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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists

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Year : 2021  |  Volume : 25  |  Issue : 3  |  Page : 533-536

Basaloid squamous cell carcinoma

Department of Oral and Maxillofacial Pathology, Tagore Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Submission23-Oct-2021
Date of Acceptance29-Oct-2021
Date of Web Publication11-Jan-2022

Correspondence Address:
V Jai Santhosh Manikandan
NO.6 Veeramani Street, Thiruvalluvar Nagar, Pammal, Chennai - 600 075, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jomfp.jomfp_382_21

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Basaloid squamous cell carcinoma (BSCC) is a rare variant of squamous cell carcinoma characterized by a conglomerate of clinically aggressive course and disparate histopathological features. It is frequently seen in upper aerodigestive tract area. Histopathologically, it is biphasic and composed of two types of tumor cells, namely basaloid and squamous cells. Tumor markers, namely, BerEp4, epithelial membrane antigen and p53 are used in this case to differentiate from similar tumors which impersonate BSCC histologically but differ prognostically. We report a case of BSCC in a 48-year-old female patient, involving the lateral border of the tongue with an exhaustive picture of its histological and immunohistochemical appearance.

Keywords: Basaloid squamous cell carcinoma, BerEp4, epithelial membrane antigen, oral cavity, oropharynx, p53, squamous cell carcinoma

How to cite this article:
Santhosh Manikandan V J, Krishna P S, Makesh Raj L S, Sekhar P. Basaloid squamous cell carcinoma. J Oral Maxillofac Pathol 2021;25:533-6

How to cite this URL:
Santhosh Manikandan V J, Krishna P S, Makesh Raj L S, Sekhar P. Basaloid squamous cell carcinoma. J Oral Maxillofac Pathol [serial online] 2021 [cited 2022 Aug 18];25:533-6. Available from: https://www.jomfp.in/text.asp?2021/25/3/533/335533

   Introduction Top

Basaloid squamous cell carcinoma (BSCC) is an aggressive and histologically distinct variant of squamous cell carcinoma, first described by Wain et al. in 1986.[1] It has a predilection for upper aerodigestive tract. It is rarely seen in oral cavity with predilection for base of the tongue.[2] It commonly affects males usually above sixth decade.[3] It is considered to be more aggressive when compared to classical squamous cell carcinoma, due to its frequent metastasis.[4] The presence of ulceration makes it difficult to diagnose histopathologically, as it might mask the origin from the superficial mucosa. In the above scenario, it is prudent to use the immunohistochemistry markers which can help us in supporting the diagnosis. We are present a case of similar situation where three tumor markers are used namely p53, BerEp4 and epithelial membrane antigen (EMA) to establish the diagnosis.[5],[6],[7]

   Case Details Top

A 48-year-old female patient came with the chief complaint of difficulty in opening the mouth and painful ulcer in the tongue for the past 6 months. Medical history reveals no significant findings. The patient had no history of tobacco habits and was well built. On extraoral examination, submandibular lymph nodes were palpable on the left side which was firm in consistency. On intraoral examination, an ulceroproliferative lesion was found on the left lateral side of the tongue measuring 3 cm × 2 cm, which was firm in consistency with indurated margin.

Microscopic findings

  1. Overlying epithelium showed dysplastic stratified squamous epithelium infiltrating into the underlying connective tissue [Figure 1]a
  2. Two types of tumor cells, namely squamous cells and basaloid cells, are seen [Figure 1]b
  3. Tumor cells are characterized by sheets of basaloid cells with hyperchromatic nuclei and scanty cytoplasm predominantly arranged in lobular pattern [Figure 1]c and [Figure 1]d
  4. Squamous differentiation seen in center of tumor islands [Figure 2]a
  5. Tumor cells show peripheral palisading [Figure 2]b, marked mitotic activity [Figure 2]c and skeletal muscle infiltration [Figure 2]d.
Figure 1(a-d): Histopathological image shows overlying dysplastic stratified squamous epithelium infiltrating into the underlying connective in the form of sheets and lobular pattern. Tumor cells show hyperchromatic nuclei, scanty cytoplasm

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Figure 2(a-d): Histopathological image shows central squamous differentiation, peripheral palisading, increased mitotic activity and skeletal muscle infiltration of tumor cells

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Immunohistochemistry findings

