsy under local anesthesia was done.

The tissue was routinely fixed, processed, and stained with hematoxylin and eosin. The section revealed a stratified squamous epithelium overlying the connective tissue stroma. Many invasive solid islands of basaloid-appearing cells were seen. Few of these islands showed pseudoglandular pattern with prominent peripheral palisading of nucleus. Basaloid cells displayed large vesicular nuclei with an increased nuclear-to-cytoplasmic ratio and scant amphophilic cytoplasm. Surface epithelium showed basilar hyperplasia with increased mitotic figures and nuclear pleomorphism [Figure 2],[Figure 4].

Many lobules exhibited central comedo-type necrosis [Figure 3] and few microcystic spaces. Stroma around the tumor was composed of fibrous connective tissue infiltrated by chronic inflammatory cells. Based on the histopathological features, diagnosis of basaloid squamous cell carcinoma of floor of the mouth was given. The patient was referred to the Department of Oral and Maxillofacial Surgery and was advised total excision of lesion with radical neck dissection followed by radiotherapy and chemotherapy.


   Discussion Top


BSCC is the designation initially introduced by Wain et al. in 1986, with its predilection for the head and neck region in men in their 60s or 70s. [2],[8] Though Quick and Cutler in 1927 mentioned the existence of undifferentiated SCC of the nasopharynx, tonsil, and tongue base, where BSCC occurs more frequently, they provided no histological details other than suggesting that these were highly malignant and radiosensitive. They recommended the name 'transitional cell epidermoid carcinoma'. [4],[9] Cadier and others first reported it in the oral cavity. [10],[11] Till now 45 cases of BSCC involving the oral cavity have been reported in literature, with a strong predilection for base of the tongue [61%] and floor of the mouth [30%]. [4]

All other clinical and histological features matched and also supported the observations initially described in detail by Wain et al. [2] and recently substantiated by Barnes et al. [5] They suggested the following characteristic features to diagnose a case of BSCC. These features include predilection for head and neck region in men in their 60s or 70s, an ulcerated or exophytic mass with submucosal soft tissue infiltration, solid basaloid-appearing dysplastic islands with biphasic pattern showing comedo-type necrosis and pseudo-glandular pattern, abrupt foci of squamous differentiation with or without keratin pearls, and surface mucosal epithelium showing dysplastic features.

Despite reported characteristic histopathologic pattern, BSCC can be misdiagnosed as adenoid cystic carcinoma [solid-type], adenosquamous carcinoma, polymorphous low-grade adenocarcinoma, small-cell undifferentiated carcinoma, basal cell adenosquamous carcinoma, salivary duct carcinoma and neuroendocrine carcinoma. [4],[5]

The biological behavior of BSCC has been reported to be worse than that of conventional SCC, and patients with these tumors have an unfavorable prognosis. Studies done by Ricardo et al. have shown significantly higher AgNOR and PCNA positively in BSCC when compared with SCC. Immunostaining for p53 also showed a higher percentage of positive cells. Expression of MMP-1, MMP-2, and MMP-9 was reported higher in cells of BSCC than in cells of SCC, suggesting an aggressive behavior. [8]

In conclusion, BSSCs have been reported to have poorer prognosis as compared to SCCs. They are very often misdiagnosed. Diagnosis depends on characteristic clinical and histopathological features. Initial presentation was of an inflammatory condition, which subsequently presented as a nonspecific, small nodular growth. The characteristic histopathological features helped in achieving an accurate diagnosis for proper treatment.

 
   References Top

1.Zbδren P, Nuyens M, Stauffer E. Basaloid squamous cell carcinoma of head and neck. Curr Opin Otolaryngol Head Neck Surg 2004;12:116-21.  Back to cited text no. 1    
2.Wain SL, Kier R, Vollmer RT, Bossen EH. Basaloid Squamous carcinoma of the tongue, hypopharynx and larynx: Report of 10 cases. Hum Pathol 1986;17:1158-66.  Back to cited text no. 2    
3.World Health Organization. Histological typing of tumor of the upper respiratory tract and ear. Berlin, Germany: Springer Verlag; 1991.  Back to cited text no. 3    
4.Ide F, Shimoyama T, Horie N, Kusama K. Basaloid squamous cell carcinoma of the oral mucosa: A new case and review of 45 cases in the literature. Oral Oncol 2002;38:120-4.  Back to cited text no. 4    
5.Barnes L, Ferlito A, Altavilla G, MacMillan C, Rinaldo A, Doglioni C. Basaloid squamous cell carcinoma of the head and neck: Clinicopathological features and differential diagnosis. Ann Otol Rhinol Laryngol 1996;105:75-82.  Back to cited text no. 5    
6.Winzenburg SM, Niehans GA, George E, Daly K, Adams GL. Basaloid squamous carcinoma: A clinical comparison of two histologic types with poorly differentiated squamous cell carcinoma. Otolaryngol Head Neck Surg 1998;119:471-5.  Back to cited text no. 6    
7.Luna MA, el Nagger A, Parichatikanond P, Weber RS, Batsakis JG. Basaloid squamous carcinoma of the upper aerodigestive tract. Cancer 1990;66:537-42.  Back to cited text no. 7    
8.Coletta RD, Cotrim P, Almeida OP, Alves VA, Wakamatsu A, Vargas PA. Basaloid squamous carcinoma of the oral cavity: Report of 2 cases and study of AgNOR, PCNA, p53 and MMP expression. Oral Surg Oral Med Oral Pathol 2001;91:563-9.  Back to cited text no. 8    
9.Quick D, Culter M. Transitional cell epidermoid carcinoma: A radiosensitive type of intra-oral tumor. Surg Gynecol Obstet 1927;45:320-31.  Back to cited text no. 9    
10.Cadier MA, Kelly SA, Parkhouse N, Brough MD. Basaloid Squamous carcinoma of the buccal cavity. Head Neck 1992;14:387-91.  Back to cited text no. 10    
11.Pereira MC, Oliveira DT, Landman G, Kowalski LP. Histologic subtypes of oral squamous cell carcinoma: Prognostic relevance. J Can Dent Assoc 2007;73:339-44.  Back to cited text no. 11    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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