8560/3 Adenosquamous carcinoma


Synonyms

Mixed adenocarcinoma and squamous cell carcinoma
Mixed adenocarcinoma and epidermoid carcinoma

Definitions

Esophagus
ICD-O-3 topography code: C15
ICD10: C15
           

This carcinoma has mixed elements of adenocarcinoma and squamous cell carcinoma, which remain clearly distinguishable within the tumour 1
 
Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010


 .



Hypopharynx, Larynx and Trachea
ICD-O-3 topography code: C13, C32, C33
ICD10: C13, C32, C33
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.



Stomach
ICD-O-3 topography code: C16
ICD10: C16
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.



Pancreas
ICD-O-3 topography code: C25
ICD10: C25
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.

Adenosquamous carcinoma of the pancreas
Adenosquamous carcinoma is a malignant epithelial neoplasm of the pancreas that has both significant ductal and significant squamous differentiation. The squamous component should account for at least 30% of the neoplasm. Neoplasms with these features were previously designated adenoacanthoma, mixed squamous and adenocarcinoma, and mucoepidermoid carcinoma. Adenosquamous carcinomas account for only 1?4% of exocrine pancreatic malignancies 2
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Hsu JT, Yeh CN, Chen YR, Chen HM, Hwang TL, Jan YY, Chen MF (2005)
Adenosquamous carcinoma of the pancreas.
Digestion 72: 104-8


 3
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Madura JA, Jarman BT, Doherty MG, Yum MN, Howard TJ (1999)
Adenosquamous carcinoma of the pancreas.
Arch Surg 134: 599-603


 . Pure squamous carcinoma of the pancreas is very rare, and a metastasis from another site (e.g. lung) should be excluded if a neoplasm has purely squamous differentiation. Even focal glandular differentiation in a carcinoma with predominant squamous differentiation warrants a diagnosis of adenosquamous carcinoma. Patients with resected adenosquamous carcinoma have a poorer prognosis (median survival, 7?11 months) than do those with pure adenocarcinoma 4
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Kardon DE, Thompson LD, Przygodzki RM, Heffess CS (2001)
Adenosquamous carcinoma of the pancreas: a clinicopathologic series of 25 cases.
Mod Pathol 14: 443-51


 5
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Okabayashi T, Hanazaki K (2008)
Surgical outcome of adenosquamous carcinoma of the pancreas.
World J Gastroenterol 14: 6765-70


 6
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Voong KR, Davison J, Pawlik TM, Uy MO, Hsu CC, Winter J, Hruban RH, Laheru D, Rudra S, Swartz MJ, Nathan H, Edil BH, Schulick R, Cameron JL, Wolfgang CL, Herman JM (2010)
Resected pancreatic adenosquamous carcinoma: clinicopathologic review and evaluation of adjuvant chemotherapy and radiation in 38 patients.
Hum Pathol 41: 113-22


 7
 
Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010


 .



Cervix uteri
ICD-O-3 topography code: C53
ICD10: C53
           

Adenosquamous carcinoma is composed of malignant glandular and malignant squamous cells. Both elements show atypical features.
The prognosis of adenosquamous carcinoma remains uncertain 8
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Alfsen GC, Kristensen GB, Skovlund E, Pettersen EO, Abeler VM (2001)
Histologic subtype has minor importance for overall survival in patients with adenocarcinoma of the uterine cervix: a population-based study of prognostic factors in 505 patients with nonsquamous cell carcinomas of the cervix.
Cancer 92: 2471-83


 9
 
Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003


 .



Skin
ICD-O-3 topography code: C44
ICD10: C44
           

Adenosquamous carcinoma is a rare aggressive variant of squamous cell carcinoma characterized by the formation of mucin secreting glands. The tumour is composed of invasive tongues and columns of atypical squamous cells, connected with glandular structures with epithelial mucin secretion. It may present as a smooth-surfaced dermal nodule or a large, ulcerated, deeply invasive tumour indistinguishable from squamous cell carcinoma or basal cell carcinoma.
Most reported cases of adenosquamous carcinoma developed in elderly patients, with a male predominance. The most commonly affected site is the head and neck region. The clinical course is usually aggressive. The tumours may recur locally or metastasize. Early detection and superficial location are associated with a better prognosis 10
 
LeBoit PE, Burg G, Weedon D, Sarasin A (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Skin Tumours
3rd Edition
IARC Press: Lyon 2005


 .



Lip, Oral Cavity and Oropharynx
ICD-O-3 topography code: C00-C06, C09-C10, C14
ICD10: C00-C06, C09-C10, C14
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.



Breast
ICD-O-3 topography code: C50
ICD10: C50
           

Adenosquamous carcinoma belongs to the group of metaplastic carcinomas. It is an invasive carcinoma composed of malignant glandular cells admixed with nests of malignant squamous cells. The squamous component ranges form well differentiated keratinizing to poorly differentiated non-keratinizing areas11
 
Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003


 .



