Esophageal basaloid squamous cell carcinoma - light
microscopy, electron microscopy and immunohistochemical study of
Authors: Liwen Yan, Niu Feng-xia, Li-yun
【Abstract】 Objective To observe the esophageal basaloid
squamous cell carcinoma (basaloid squamous carcinoma, BSC)
of the histological features, to explore the diagnosis and differential diagnosis. Methods 15 cases of BSC specimens for light microscopy, electron microscopy and immunohistochemical studies. Results BSC histology have many salivary adenoid cystic carcinoma (adenoid cystic carcinoma, ACC) similar characteristics. However, cancer cells divide less BSC strong atypia, cancer cells were the fence around the nest-like
arrangement of tumor surface, often accompanied by squamous
cell carcinoma in situ or superficial invasive squamous cell carcinoma; occasionally nest and surface squamous cancer connected to the basal low-level, or occasionally the
formation of squamous cell carcinoma nests or duct-like
structure, different from those with ACC. Ultrastructure and ACC similar, but less differentiated cancer cells and intracytoplasmic tonofilaments can be seen with the ACC different. Immunohistochemical Results: Basal cell-like
components: CK (pan) 15/15, EMA 15/15, CEA 6 / 15, S 100 6
/ 15, SMA 7 / 15 positive, the tumor contains epithelial and myoepithelial cells. Conclusion BSC is a relatively low differentiation, invasive stronger, there is the adenoid, squamous, and myoepithelial cell differentiation tendencies,
unique clinical and pathological features of malignant tumors, their histological features can be used as diagnostic criteria of pathology, ultrastructure and immunohistochemical features supplement the differential diagnosis.
Key words Esophageal cancer; Basaloid squamous cell
Basaloid Squamous Carcinoma of the Esophagus
Immunohistochemical, Light and Electron Microscopic
Key words: Esophageal Neoplasm; Carcinoma Basasquamous; Immunohistochemistry
Esophageal basaloid squamous cell carcinoma is a rare high-grade tumors have unique clinical and pathological features of reported confusion in past literature, often be misdiagnosed as adenoid cystic carcinoma of the esophagus. This collection of 15 cases by light microscopy, electron microscopy and immunohistochemical observation of
morphological characteristics of their organizations, clear diagnostic criteria and differential diagnosis.
1 Materials and methods
1.1 The material collected in our hospital 2359 cases of resected esophageal cancer specimens from 15 cases in line
with BSC forms studied. 2 cases among females, male 13 cases, aged 50 to 73 years, with an average age of 60. Follow-up only
2 cases survived for more than 3 years, I have died within 2 years after surgery.
1.2.1 Light microscopy observation of paraffin embedding, HE staining of conventional sections by two experienced pathologists reviewed.
1.2.2 electron microscope specimens from 15 cases of BSC, 5 cases of fresh tissue obtained by dehydration of
conventional fixed-embedded, ultrathin sections with uranyl acetate and lead citrate staining, TEM 1200, Japan-based
1.2.3 Immunohistochemical staining of 15 cases of BSC specimens made of 4μm thick paraffin sections in order to broad-spectrum keratin (cytokeratin, CKpan), epithelial membrane antigen (EMA), smooth muscle actin (SMA), S 100
protein , carcinoembryonic antigen (CEA), vimentin (vimetin),
chromogranin (CgA), neuron-specific enolase (NSE) antibody by
the SP method for immunohistochemical staining.
2.1 The visual observation of 15 cases of BSC in the four cases in the lower esophagus, 11 cases in the middle. Eye medullary in 10 cases, ulcer type in 5 cases, tumor largest diameter 4 ~ 6cm, an average of 5cm. Tumors were 15 cases of
full-thickness infiltration of esophageal wall.
2.2 histopathology (1) tumor nests of basal cell carcinoma in the subcutaneous infiltration. Cancer cells cylindrical or oval shape, are shaped, less cytoplasm, nucleus, deep-dyed or chromatin was finely granular, visible nucleoli, mitotic more. (2), adenoid cystic carcinoma cell nests may be of different sizes was solid, cribriform, or beam cable-like, occasionally focal squamous cell or adenoid structure. Cancer nest-like arrangement of the fence
surrounding cells Changcheng, the center can be seen acne-like
necrosis; cancer can be seen both inside and outside the nest red stained glass-like change. (3) tumor surface, often
accompanied by squamous cell carcinoma in situ, dysplasia, or
superficial invasive squamous cell carcinoma, shown in Figure 1 ~ 3.
