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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (1): 62-67. doi: 10.19723/j.issn.1671-167X.2022.01.010

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Clinicopathological study in 28 cases of oral basaloid squamous cell carcinomas

ZHOU Chuan-xiang,ZHOU Zheng,ZHANG Ye,LIU Xiao-xiao,GAO Yan()   

  1. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2021-10-12 Online:2022-02-18 Published:2022-02-21
  • Contact: Yan GAO E-mail:gaoyan0988@163.com
  • Supported by:
    Beijing Nature Science Foundation(7192232)

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Abstract:

Objective: To investigate the clinicopathologic features and prognostic factors in oral basaloid squamous cell carcinoma. Methods: Retrospective analysis of oral basaloid squamous cell carcinomas patients who underwent tumor resection during the period from January 2002 to December 2020 in the authors’ hospital, especially the clinicopathologic characteristics of 28 cases with confirmed diagnosis and follow-up data. Immunohistochemistry was performed to define the helpful markers for differentiation diagnosis. The factors influencing the prognosis were evaluated based on Kaplan-Meier method. Results: The tongue and mouth floor (11 cases, 39.3%) were the most frequently involved sites, followed by gingiva (6 cases, 21.4%), buccal (5 cases, 17.9%), palate (4 cases, 14.3%), and oropharynx (2 cases, 7.1%). The majority of basaloid squamous cell carcinomas were in advanced stage, with 12 cases in stage Ⅱ and 16 cases in stages Ⅲ-Ⅳ. Twelve of 28 patients were identified to have cervical lymph node metastasis, which was confirmed by histopathological examination. The incidence rate of lymph node metastasis was 42.9% (12/28). Nine tumors recurred, with one metastasized to the lung. At the meantime, the 28 conventional squamous cell carcinomas were matched with the same stage, among which 13 cases were identified with cervical lymph node metastasis. The incidence rate of lymph node metastasis was 46.4% (13/28). Five cases recurred, with two cases that metastasized to the lung and one to the brain. The 5-year overall survival rates of the basaloid squamous cell carcinoma and conventional squamous cell carcinoma patients were 54.6% and 53.8%, respectively. Histopathologically, basaloid cells consisted of tumor islands without evident keratinization but frequently with comedo-like necrosis within the tumor islands. CK5/6 and P63 exhibited strongly positive in all the 28 cases, whereas neuroendocrine markers, CgA and Syn, were negative. Eight cases positively expressed P16; one case showed focal SOX10 positive but CK7 negative. Conclusion: The majority of oral basaloid squamous cell carcinomas present in advanced stage with a high tendency to lymph node metastasis, but the overall survival rates are not significantly different from conventional squamous cell carcinomas matched with the same stage. The human papilloma virus (HPV),as HPV-positivity rate is high, correlates to good prognosis. In addition, CK7 & SOX10 immunohistochemistry could contribute to differential diagnosis for basaloid squamous cell carcinoma with solid adenoid cystic carcinoma.

Key words: Squamous cell carcinoma, Adenoid cystic carcinoma, P16, Human papilloma virus

CLC Number: 

  • R780.2

Table 1

The clinicopathologic features of the patients with BSCC and conventional SCC"