  1. Tumor cells stained positive for p53, except in the areas of squamous differentiation in the center of tumor island [Figure 3]a, [Figure 3]b, [Figure 3]c, [Figure 3]d
  2. Tumor cells stained negative for BerEp4 [Figure 4]a, [Figure 4]b, [Figure 4]c, [Figure 4]d.
  3. Tumor cells stained positive for EMA, except in the areas of squamous differentiation within tumor island, which stained positive for EMA [Figure 5]a, [Figure 5]b, [Figure 5]c, [Figure 5]d.
Figure 3(a-d): Histopathological image shows tumor cells stained positive for p53 except in the areas of squamous differentiation within tumor island

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Figure 4(a-d): Histopathological image shows tumor cells stained negative for Ber-Ep4

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Figure 5(a-d): Histopathological image shows tumor cells predominantly stained negative for epithelial membrane antigen. Focal positive stain is seen in the areas of squamous differentiation

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Differential diagnosis of BSCC is mentioned in [Table 1],[8],[9],[10],[11],[12],[13],[14] Final diagnosis was made BSCC.
Table 1: Differential diagnosis

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

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. 1
Hirai E, Yamamoto K, Yamamoto N, Yamashita Y, Kounoe T, Kondo Y, et al. Basaloid squamous cell carcinoma of the mandible: Report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:e54-8.  Back to cited text no. 2
Linskey KR, Gimbel DC, Zukerberg LR, Duncan LM, Sadow PM, Nazarian RM. BerEp4, cytokeratin 14, and cytokeratin 17 immunohistochemical staining aid in differentiation of basaloid squamous cell carcinoma from basal cell carcinoma with squamous metaplasia. Arch Pathol Lab Med 2013;137:1591-8.  Back to cited text no. 3
Cardesa A, Zidar N, Ereño C. Basaloid squamous cell carcinoma. In: Barnes L, Eveson JW, Reichart P, editors. WHO Classification Head and Neck Tumours. Pathology & Genetics Head and Neck Tumours. Lyon: IARC Press; 2005. p. 124-5.  Back to cited text no. 4
Mane DR, Kale AD, Angadi P, Hallikerimath S. Expression of cytokeratin subtypes: MMP-9, p53, and αSMA to differentiate basaloid squamous cell carcinoma from other basaloid tumors of the oral cavity. Appl Immunohistochem Mol Morphol 2013;21:431-43.  Back to cited text no. 5
Sramek B, Lisle A, Loy T. Immunohistochemistry in ocular carcinomas. J Cutan Pathol 2008;35:641-6.  Back to cited text no. 6
Beer TW, Shepherd P, Theaker JM. Ber EP4 and epithelial membrane antigen aid distinction of basal cell, squamous cell and basosquamous carcinomas of the skin. Histopathology 2000;37:218-23.  Back to cited text no. 7
Ciążyńska M, Sławińska M, Kamińska-Winciorek G, Lange D, Lewandowski B, Reich A, et al. Clinical and epidemiological analysis of basosquamous carcinoma: Results of the multicenter study. Sci Rep 2020;10:18475.  Back to cited text no. 8
Thompson L. Malignant neoplasm of the larynx, hypopharynx and trachea. In: Thompson L, Bishop J, editors. Head and Neck Pathology. Philadelphia: Elsevier: 2006. p. 51-88.  Back to cited text no. 9
Ereño C, Gaafar A, Garmendia M, Etxezarraga C, Bilbao FJ, López JI. Basaloid squamous cell carcinoma of the head and neck: A clinicopathological and follow-up study of 40 cases and review of the literature. Head Neck Pathol 2008;2:83-91.  Back to cited text no. 10
Chen JC, Gnepp DR, Bedrossian CW. Adenoid cystic carcinoma of the salivary glands: An immunohistochemical analysis. Oral Surg Oral Med Oral Pathol 1988;65:316-26.  Back to cited text no. 11
Robinson RA. Upper airway squamous dysplasia, early invasive squamous carcinoma, and squamous carcinoma variants. In: Head and Neck Pathology: Atlas for Histologic and Cytologic Diagnosis. Lippincott Williams & Wilkins; 2010. p. 1-24.  Back to cited text no. 12
Mittal R, Kaza H, Agarwal S, Rath S, Gowrishankar S. Small cell neuroendocrine carcinoma of the orbit presenting as an orbital abscess in a young female. Saudi J Ophthalmol 2019;33:308-11.  Back to cited text no. 13
Shinno Y, Nagatsuka H, Chong-Huat S, Tsujigiwa H, Tamamura R, Gunduz M, et al. Basaloid squamous cell carcinoma of the tongue in a Japanese male patient: A case report. Oral Oncol Extra 2005;4:65-9.  Back to cited text no. 14


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

  [Table 1]


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