Case Number : 91 Posted By: Guest

Richard Carr - Warwick (UK) Wrote:

Great to have a good discussion. As far as I know signet ring SCC has keratins not mucin. I thought this case had mucin on the H&E so I would call it adenosquamous. I had to look up muciparous metaplasia (thanks Wayne!!) and found the following reference from 1969! Zak FG, Palladino VS. Muciparous metaplasia and primary mucoepidermoid skin tumors. Arch Dermatol. 1969 Jul;100(1):23-5. (I have requested the paper for my own learnign and interest).

Submitted on 15/10/2010 09:48
________________________________________
Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Hi Dr Iskandar, I am now confused. Is Signet ring SCC the same as adenosquamous carcinoma. Dr Richard suggested adenosquamous carcinoma. As much as I know, adenosquamous carcinoma is different than Signet ring SCC. It is made of islands of SCC and areas with glandular differentiation within such areas the cells are containing mucin and the lumina are containing mucin. Do u mean by signet ring SCC a SCC with mucinous metaplasia in which we find mucin secreting signet ring cells within the SCC islands. If this what u mean, I think I suggested this entity first!!!!

Submitted on 14/10/2010 22:42
________________________________________
Iskander Chaudhry - Manchester Royal Infirmary (Manchester, UK) Wrote:

Dear All. I tried not to interfer today after yesterday's case and also knowing you were all on the right track! The final diagnosis is signet-ring squmaous cell carcinoma, which is very rare as mentioned by Richard!!! I think we still need a spot diagnosis to catch Richard out - I am working on it.

Submitted on 14/10/2010 22:28
________________________________________
Wayne Grayson - (Johannesburg, South Africa) Wrote:

I favour a metastatic adenosquamous carcinoma. If the neoplasm is indeed primary, one would have to consider an primary adenosquamous Ca, a primary cutaneous mucoepidermoid Ca or a "SCC with muciparous metaplasia".

Submitted on 14/10/2010 18:30
________________________________________
Richard Carr - Warwick (UK) Wrote:

This does have an adenosquamous look with nice intracytoplasmic mucin. Primary cutaneous adenosquamous carcinomas with mucin production are rare but reported. More commonly adenosquamous carcinomas in the skin have more of a cuticular squamoid ductal differentiation. We would still need to consider a metastasis (CK5 and p63 staining would favour a primary cutaneous adenocarcinoma but in the context of an lesion that looks adenosquamous I doubt they would be helpful - I think all squamous carcinomas tend to be CK5 and p63 positive). Statistics favour a metastatic adenosquamous carcinoma e.g. lower oesophagus; lung; cervix; high-grade mucoepidermoid (salivary)

Submitted on 14/10/2010 17:51
________________________________________
alva mtz angoa - hospital gral puebla (puebla mexico) Wrote:

Sebaceous carcinoma poorly differentiated variant

Submitted on 14/10/2010 17:17
________________________________________
Mona Abdel-Halim - Dermatology Department, Cairo University (Egypt) Wrote:

Hi, all, The issue of the signet ring cell is interesting. I saw it but as an incidental signet ring cell change in a SCC as I know there is a variant of SCC called signet ring cell. But, I checked the section again and the cell in the centre looks like having mucin in the cytoplasm not just a clear cell with eccenteric nucleus (signet ring cell like). However, I am not convinced with the idea of a metastatic adenocarcinoma. The cells at the rim of the island looks squamoid as much as I know (Large cells with abundant esinophilic cytoplasm and large oval vesicular nuclei), so I am suggesting a SCC with mucinous metaplasia. There are many reports in the internet about such entity in which within the contest of SCC, one find mucin containing signet ring cells.

Submitted on 14/10/2010 16:29
________________________________________
Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Agree with metastatic adenocarcinoma.

Submitted on 14/10/2010 15:29
________________________________________
Saleem Taibjee - Warwick () Wrote:

I agree that there appears to be signet ring cell change, with epithelial (cytoplasmic) mucinous secretion. Adenocarcinoma, either primary or metastatic. Not sure if I can tell the difference based on this one field, but perhaps metastasis is statistically more likely ?GI tract ?breast

Submitted on 14/10/2010 07:57
________________________________________
Eduwiges Martínez-Luna - Hospital Manuel Gea González (Trainee) (Mexico City) Wrote:

I can see a signet ring cell. Could be an Adenocarcinoma?

Submitted on 14/10/2010 07:48
________________________________________
Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

This is an island of malignat squamous cells, acantholysis is evident in the centre. Cells at the periphery are more cohesive. This is Adenoid (acantholytic) SCC.

Submitted on 14/10/2010 05:50
________________________________________
Marwa Fawzi - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

SCC of adenoid [acantholytic ]type

Submitted on 14/10/2010 00:50
________________________________________