Well-differentiated Squamous Cell Carcinoma With Sarcomatous Differentiation in Patient With a History of Recurrent Verrucous Carcinoma.

Human papillomavirus-independent vulvar squamous cell carcinoma has a peak incidence in about the eighth decade of life. A variable portion of the vulvar squamous cell carcinoma are human papillomavirus-independent comprising 20% to 80% of all cases. Verrucous carcinoma (VC) is part of the spectrum of human papillomavirus-independent carcinomas and its combination with well-differentiated squamous cell carcinoma with sarcomatous differentiation is an extremely unusual neoplasm. The available literature on VC is currently limited to case reports and small single-institution studies. Here, we present a case concerning an 81-year-old woman with a history of chronic itching, swelling, and lichen sclerosis with variable-sized multiple white-pink plaques of the vulva. The pathologic diagnosis of VC was made. The patient later on developed multiple lesions of biopsy proved VC and most recent biopsy shows well-differentiated squamous cell carcinoma with abrupt sarcomatous differentiation. A review of the literature shows the rarity of this lesion of the female genital tract. Clinicians and patients should be aware of the aggressive behavior of cancers and adjust their surgical management together with the follow-up strategy. To the best of our knowledge, this is the first description of a VC and well-differentiated squamous cell carcinoma with abrupt sarcomatous differentiation occurring in the vulva.

Molecular testing of cytology specimens: Issues in specimen adequacy and clinical utility.

BACKGROUND: Next generation sequencing (NGS) is standard of care for workup of many neoplasms including adenocarcinomas of the lung. Molecular testing of cytology samples is used for many types of neoplasms but the value of such testing for the selection of "first"- and "second-line" treatment protocols is incompletely understood. METHODS: Fifty-six sequentially performed cytology specimens (49 fine needle aspirates and 7 fluids) submitted for molecular analysis were reviewed by a medical oncologist to determine specimen adequacy and utility of results for therapy selection. Chart review was performed to determine availability of microsatellite instability status, tumor mutational burden, and presence of driver mutations treatable with targeted therapy in a "first"- or "second-line" application. RESULTS: Forty of 56 cases were successfully sequenced and 34% (19/56) had targetable mutations detected by NGS. Ten of these 19 cases (53%) received targeted therapy for their tumor type with five of 10 patients receiving "first-line" therapy and five (50%) "second-line" therapy. Twenty-two mutations were detected where no targeted therapy for the patient's tumor type existed but targeted therapies were available for other tumor types. Of these specimens, only one patient received treatment using protocols associated with a second tumor type. Total mutation burden and microsatellite instability status results were obtained in 29 of 56 cases (52%). CONCLUSIONS: 71% (40/56) of cytologic specimens were adequate for sequencing with 34% (19/56) demonstrating a targetable mutation and 53% of these patients receiving therapy targeted to the driver mutation of their tumor type.

Papillary Thyroid Carcinoma With Squamous Dedifferentiation: A Potential Diagnostic Pitfall.

BACKGROUND/AIM: Squamous cell carcinoma (SCC) of the thyroid is a rare variant of the primary thyroid neoplasm, and some of such cases may involve dedifferentiation from papillary thyroid carcinoma (PTC). CASE REPORT: We herein present a case of 76-year-old male who initially presented with dysphagia and weight loss. His imaging studies revealed a hypopharyngeal mass and bilateral thyroid nodules. Upon surgical resection, the right pyriform sinus mass showed typical histomorphology of a moderately differentiated SCC, whereas the right peritracheal mass revealed histomorphology of a conventional PTC. The right pyriform sinus SCC demonstrated positive immunoreactivity of PAX8, supporting its thyroid origin. One of two paratracheal lymph nodes was positive for metastatic SCC and PTC, respectively. CONCLUSION: This report highlights a rare case of SCC arising from PTC dedifferentiation. The clinical course, imaging and histopathological evaluation, and a review of literature are presented. Due to its rarity, this could present as a clinical dilemma. Improving awareness of this rare entity with the clinic-histopathological correlation will lead to correct diagnosis and optical treatment.