2.3 Ultrastructure of cells showed polygonal cytoplasm little lower division, containing a small amount of mitochondria, rough endoplasmic reticulum and tonofilaments. Rich in free ribosomes. Nucleus large, round, oval or irregular shape, often rich in chromatin, heterochromatin number of different, showing 1 to 3 nucleoli. Can be seen in the cancer cell nest of adenoid lacuna (original gland cavity) and the extracellular space, the cells can be seen between the resonator edge of microvilli, cancer cells and connections between the desmosome complex. Extracellular space containing overlapping substrate-like mass. The latter in the basal and stromal cells can also be seen inside. Cancer cells no
neurosecretory granules, shown in Figure 4 ~ 5. Reposted elsewhere in the paper for free download http://
2.4 Immunohistochemistry of basal cell-like components:
CK, EMA 15 cases were positive, but in the sections for the part of the EMA-positive, CEA 6 cases were positive. Multi-
positive cells in cancer nests at the center while peripheral cells negative. S 100 6 were positive, Cheng He pulp
staining, SMA 7 cases were positive for the plasma membrane or with staining, vimetin, CgA, NSE were negative; squamous cell carcinoma of CK, EMA 15 cases were operated positive, CEA 5 Li positive, S 100, SMA, vimetin, CgA, NSE were negative, shown in Figure 6.
As the pathological esophageal BSC with salivary gland
ACC have many similarities, their understanding of past lack of clarity in the WHO histologic types of esophageal cancer has not been raised , resulting in confusion reported in the literature. But in recent years has gradually clear that the report found that many reports of esophageal ACC actual Jie Wei BSC. Esophageal BSC is indeed a group of unique clinical and pathological features of entities, and their biological behavior of invasive stronger than the ACC, pathological in line with Wain 1986, proposed to occur in the
upper respiratory tract BSC . Esophageal BSC rare, this group found in 2359 cases of esophageal cancer in 15 cases, accounting for 0.64%. Tumors more common in the elderly, good-
fat middle esophagus. 15 cases of tumors were invaded and
fresh full-thickness wall. BSC observed in this group there are a number of pathological salivary gland ACC with similar characteristics, tumor mainly by the basal cell-like cells
constitute the solid, cribriform carcinoma nest or beam cable on the surface skin infiltration, Cancer Center, visible acne necrosis nest , cancer can be seen both inside and outside the nest stained glass-like variable properties. These with ACC, especially in solid-type medium are very similar, but found the BSC cell differentiation than the ACC is low, profiled strong, mitotic phase and more common around the cancer nest palisading cells, the surface of squamous cell carcinoma often See carcinoma in situ or invasive cancer, superficial, a small number of cases without cancer, and the surface epithelium
showed squamous dysplasia. Occasionally nests in basal cell carcinoma, squamous cell or slightly glandular epithelium differentiation, which are different with the ACC. Our data found that the lower electron microscope, cancer cells divide,
cytoplasmic organelles was poor in the nest can be seen in cancer cells drape microvilli between cavity and see the bridge and connecting complex tablets, which are
characteristic of adenocarcinoma performance, but there are tensions in the cytoplasm of the original fibers, with the ACC that it is different from a squamous cell differentiation components. Immunohistochemical staining, some authors reported that basal cell-like components of the CEA, EMA were negative . In addition, some authors reported that basal
cell-like components of the CEA and SMA staining are negative , they not only negate the tumor epithelial cells containing secretion of gonadal component, but also denied the existence of myoepithelial cells, but that the BSC primarily
in basal-like and Squamous cell carcinoma of the two kinds of tumor components. In the immunohistochemical staining in this group there are different results, showing that CEA (6 / 15), EMA (15/15) positive, and CEA-positive cells distributed in
the cancer nest center, combined with electron microscopy findings, expressed as a secretory gland epithelium cell characteristics; the same time, SMA (7 / 15), S 100 (6 /
15)-positive. Positive cells were mainly distributed in the area around the cancer nest, showing the characteristics of myoepithelial cells. Literature has reported that the tumor is made from the end of esophageal mucus gland intercalated duct
occurred in ACC [5,6]. Also reported in the CK19-positive
basal cell-like components with the normal squamous cells in the basal end of CK19 expression in line . This study did not find the tumor and mucous gland ducts, but found that the
individual cases of basal cell-like composition and the
surface of cells in the basal end of phase extension. According to this group histopathology, electron microscopy and immunohistochemical observation, the authors agree that some of the views of literature authors [3,7 10], that the
BSC comes from esophageal squamous cells of the basal end of immature pluripotent stem cells, it has to glandular epithelium, squamous epithelium, myoepithelial cells, a variety of cell differentiation capacity. The tumor as a kind
of differentiation is low (differentiation is unknown) has a unique clinical and pathological features of tumors, because of their invasive ability than the average esophageal squamous cell carcinoma and ACC strong, but lower than the esophageal
small-cell undifferentiated carcinoma , so differential diagnosis very important. In the differential diagnosis, in addition to ACC, other, such as poorly differentiated squamous cell carcinoma, small cell undifferentiated cancer, and so
have even confused, but according to the cancer's unique histopathologic features, combined with the clinical diagnosis
can be made right. The use of electron microscopy and immunohistochemistry can be further assisted differential diagnosis.
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