Basaloid Squamous Cell Carcinoma of the Head and Neck
A Clinicopathological and Follow-Up Study of 40 Cases and Review of the Literature
First Online: 21 March 2008 Received: 16 February 2008 Accepted: 18 February 2008 DOI:
Cite this article as: Ereño, C., Gaafar, A., Garmendia, M. et al. Head and Neck Pathol (2008) 2: 83. doi:10.1007/s12105-008-0045-6 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 Head and neck Larynx Hypopharynx Oropharynx Oral cavity Differential diagnosis Prognosis Recurrence Metastasis
This piece of knowledge has been partially presented as a poster (abstract #1017) in the 96th Annual Meeting of the United States and Canadian Academy of Pathology, in San Diego, CA, March 24–30, 2007.
Wain SL, Kier R, Wollmer RT, et al. Basaloid-squamous carcinoma of the tongue, hypopharynx, and larynx: report of 10 cases. Hum Pathol. 1986;17:1158–66.
Banks ER, Frierson HF Jr, Mills SE, et al. Basaloid squamous cell carcinoma of the head and neck. A clinicopathologic and immunohistochemical study of 40 cases. Am J Surg Pathol. 1992;16:939–46.
Barnes L. Basaliod squamous cell carcinoma. In: Barnes L, editor Surgical pathology of the head and neck, 2nd ed. New York: Marcel Dekker, 2001. p. 184–89.
Luna MA, El Naggar A, Parichatikanond P, et al. Basaloid squamous carcinoma of the upper aeorodigestive tract. Clinicopathologic and DNA flow cytometric analysis. Cancer. 1990;66:537–42.
Paulino AFG, Singh B, Shah JP, et al. Basaloid squamous cell carcinoma of the head and neck. Laryngoscope. 2000;110:1479–82.
Hellquist HB, Dahl F, Karlsson MG, et al. Basaloid squamous cell carcinoma of the palate. Histopathology. 1994;25:178–80.
Coppola D, Catalano E, Tang CK, et al. Basaloid squamous cell carcinoma of the floor of the mouth. Cancer. 1993;72:2299–305.
Ide F, Shimoyama T, Horie N, et al. Basaloid squamous cell carcinoma of the oral mucosa: a new cases and review of 45 cases in the literature. Oral Oncol. 2002;38:120–4.
Wieneke JA, Thompson LD, Wenig BM. Basaloid squamous cell carcinoma of the sinonasal tract. Cancer. 1999;85:841–54.
Wan SK, Chan JKC, Lau WH, et al. Basaloid-squamous carcinoma of the nasopharynx. An Epstein-Barr virus-associated neoplasm compared with morphologically identical tumors occurring in other sites. Cancer. 1995;76:1689–93.
Saltarelli MG, Fleming MV, Wenig BM, et al. Primary basaloid squamous cell carcinoma of the trachea. Am J Clin Pathol. 1995;104:594–98.
Sarbia M, Verreet P, Bittinger F, et al. Basaloid squamous cell carcinoma of the esophagus. Diagnosis and prognosis. Cancer. 1997;79:1871–78.
Brambilla E, Moro D, Veale D, et al. Basal cell (basaloid) carcinoma of the lung: A new morphologic and phenotypic entity with a separate prognostic significance. Hum Pathol. 1992;23:993–1003.
Chetty R, Serra S, Hsieh E. Basaloid squamous carcinoma of the anal canal with and adenoid cystic pattern. Histologic and immunohistochemical reappraisal of an unusual variant. Am J Surg Pathol. 2005;29:1668–72.
Brainard J, Hart W. Adenoid basal epitheliomas of the uterine cervix: a reevaluation of distinctive cervical basaloid lesions currently classified as adenoid basal carcinoma and adenoid basal hyperplasia. Am J Surg Pathol. 1998;22:965–75.
Cubilla AL, Reuter VE, Gregoire L, et al. Basaloid squamous cell carcinoma: distinctive human papillomavirus related penile neoplasm. A report of 20 cases. Am J Surg Pathol. 1998;22:755–61.
Vakar-López F, Abrams J. Basaloid squamous cell carcinoma occurring in the urinary bladder. Arch Pathol Lab Med. 2000;124:455–9.
Greene FL, Page DL, Fleming ID, et al., editors. AJCC cancer staging handbook. TNM classification of malignant tumors. New York, 2002.
Cardesa A; Zidar N, Ereño C. Basaloid squamous cell carcinoma. In: Barnes L, Eveson JW, Reichart P, Sidrasky D, editors. Pathology and genetics of head and neck tumours. Kleihues P, Sobón LH, series editors. World Health Organization classification of tumours. Lyon, France: IARC Press; 2005. p. 124–5.
Kleist B, Bankau A, Lorenz G, et al. Different risk factors in basaloid and common squamous head and neck cancer. Laryngoscope. 2004;114:1063–68.
El-Mofty SK, Patil S. Human papillomavirus (HPV)-related oropharyngeal nonkeratinizing squamous cell carcinoma: characterization of a distinct phenotype. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:339–45.
