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Acantholytic squamous cell carcinoma of the oral cavity: a more aggressive entity?

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Abstract

Acantholytic squamous cell carcinoma is a histologically distinct variant of squamous cell carcinoma that arises most commonly in areas of the skin exposed to the sun. It is rare on mucosal surfaces of the upper aerodigestive tract, where there is some suggestion that it might behave more aggressively than conventional squamous cell carcinoma. This case which describes a 56-year-old patient presenting with Stage II disease of the tongue who succumbed to disease nine months after presentation despite aggressive multi-modality treatment adds weight to that argument.

Introduction

Acantholytic (adenoid) squamous cell carcinoma (ASCC) is an uncommon, histologically distinct variant of squamous cell carcinoma (SCC). It is characterised by extensive acantholysis that results in pseudo-glandular or pseudo-vascular. It occurs most commonly in areas of the skin that are exposed to the sun, and was first recognised as a distinct entity in the 1940s.1 It has only rarely been documented in the mucosal upper aerodigestive tract.2, 3, 4, 5 Its prognosis in the mucosal environment is controversial, with some reports suggesting more aggressive behaviour and poorer prognosis. This case adds weight to that argument.

Section snippets

Case report

A 56-year-old man presented with a three-month history of a painful lesion on the right side of his tongue (Fig. 1). He was a non-smoker who drank fewer than two units of alcohol a week. Apart from a history of an aortic systolic murmur and depression that was treated with a selective serotonin re-uptake inhibitor he had maintained good health. An incisional biopsy confirmed an acantholytic variant of SCC with acantholysis of the malignant squamous cells producing pseudolumina that mimicked

Discussion

Acantholytic SCC is a well-recognised variant of squamous cell carcinoma that was first described in 1947.1 In his initial report Lever referred to the neoplasm as an adenocanthoma of sweat glands, but in subsequent studies it became evident that the tumour was a distinct variant of squamous cell carcinoma of non-eccrine origin. Although it commonly occurs in areas of the skin exposed to the sun it has only rarely been seen in mucosal sites such as the lip, oral cavity, nasopharynx, larynx, and

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