Colon and rectum
ICD-O-3 topography code: C18-C20
ICD10: C18-C20
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.

Adenosquamous carcinoma of the colon and rectum
This unusual tumour has features of both squamous cell carcinoma and adenocarcinoma, either as separate areas within the tumour or admixed. This variant has more than just occasional small foci of squamous differentiation. Pure squamous cell carcinoma is very rare12
 
Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010


 .



Gallbladder and extrahepatic biliary tract
ICD-O-3 topography code: C23-C24.0
ICD10: C23-C24
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.

Adenosquamous carcinoma of the gallbladder
The extent of differentiation of the two malignant components, glandular and squamous, varies, but in general they tend to be moderately differentiated 13
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Akcali Z, Ozyilkan O, Sakalli H, Bal N, Noyan T (2005)
Gallbladder adenosquamous cell carcinoma: report of two cases.
Acta Gastroenterol Belg 68: 440-2


 14
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Albores-Saavedra J, Grider DJ, Wu J, Henson DE, Goodman ZD (2006)
Giant cell tumor of the extrahepatic biliary tree: a clinicopathologic study of 4 cases and comparison with anaplastic spindle and giant cell carcinoma with osteoclast-like giant cells.
Am J Surg Pathol 30: 495-500


 15
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Chan KM, Yu MC, Lee WC, Jan YY, Chen MF (2007)
Adenosquamous/squamous cell carcinoma of the gallbladder.
J Surg Oncol 95: 129-34


 16
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Lim SH, Yang HW, Kim A, Cha SW, Jung SH, Go H, Lee WC (2007)
Adenosquamous carcinoma of extrahepatic bile duct: a case report.
Korean J Intern Med 22: 206-10


 17
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Mingoli A, Brachini G, Petroni R, Antoniozzi A, Cavaliere F, Simonelli L, Chirletti P, Modini C (2005)
Squamous and adenosquamous cell carcinomas of the gallbladder.
J Exp Clin Cancer Res 24: 143-50


 18
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Nishihara K, Nagai E, Izumi Y, Yamaguchi K, Tsuneyoshi M (1994)
Adenosquamous carcinoma of the gallbladder: a clinicopathological, immunohistochemical and flow-cytometric study of twenty cases.
Jpn J Cancer Res 85: 389-99


 . Keratin pearls are often present in the squamous component, and mucin is usually demonstrable in the neoplastic glands.



Penis
ICD-O-3 topography code: C60
ICD10: C60
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.



Region of the ampulla of Vater
ICD-O-3 topography code: C24.1
ICD10: C24.1
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.

Adenosquamous carcinoma of the ampulla of Vater
This unusual neoplasm represents 1% of all ampullary carcinomas and is characterized by a variable combination of two malignant components, one glandular and the other squamous, like adenosquamous carcinomas seen in other anatomic sites 19
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Song DE, Park JK, Hur B, Ro JY (2004)
Carcinoid tumor arising in a tailgut cyst of the anorectal junction with distant metastasis: a case report and review of the literature.
Arch Pathol Lab Med 128: 578-80


 . Although the proportion of each component varies, the adenocarcinoma usually predominates, is well- to moderately differentiated, and of pancreatobiliary phenotype. The squamous carcinoma component is focally keratinizing and by convention should represent at least 25% of the tumour. In contrast, any amount of glandular differentiation suffices to designate a predominantly squamous neoplasm as adenosquamous carcinoma. In some cases, clear cells line the glands and are mixed with the squamous elements. A micropapillary pattern can be seen rarely 20
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Khayyata S, Basturk O, Adsay NV (2005)
Invasive micropapillary carcinomas of the ampullo-pancreatobiliary region and their association with tumor-infiltrating neutrophils.
Mod Pathol 18: 1504-11


 . Some adenosquamous carcinomas arise from preexisting adenomas 21
 
Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010


 .



Small intestine
ICD-O-3 topography code: C17
ICD10: C17
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.



Prostate gland
ICD-O-3 topography code: C61
ICD10: C61
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.



Nasal cavity and Sinuses
ICD-O-3 topography code: C30-C31
ICD10: C30-C31
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.



Bronchus and lung
ICD-O-3 topography code: C34
ICD10: C34
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.



Vulva
ICD-O-3 topography code: C51
ICD10: C51
           

Adenosquamous carcinoma is composed of malignant mucin-containing glandular cells and malignant squamous cells. It is typically a solid and deeply infiltrative lesion.
In the vulva, primary adenosquamous carcinoma is rare. It can arise at the site of the Bartholin gland, resulting in an enlargement of the Bartholin gland area that may resemble a Bartholin duct cyst. Patients are predominantly older women >50 years of age. Approximately 20% of patients have ipsilateral inguinofemoral lymph node metastases at presentation 22
 
Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003


 .



Vagina
ICD-O-3 topography code: C52
ICD10: C52
           

A carcinoma composed of malignant glandular cells and malignant squamous cells.