Cabanillas R, Rodrigo JP, Ferlito A, et al. Is there an epidemiological link between human papillomavirus DNA and basaloid squamous cell carcinoma of the pharynx? Oral Oncol. 2007;43:327–32.
Thompson LDR. Basaloid squamous cell carcinoma (BSCC). In: Thompson LDR, Golblum JR, editors. Head and neck pathology. Philadelphia: Churchill Livingstone; 2006. p. 70–3.
Muller S, Barnes L. Basaloid squamous cell carcinoma of the head and neck with a spindle cell component. An unusual histologic variant. Arch Pathol Lab Med. 1995;119:181–2.
Kimura T, Mukai M, Shiotani A, et al. Basaloid squamous carcinoma of the hypopharynx with an extensive spindle cell component exhibiting a pedunculated polypoid mass. Arch Pathol Lab Med. 2005;129:94–6.
Altrabulsi B, Carrizo F, Luna MA. Spindle basaloid squamous carcinoma of the upper aerodigestive tract: immunohistochemical and clinicopathological study of three cases. Ann Diagn Pathol. 2006;10:149–53.
Banks ER, Frierson HF, Covell JL. Fine needle aspiration cytologic findings in metastatic basaloid squamous cell carcinoma of the head and neck. Acta Cytol. 1992; 36:126–31.
Zamecnik M, Skalova A, Pelikan K, et al. Basaloid squamous carcinoma with collagenous spherules and crystaloids. Ann Diagn Pathol. 2001;5:233–9.
Morice WG, Ferreiro JA. Distinction of basaloid squamous cell carcinoma from adenoid cystic and small cell undifferentiated carcinoma by immunohistochemistry. Hum Pathol. 1998;29:609–12.
Hunt JL, Barnes L. Immunohistology of head and neck neoplasms. Basaloid squamous cell carcinoma. In: Dabbs DJ, editor. Diagnostic immunohistochemistry, 2nd ed. Philadelphia: Churchill Livingstone; 2006. p. 229–30.
Klijanienko J, El- Naggar A, Ponzio-Priom A, et al. Basaloid squamous carcinoma of the head and neck. Immunohistochemical comparison with adenoid cystic carcinoma and squamous cell carcinoma. Arch Otolaryngol Head Neck Surg. 1993;119:887–90.
Coletta RD, Almeida OP, Vargas PA. Cytokeratins 1, 7 and 14 immunoexpression are helpful in the diagnosis of basaloid squamous cell carcinoma. Histopathology. 2006;48:773–4.
Emanuel P, Wang B, Wu M, et al. p63 immunohistochemistry in the distinction of adenoid cystic carcinoma from basaloid squamous cell carcinoma. Mod Pathol. 2005;18:645–50.
De Sampaio G, Grizzo FC, Oliviera DT, et al. Prognosis of oral basaloid squamous cell carcinoma and squamous cell carcinoma: a comparison. Arch Otolaryngol Head Neck Surg. 2004;130:83–6.
Winzenburg SM, Niehans GA, George E, et al. Basaloid squamous carcinoma: a clinical comparison of two histologic types with poorly differentiated squamous cell carcinoma. Otolaryngol Head Neck Surg. 1998;119:471–5.
Erdamar B, Suoglu Y, Sirin M, et al. Basaloid squamous cell carcinoma of the supraglottic larynx. Eur Arch Otolaryngol. 2000;257:154–7.
Erisen LM, Coskun H, Ozuysal S, et al. Basaloid squamous cell carcinoma of the larynx: a report of four new cases. Laryngoscope. 2004;114:1179–83.
Bahar G, Feinmesser R, Popovtzer A, et al. Basaloid squamous carcinoma of the larynx. Am J Otolaryngol. 2003;24:204–8.
Rodriguez Tojo MJ, Garcia Cano FJ, Infante Sanchez JC, et al. Immunoexpression of p53, Ki-67 and E-Cadherin in basaloid squamous cell carcinoma of the larynx. Clin Transl Oncol. 2005;7:100–4.
Salerno G, Di Vizio D, Staibano S, et al. Prognostic value of p27Kip1 expression in Basaloid Squamous Cell Carcinoma of the Larynx. BMC Cancer. 2006;6:146.
Marioni G, Octaviano G, Marchese-Ragona R, et al. High nuclear expression of the apoptosis inhibitor protein is associated with disease recurrence and poor prognosis in laryngeal basaloid squamous cell carcinoma. Acta Oto-Laryngol. 2006;126:197–203.
McKay MJ, Bilous AM. Basaloid squamous carcinoma of the hypopharynx. Cancer. 1989;63:2528–31.
Seidman JD, Berman JJ, Yost BA, et al. Basaloid squamous carcinoma of the hypopharynx and larynx associated with second primary tumors. Cancer. 1991;68:1545–49.
Lam KY, Law S, Luk JM, et al. Oesophageal basaloid squamous cell carcinoma: a unique clinicopathological entity with telomerase activity as a prognostic indicator. J Pathol. 2001;195:435–42.