Basaloid squamous cell carcinoma of the head and neck: a clinicopathological and follow-up study of 40 cases and review of the literature

Abstract

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of cancer that mainly arises in the upper aerodigestive tract. This study reviews the clinico-pathological features and follow-up of a series of cases occurring in the head and neck. During a 32-year period (1974-2005), a total of 40 BSCCs have been diagnosed in the head and neck in our Institution. Males predominated in the series (35M/5F). The average age was 60.2 years (range, 40-85). Tobacco and alcohol consumption was found in more than 80% of the cases. Topographic distribution was as follows: larynx and hypopharynx, 22 cases (55%); oropharynx, 12 cases (30%); and oral cavity 6 cases (15%). The basaloid component predominated in 29 cases (72.5%). Vasculo-lymphatic invasion was detected in 5 cases (12.5%). Lymph node metastases were seen in 25 cases (62.5%, levels II and III in the neck dissection). Local recurrences appeared in 11 cases (27.5%) and distant metastases in 6 (15%). In 7 cases (17.5%) a second primary tumour was detected. The 2002 TNM staging was as follows: Stage I, 5 cases (12.5%); Stage II, 7 cases (17.5%); Stage III, 8 cases (20%), and Stage IV, 20 cases (50%). On follow-up, 21 cases (52.5%) are alive and 19 (47.5%) died of disease. Three- and 5-year overall survival was 50% and 38.5%, respectively. A significant shorter survival was detected in node positive patients (P<0.05).

Keywords: Basaloid-squamous cell carcinoma; Differential diagnosis; Head and neck; Hypopharynx; Larynx; Metastasis; Oral cavity; Oropharynx; Prognosis; Recurrence.

Fig. 1

Laryngectomy specimen showing a basaloid squamous cell carcinoma invading the base of tongue and laryngeal vallecula

Fig. 2

Panoramic view of the superficial spreading area of a laryngeal basaloid squamous cell carcinoma displaying solid tumour nests of basaloid and squamous cells

Fig. 3

Cytological detail showing a solid pattern of growth with prominent peripheral palisading

Fig. 4

Typical biphasic arrangement in a basaloid squamous cell carcinoma with squamous tumour nests centering basaloid areas

Fig. 5

Comedonecrosis is a prominent feature in 27.5% of basaloid squamous cell carcinomas

Fig. 6

Cytological detail showing a solid pattern of growth with prominent pericellular hyalinization

Fig. 7

Cytological detail showing a solid pattern of growth with small cystic spaces

Fig. 8

Lymph node metastasis of a basaloid squamous cell carcinoma of the larynx with the basaloid and squamous components close one to each other