Department of Dermatology Hospital Universitario de Caracas,

Venezuela/Department of Pathology Baptist Health System, USA

Introduction
Lever 1947: “Sweat gland adenoacanthoma”: squamous cell tumor
that formed solid and pseudoglandular structures.

Muller 1964: Describes epidermic connection, shape, presence of

pseudoglandular elements, dyskeratosis and acantholysis;
mitosis; pleomorphism; appearance of stroma; perineural
extension, etc.

Location: Skin of photoexposed areas, vulva, oral mucosa, penis,

nasopharynx , breast , and conjunctive.

Histologic Differential Diagnosis: Basal cell carcinoma, eccrine

adenocarcinoma, metastatic adenocarcinoma and,
angiosarcoma.

Other terms used for adenoid squamous cell carcinoma:

Dyskeratotic squamous cell carcinoma, acantholytic squamous
cell carcinoma and, pseudoglandular squamous cell carcinoma.
Materials and Methods:
 Archives of the Laboratory of Dermatopathology of the department of
Dermatology of the HUC.

 Pathology reports of all squamous cell carcinomas (keratoacanthomas,

Bowen’s disease, erythoplasia of Queyrat and pseudoglandular squamous
cell carcinoma) retrieved

 January 1994 January 2004.

 Clinical data collected: age, sex, clinical course, location, clinical diagnosis,
skin phototype, and associated diseases.

 Histologic features evaluated: Shape, connection to epidermis, presence of

pseudoglandular structures, acantholysis, dyskeratosis, mitosis, nuclear
pleomorphism, perineural extension, associated actinic damage,
appearance of stroma and, association with other tumors.

 Histologic criteria for pseudoglandular squamous cell carcinoma: 1.

Keratinizing squamous tumor cell type. 2. Adenoid structures with round
spaces with a defined wall of at least one cell width. 3. Spaces with isolated
or grouped dyskeratotic acantholytic cells.
 Results: Clinical features. 32 patients 35 tumors

14254 specimens 503 Squamous cell Ca

 Age range: 37 – 89 years ( 71.82)

 32 patientes with phototype II – III

3 patients with phototype IV

 Size: 4 mm - 6 cm (2.5 cm)

Duration: 1 month – 4 years

(12.95 months)
 Results: Clinical features.
Anatomic Location
One case of lymph node metastasis

Clinical Impression

Associated diseases: 1 immunocompromised (renal transplant). 3 with previous history of skin cancer.
 Results. Histologic features:
Shape:
Nodular: 88.57%.
Ulcerated: 40%.
Crateriform: 11.42%.

Pleomorphism:
Mild: 14.28%.
Moderate: 40%.
Severe: 45.71%.
Keratinizing tumor with epidermic connection: 97.4 %
Mitotic activity:
Mild (0-10): 48.57%.
Moderate (11-19 mitosis):
37.14%.
Severe (> 20 mitosis): 28%.

Perineural invasion: 5.71%.

Presence of stromal mucin: 20%.

Actinic damage: 80%.

Acantholysis: 94.28 %
 Basal cell Ca + Pseudoglandular Results. Histologic features:
squamous cell Ca

Coexistent associated lesions:

1.Basal cell Ca. 3 cases.
2.Classic squamous cell Ca.
1 case.
3. Acantholytic actinic
keratosis. 1 case.
4.Compound nevus. 1 case.

Associated lesions in other

Pseudoglandular structures Locations:

1.Basal cell Ca. 4 cases

2.Classic squamous cell Ca.
2 cases.
3.Lentigo maligna. 1 case.
4.Intraepidermic melanocytic
nevus. 1 case.
5. Epidermic cyst with giant
cell reaction. 1 case.

Dyskeratotic acantholytic cells

Conclusions
 Less frequent variant of squamous cell carcinoma.
 Age of presentation: Elderly patients with marked actinic
damage.
 Male predominance.
 Phototype II-III.
 Photoexposed areas.
 Tumor composed of squamous cells that form nests and
columns towards the dermis with adenoid pattern.
 Nuclear pleomorphism and number of mitosis variable.
 Presence of dyskeratosis and acantholysis.
 Emphasis in the search of other malignant lesions of
skin.
 We propose the term of pseudoglandular-acantholytic
squamous cell carcinoma.
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