Case
no.		 BSCC Case
no.		 SCC
Agea/
gender		 Location Stage LN
metastasis		 Follow-up P16
IHC		 Agea/
gender		 Location Stage LN
metastasis		 Follow-up P16
IHC
1 77/M Palate Ⅲ + Dead/3 y - 1 67/M Palate Ⅲ - Alive/5 y +
2 71/M Tongue Ⅱ - Alive/11 y + 2 73/M Tongue Ⅱ - Alive/4 y -
3 57/M Floor of mouth Ⅳ + Alive/9 y + 3 48/M Floor of mouth Ⅳ + Alive/4 y +
4 70/M Gingiva Ⅱ - Alive/6 y + 4 68/F Gingiva Ⅱ - Alive/5 y -
5 62/M Oropharynx Ⅱ - Dead/4 y - 5 38/M Oropharynx Ⅱ - Alive/3 y -
6 75/F Buccal Ⅱ - Alive/5 y - 6 81/F Buccal Ⅱ - Dead/2.5 y -
7 60/M Gingiva Ⅱ - Dead/1 y - 7 46/M Gingiva Ⅱ - Alive/4 y -
8 33/F Palate Ⅱ - Alive/5 y + 8 71/M Palate Ⅱ - Alive/2 y -
9 58/M Gingiva Ⅱ - Alive/5 y + 9 62/M Gingiva Ⅱ - Dead/2 y +
10 60/M Gingiva & buccal Ⅳ - Dead/2 y - 10 79/M Gingiva Ⅳ + Dead/4 y -
11 52/M Floor of mouth
& Tongue		 Ⅳ + Alive/3 y - 11 54/M Floor of mouth Ⅳ + Alive/4 y -
12 67/M Gingiva Ⅳ - Alive/3 y - 12 71/F Gingiva Ⅳ + Dead/1.5 y -
13 41/M Palate Ⅲ + Alive/2 y - 13 56/M Palate Ⅲ - Alive/2 y -
14 53/M Floor of mouth Ⅳ + Alive/1.5 y - 14 60/M Floor of mouth Ⅳ + Dead/3 y -
15 68/M Tongue Ⅱ - Alive/1 y - 15 64/F Tongue Ⅱ - Alive/4 y -
16 60/M Floor of mouth Ⅲ + Alive/1 y - 16 74/M Floor of mouth Ⅲ - Dead/1 y -
17 62/M Tongue Ⅳ + Dead/2 y - 17 71/F Tongue Ⅳ + Dead/2.5 y -
18 51/M Gingiva Ⅳ - Alive/1 y - 18 73/F Gingiva Ⅳ + Dead/2.5 y +
19 67/M Floor of mouth Ⅱ - Alive/1 y - 19 52/M Floor of mouth Ⅱ - Alive/4 y -
20 58/M Buccal Ⅲ + Alive/2 y - 20 43/M Buccal Ⅲ + Alive/3 y +
21 39/M Tongue Ⅱ - Alive/1.5 y - 21 66/M Tongue Ⅱ - Alive/5 y -
22 34/M Palate Ⅲ + Alive/4 y + 22 62/M Palate Ⅲ + Alive/3 y -
23 57/M Oropharynx Ⅳ - Alive/1 y + 23 64/M Oropharynx Ⅳ + Dead/1 y -
24 58/M Buccal Ⅱ - Alive/2.5 y - 24 66/M Buccal Ⅱ - Dead/3 y -
25 66/M Buccal Ⅳ + Dead/3 y - 25 53/M Buccal Ⅳ + Alive/3 y +
26 44/F Tongue Ⅲ + Dead/3 y - 26 52/F Tongue Ⅲ + Alive/4 y -
27 47/M Gingiva Ⅱ - Alive/3 y + 27 72/M Gingiva Ⅲ - Dead/2 y -
28 50/M Floor of mouth Ⅳ + Dead/2 y - 28 76/M Floor of mouth Ⅳ + Dead/2 y -

Figure 1

Pathological features of BSCC A, basaloid tumor cells showing solid growth with central comedo-like necrosis (HE ×100); B, basaloid cells with high nucleocytoplasmic ratio and prominent mitotic figures (HE ×200); C, basaloid cells showing a cribriform-like pattern (HE ×100); D, BSCC lymph node metastasis pattern (HE ×40); BSCC, basaloid squamous cell carcinoma."

Figure 2

Immunohistochemical staining in BSCC A, positive immunostaining for P16 in BSCC (IHC ×100); B, positive immunostaining for P16 in BSCC (IHC ×200); C, positive immunostaining for AR in BSCC (IHC ×200); D, high expression of Ki-67 in BSCC (IHC ×200); E, negative immunostaining for CK7 in basaloid tumor cells (IHC ×100); F, negative immunostaining for SOX10 in basaloid tumor cells (IHC ×100); BSCC, basaloid squamous cell carcinoma; IHC, immunohistochemistry."

Figure 3

Kaplan-Meier analysis of BSCC and conventional SCC A, comparison of survival curves between patients with BSCC and conventional SCC; B, comparison of survival curves between patients with P16 positive and negative; BSCC, basaloid squamous cell carcinoma; SCC, squamous cell carcinoma."

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