Acantholytic squamous cell carcinoma: pathological study of nine cases with review of literature

Vol. 55 No. 2 Suppl., 2014
This supplement was not sponsored by Outside Organizations.


Maria Sajin, Alina Hodorogea Prisacaru, Mihaela Cristina Luchian, Oana Maria Patrascu, Adrian Dumitru, Diana Costache, Doina Dumitrescu, Daniela Vrinceanu, Liliana Mary Voinea, Olga Simionescu, Mariana Costache

Squamous cell carcinoma (SCC) is classified in many subtypes or forms; one of them is the acantholytic squamous cell carcinoma, also called pseudoglandular, adenoid, epithelioma dyskeratoticum segregans, or adenoacanthoma. Researching and analyzing nine cases of acantholytic squamous cell carcinoma, we intend to verify if the data provided by the cases studied can be validated by the scientific literature. All the cases presented lesions found on the head and neck skin, with two exceptions - one on the larynx and the other one on the tonsil, all of them ulcerated lesions. In two cases, the tumors developed on the skin, in preneoplasic lesions (actinic keratosis). The tumors had dimensions between 4/3/4 mm and 100/90/36 mm. During one year, two of the cases studied presented multiple recurrences. We also found two cases of metatypical carcinoma accompanied the acantholytic variant of squamous cell carcinoma. None of the analyzed cases presented distant metastasis. The histopathological criteria for selection were: keratinised squamous tumor cell type, adenoid structures with round spaces with a defined wall of at least one cell width, spaces with isolated or grouped dyskeratotic acantholytic cells.

Corresponding author: Mariana Costache, Associate Professor, MD, PhD; e-mail:

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Daniela-Elise Tache, Camelia Elena Stanciulescu, Ileana Monica Banita, Stefana Oana Purcaru, Ana Marina Andrei, Violeta Comanescu, Catalina Gabriela Pisoschi

Background: Nitric oxide (NO) production by the action of the inducible nitric oxide synthase (iNOS or NOS2) is increased in tissues that are stimulated by cytokine and endotoxins. The role of NO in the pathogenesis of chronic viral hepatitis is not fully understood but it seems that its overproduction is responsible for the pathological changes under inflammatory conditions. Aim: In this paper, we analyzed the correlation between immunohistochemical expression of iNOS and liver fibrosis in chronic viral hepatitis. Materials and Methods: Liver biopsies from patients diagnosed with chronic viral hepatitis B and C were embedded in paraffin and further used for histological staining and immunohistochemical reactions to detect the expression of iNOS and TGF-beta1. The degree of liver fibrosis was established using special staining (trichromic Masson and Gomori s silver impregnation). Results: In samples with low degree of fibrosis, we observed a discrete positivity for iNOS in periportal hepatocytes and the immunohistochemical reaction for TGF-beta1 were limited to the endothelial cells of liver sinusoids and pro-inflammatory cells from the portal tracts. Positive reaction for TGF-beta1 increased with the degree of liver fibrosis, while the expression of iNOS was enhanced in hepatocytes, as well as in bile ducts and endothelial cells. Conclusions: Infection with hepatitis B and C viruses induces iNOS expression in hepatocytes, suggesting that NO overproduction might have an important role in progression of chronic viral hepatitis to cirrhosis._x000D_

Corresponding author: Ileana Monica Banita, Professor, MD, PhD; e-mail:

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