Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Department of Dermatology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
J Cutan Pathol. 2021 Mar;48(3):374-383. doi: 10.1111/cup.13888. Epub 2020 Nov 5.
Basal cell carcinomas metastasize rarely, and there have been limited studies of potential drivers for this metastasis. Epithelial-mesenchymal transition (EMT) may play a role, although this has not been investigated in detail. We reviewed clinicopathologic features of 22 patients with metastasizing basal cell carcinoma (MBCC). Immunohistochemical markers of EMT, including CD44, E-cadherin, claudin, smooth muscle actin, beta-catenin, Twist1, and Oct 3/4, were evaluated on 10 MBCC (primary and metastases) and 18 non-metastasizing BCC. Primary sites included the head and neck, trunk, and extremity, while metastatic sites included lymph nodes, lung, bone, and soft tissue. Of 19 cases with follow-up, the range of follow-up after diagnosis of metastasis was 5 to 248 months (median: 50 months). Two cases were of unknown primary, nine metastases were diagnosed concurrently with primary tumors, and remaining cases showed a median latency between diagnosis of primary and metastatic tumors of 27.5 months (range: 3-81 months). Median survival was 66 months. Compared to non-metastasizing BCC, MBCC demonstrated reduced CD44 expression (primary [P = .0036], metastatic [P = .011]) and increased Twist1 expression (primary, P = .0017). MBCC shows variably aggressive behavior, and reduced CD44 and increased Twist1 expression may indicate significant EMT in metastasizing tumors and signify a metastatic phenotype.
基底细胞癌转移罕见，目前对于导致其转移的潜在驱动因素的研究有限。上皮-间质转化 (EMT) 可能起作用，但尚未对此进行详细研究。我们回顾了 22 例转移性基底细胞癌 (MBCC) 患者的临床病理特征。对 10 例 MBCC（原发和转移灶）和 18 例非转移性 BCC 进行了 EMT 的免疫组织化学标志物（包括 CD44、E-钙黏蛋白、claudin、平滑肌肌动蛋白、β-连环蛋白、Twist1 和 Oct 3/4）检测。原发部位包括头颈部、躯干和四肢，而转移部位包括淋巴结、肺、骨和软组织。在有随访的 19 例病例中，自转移诊断后随访范围为 5 至 248 个月（中位数：50 个月）。2 例为不明原发灶，9 例转移灶与原发灶同时诊断，其余病例原发灶与转移灶之间的潜伏期中位数为 27.5 个月（范围：3-81 个月）。中位生存时间为 66 个月。与非转移性 BCC 相比，MBCC 表现出降低的 CD44 表达（原发[P =.0036]，转移[P =.011]）和增加的 Twist1 表达（原发，P =.0017）。MBCC 表现出不同程度的侵袭性行为，降低的 CD44 和增加的 Twist1 表达可能表明转移瘤中存在显著的 EMT，并提示转移性表型。
