Esophagus

Carcinoma

Basaloid squamous cell carcinoma


Editorial Board Member: Wei Chen, M.D., Ph.D.
Deputy Editor-in-Chief: Catherine E. Hagen, M.D.
Jinping Lai, M.D., Ph.D.

Last author update: 11 February 2022
Last staff update: 11 February 2022

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PubMed Search: Basaloid squamous cell carcinoma[TI] esophagus

Jinping Lai, M.D., Ph.D.
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Cite this page: Lai J. Basaloid squamous cell carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/esophagusbasaloidSCC.html. Accessed July 5th, 2022.
Definition / general
  • Variant of squamous cell carcinoma with distinct basaloid morphology
Essential features
  • Esophageal basaloid squamous cell carcinoma (BSCC) is a rare variant of SCC
  • Morphological differential diagnoses could include adenoid cystic carcinoma, neuroendocrine carcinoma (particularly small cell type), carcinosarcoma and epithelioid sarcoma
  • BSCC is not human papillomavirus (HPV) related and has a relatively poor prognosis as compared to morphologically similar HPV related SCC
ICD coding
  • ICD-10: C15.9 - malignant neoplasm of esophagus, unspecified
Epidemiology
  • Generally older males
  • Reported incidence: 1 - 11% of squamous cell carcinomas; true incidence likely ~2%
Sites
  • More common in mid to distal esophagus
Pathophysiology
Etiology
  • Genetic and environment
Clinical features
  • Patients present with dysphagia and weight loss
  • Usually widespread metastases at presentation
Diagnosis
  • Endoscopic biopsy
Radiology description
  • Positive for esophageal wall thickening or mass on CT scans
  • Positive for high metabolism in PET / CT
Radiology images

Contributed by Jinping Lai, M.D., Ph.D.
CT scan

CT scan

PET/CT

PET / CT

Prognostic factors
Case reports
Treatment
Clinical images

Contributed by Jinping Lai, M.D., Ph.D.
Subepithelial mass

Subepithelial mass

Fungating masses

Fungating masses

Gross description
  • Generally deeply invasive, large bulky ulcerated fungating masses
Gross images

Images hosted on other servers:

Mid esophageal mass gross examination

Frozen section description
  • Tumor cells show nests, trabeculae, cords and cribriform pattern infiltrating the myxoid stroma
  • Morphologically it could mimic adenoid cystic carcinoma
Frozen section images

Contributed by Jinping Lai, M.D., Ph.D.
Frozen section

Morphological nests, cords and cribriform appearances

Microscopic (histologic) description
  • Solid, cribriform or microcystic nests, strands, trabeculae or lobules of tumor cells (Histopathology 2000;36:331, Methods Mol Biol 2020;2129:7)
  • Strands of tumor cells often connected to overlying squamous epithelium
  • Nuclei are round to oval, hyperchromatic and peripheral palisading, often with central comedo type necrosis
  • Many mitotic figures
  • Microcystic pattern contains basophilic material
  • While microcysts or necrosis may cause a resemblance to lumina, true lumens are lacking
  • Many have areas of stromal hyalinization
  • Often admixed with conventional invasive or in situ squamous cell carcinoma and may see admixed adenocarcinoma, small cell carcinoma and spindle cell squamous cell carcinoma
Microscopic (histologic) images

Contributed by Jinping Lai, M.D., Ph.D. and AFIP images
Nested arrangements

Nested arrangements

Tumor cells touch the epithelium

Tumor cells touch the epithelium

Small blue tumor cells

Small blue tumor cells

Mitosis Mitosis and apoptosis

Mitosis and apoptosis

p16

p16


p40

p40

p63

p63

p53

p53

CDX2 IHC

CDX2

Synaptophysin

Synaptophysin

Chromogranin

Chromogranin


CK7

CK7

Small dark tumor cells

Small dark tumor cells

Peripheral basal type cells

Peripheral basal type cells

Focus of squamous differentiation

Focus of squamous differentiation

Strands of tumor cells touch epithelium

Strands of tumor cells touch epithelium

Cytology description
  • Basaloid cells
Negative stains
Electron microscopy description
  • Relatively undifferentiated cellular characteristics
  • Undeveloped cell organelles
  • Markedly replicated basement membrane
Molecular / cytogenetics description
Sample pathology report
  • Esophagus, mid, mass, biopsy:
    • Basaloid squamous cell carcinoma (see comment)
    • Comment: Clinical photos are noted. Sections of the biopsy show subepithelial basaloid neoplasm with microcystic nests, strands, trabeculae of tumor cells infiltrating a myxoid stroma. The tumor cells are positive for p40, p63, p53 and intact INI1, while negative for p16, CK7, CK20, CDX2 and synaptophysin. The histologic features and immunoprofile support the diagnosis.
Differential diagnosis
Board review style question #1
Compared with conventional squamous cell carcinoma of the esophagus, basaloid squamous cell carcinoma of the esophagus has

  1. Fewer PI3KCA mutations
  2. More p53 mutations
  3. More Rb mutations
  4. More BRAF mutations
  5. More KRAS mutations
Board review style answer #1
A. No PI3KCA mutation has been observed in esophageal basaloid squamous cell carcinoma, while 23% of conventional SCCs of the esophagus harbored a PI3KCA mutation.

Comment Here

Reference: Basaloid squamous cell carcinoma
Board review style question #2

56 year old man with a smoking history for 20 years and dysphagia for 6 months. A biopsy is made of a lesion at his mid esophagus, shown in the photo above. The cells are diffusely nuclear positive for p40, p63, p53 and INI1, while negative for p16, CK7, CK20, CDX2 and synaptophysin. What is your diagnosis?

  1. Adenoid cystic carcinoma
  2. Basaloid squamous cell carcinoma
  3. Metastatic oropharyngeal HPV related squamous cell carcinoma
  4. Neuroendocrine carcinoma, small cell type
  5. SMARCB1 deficient carcinoma
Board review style answer #2
B. The most likely diagnosis is basaloid squamous cell carcinoma. The tumor cells only show 1 component and are diffusely positive for p40 and p63, making adenoid cystic carcinoma less likely. The tumor cells show eosinophilic cytoplasm with negative synaptophysin, making small cell carcinoma less likely. The tumor cells have an intact INI1, making SMARCB1 deficient carcinoma less likely. p16 is negative, making HPV related metastatic oropharyngeal squamous cell carcinoma less likely.

Comment Here

Reference: Basaloid squamous cell carcinoma
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