Pseudovascular squamous cell carcinoma with eosinophil-rich stroma

Area of Science:

• Oncology
• Oral Pathology
• Histopathology

Background:

• Pseudovascular squamous cell carcinoma (SCC) is a rare oral variant characterized by acantholysis and necrosis, mimicking glandular or vascular structures.
• Eosinophil-rich SCC is typically associated with a favorable prognosis in conventional SCC, but this feature has not been previously reported in the pseudovascular variant.
• This study addresses a gap in the literature by presenting a case of eosinophil-rich pseudovascular adenoid SCC.

Observation:

• A 38-year-old female presented with a rapidly enlarging, ulcerated inner cheek mass.
• Imaging revealed a large, enhancing mass in the left cheek, extending between the mandible and maxilla.
• Histopathology showed a pleomorphic, hypercellular lesion with necrosis, vascular-like spaces, micropapillary patterns, and significant stromal eosinophilia.

Findings:

• The tumor exhibited features of SCC with pseudovascular and adenoid differentiation.
• Immunohistochemistry confirmed SCC markers (vimentin, p53, AE1/AE3, CAM 5.2) and was negative for desmin and CD34.
• Despite initial surgical treatment, the patient developed hypercalcemia and bony metastases, progressing to hospice care after refusing further therapy.

Implications:

• This case expands the histopathological spectrum of pseudovascular SCC, introducing the eosinophil-rich subtype.
• The aggressive clinical course in this patient, despite the presence of eosinophilia, challenges the presumed favorable prognostic value of this feature in this rare variant.
• Further research is needed to understand the behavior and prognostic implications of eosinophil-rich pseudovascular SCC.