Adenosquamous carcinoma of hypopharynx with intestinal-phenotype

Abstract

Adenosquamous carcinomas of the head and neck (ADSCs) are rare locally aggressive malignancies characterized by the presence of two distinctive components, a squamous cell carcinoma and an adenocarcinoma. The immunophenotype of the glandular component of ADSCs has only been rarely studied but has been reported as being positive for keratin 7 (CK7) and carcinoembryonic antigen (CEA) and negative for keratin 20 (CK20). Herein, we report a case of an ADSCs of the hypopharynx composed of a superficial squamous cell carcinoma and an adenocarcinoma with an intestinal phenotype. The patient was a 62 year-old male with a T2 N0 M0 squamous cell carcinoma (SCC) of uvula and palate and a T1 N0 M0 of right hypopharynx. The ADSCs of the hypopharynx was composed of a minimally invasive SCC and an adenocarcinoma with tubulo-glandular and cribriform architecture. The neoplastic glands were positive for CK7, CK20, CDX2, CEA and Villin. The patient underwent radiotherapy to both tumors and remains well with no evidence of recurrent disease 19 months after treatment. To the best of our knowledge, this is the first report of an ADSCs of the head and neck with an intestinal phenotype in its glandular component.

Fig. 1

In situ and minimally invasive squamous cell carcinoma showing nuclear hyperchromasia and loss of cell polarity (a). Diffuse p63 staining in the squamous cell carcinoma (b)

Fig. 2

Focus of squamous carcinoma in situ (left) associated with underlying adenocarcinoma (right)

Fig. 3

Adenocarcinoma showing tubular and cribriform architecture. Some of the tumor cells demonstrate apical vacuoles. In this area the squamous epithelium appears unremarkable (a). Adenocarcinoma with cribriform architecture, nuclear hyperchromasia, and increased mitotic activity (b). Diffuse cytoplasmic CK20 and nuclear CDX2 expression by the adenocarcinoma (c, d)