Urechescu Horaţiu Constantin, Balica Nicolae Constantin, Sarău Cristian Andrei, Anghelina Florin, Horhat Ioana Delia, Baderca Flavia, Jifcu Emilia Manuela, Ştefănescu Eugen Horaţiu, Poenaru Mărioara, Pricop Marius Octavian
Department of Microscopic Morphology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania;
Rom J Morphol Embryol. 2018;59(3):989-996.
Basal cell carcinoma (BCC) is the most common locally invasive malignant epidermal neoplasm. It is generally a tumor that runs a slow progressive course and can usually be cured by surgery. Basosquamous carcinoma is considered by some authors a rare subtype of BCC, while others describe it as independent tumor with different evolution from BCC. The aim of the study was to present a very interesting case of initially otherwise ordinary BCC that during its repeated and extensive relapses changed its histopathology in a basosquamous carcinoma, despite the free surgical margins and leading to major surgeries with loss of right eye. We present a case of 75-year-old male diagnosed in 2008 with a tumor located in the right naso-orbital region. The patient underwent surgical treatment, the histopathology being consistent with BCC. He presented recurrences of the tumor in 2009 and 2010 that were excised at approximately 9 and 16 months, respectively, from the first intervention. In 2010, the surgical procedure was radical, with removal of the tumor and the entire right superior eyelid. This approach proved to have negative side effects over the right eye in time. Therefore, after two months, a complete exenteration of the right orbit was necessary. The tumor recurred again for three times, after 20, 30 and 42 months from the first intervention and every time surgical treatment was applied. The microscopic inspection of the biopsies showed similarities between recurrences and initial tumor. In 2013, after 57 months from the first intervention, the patient was readmitted with a lesion in the same region that was excised but that time the histopathology differed from the previous, the tumor being composed of sheets of achromic epithelioid cells, with vesicular nuclei and prominent, eosinophilic nucleoli. The tumor cells were positive for pan-cytokeratin AE1∕AE3 and negative for S100 protein, human melanoma black 45 (HMB45) and vimentin that sustained the diagnosis of basosquamous carcinoma. The paper presented an interesting case with different histopathological features from a recurrence to other, with important implication in diagnosis and prognosis. The transformation of BCC into basosquamous carcinoma sustain that the basosquamous carcinoma is better a rare, aggressive variant of BCC, than an individual lesion.
基底细胞癌（BCC）是最常见的局部侵袭性恶性表皮肿瘤。它通常是一种病程进展缓慢的肿瘤，通常可通过手术治愈。一些作者认为基底鳞状细胞癌是BCC的一种罕见亚型，而另一些人则将其描述为与BCC具有不同演变过程的独立肿瘤。本研究的目的是呈现一个非常有趣的病例，即最初为普通的BCC，在其反复广泛复发过程中，尽管手术切缘阴性，但组织病理学却转变为基底鳞状细胞癌，最终导致右眼丧失并进行了多次大手术。我们报告一例75岁男性患者，于2008年被诊断为右侧鼻眶区域肿瘤。患者接受了手术治疗，组织病理学检查结果符合BCC。他分别在2009年和2010年出现肿瘤复发，分别在首次干预后约9个月和16个月时进行了切除。2010年，手术方式为根治性手术，切除了肿瘤及整个右上眼睑。随着时间的推移，这种方法对右眼产生了负面副作用。因此，两个月后，有必要对右眼眶进行彻底切除。自首次干预后20、30和42个月，肿瘤又复发了三次，每次均进行了手术治疗。活检的显微镜检查显示复发肿瘤与初始肿瘤相似。2013年，在首次干预后57个月，患者因同一区域的病变再次入院，病变被切除，但此次组织病理学与之前不同，肿瘤由成片的无色上皮样细胞组成，细胞核呈泡状，核仁明显且嗜酸性。肿瘤细胞全细胞角蛋白AE1∕AE3呈阳性，而S100蛋白、人黑色素瘤黑色45（HMB45）和波形蛋白呈阴性，这支持了基底鳞状细胞癌的诊断。本文报告了一个有趣的病例，其复发后的组织病理学特征与其他情况不同，对诊断和预后具有重要意义。BCC向基底鳞状细胞癌的转变表明，基底鳞状细胞癌更像是BCC的一种罕见、侵袭性变体，而非独立的病变。
