Basal Cell and Adenoid Cystic Carcinoma

Basal Cell and Adenoid Cystic Carcinoma
Rafael E. Jimenez, MD
Gladell P. Paner, MD
Mahul B. Amin, MD
BCC/ACC may present with 2 patterns. The BCC pattern is characterized by infiltrative solid nests of basaloid cells with peripheral cellular palisading, similar in appearance to cutaneous BCC.
The ACC pattern is characterized by large, invasive nests with cribriform architecture containing multiple lumina resembling ACC at other sites. BCC and ACC patterns may coexist in the same tumor.
TERMINOLOGY
Abbreviations
  • Adenoid cystic carcinoma (ACC)
  • Basaloid cell carcinoma (BCC)
Synonyms
  • Adenoid basal cell tumor, adenoid cystic-like tumor
Definitions
  • Malignant neoplasm composed primarily of basaloid cells arising putatively from prostatic basal cells
ETIOLOGY/PATHOGENESIS
Origin
  • Considered to arise from basal cells along prostatic ducts and acini
CLINICAL ISSUES
Epidemiology
  • Incidence
    • Uncommon: Approximately < 75 cases reported in the literature
  • Age
    • Wide age range (28-89 years), but majority occur in older men
Presentation
  • Most commonly presents with obstructive urinary symptoms
    • Thus most cases diagnosed on transurethral resection of prostate (TURP) specimens
  • Perianal pain
  • Few tumors incidentally encountered in needle biopsy during work-up for elevated serum PSA level for other causes
Laboratory Tests
  • Serum PSA levels may be normal or elevated
Treatment
  • Most reported cases treated with TURP, with a subset undergoing radical prostatectomy
  • Advanced stage treated with adjuvant radiotherapy or chemotherapy
Prognosis
  • Limited data available on clinical behavior
  • Local recurrence, metastasis, and death from disease reported in approximately 30% of cases
  • Metastases commonly to lung and liver
  • Bone metastasis rare compared to acinar adenocarcinoma
  • Presence of large solid nests with central necrosis, high Ki-67 staining, and less immunoreactivity to basal cell markers suggested to be associated with aggressive behavior
MACROSCOPIC FEATURES
General Features
  • Grossly apparent tumor that is white and fleshy with ill-defined infiltrative edges
  • May have microcystic features
Site of Involvement
  • Tumor widely involving prostate, including peripheral zone
MICROSCOPIC PATHOLOGY
Histologic Features
  • Basaloid tumor cells have scant cytoplasm, high nuclear to cytoplasmic ratio, and irregular or angulated nuclei with open chromatin
  • Basaloid cells may exhibit nuclear and cytoplasmic microvacuolation
  • Infiltration of adjacent parenchyma is hallmark feature of BCC
  • BCC pattern
    • Variably sized solid nests, cords, or trabeculae with peripheral palisading of basaloid cells
    • May be associated with extensive central necrosis
  • ACC pattern
    • Tumor grows in nests with prominent cribriform architecture
    • Eosinophilic, hyaline, basement membrane-like material may be present
    • Basophilic mucinous secretions may be present in lumina
  • Additionally, tubuloglandular pattern with collagenous rim and basal cell hyperplasia-like patterns may occur
  • Combination of these different architectural patterns is often encountered
  • Usually associated with desmoplastic stromal response, which may be fibromyxoid or myxoid
  • Rarely acinar, sebaceous, or squamous cell differentiation may be present
  • Perineural invasion, angiolymphatic invasion, or necrosis may be present
  • Extraprostatic extension is often present, including involvement of bladder neck or seminal vesicle
  • Tumor involvement of thick bladder neck muscles detected with relatively high frequency in TURP specimens
  • Subset may have synchronous or metachronous prostate cancer, such as acinar adenocarcinoma, sarcomatoid carcinoma, or small cell carcinoma
Predominant Pattern/Injury Type
  • Neoplastic
Predominant Cell/Compartment Type
  • Epithelial
Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Basal Cell and Adenoid Cystic Carcinoma

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