You are on page 1of 3

International Journal of Dental Sciences and Research, 2014, Vol. 2, No.

6, 158-160
Available online at
© Science and Education Publishing

Adenosquamous Carcinoma in Buccal Mucosa-A Case

Gopal Chandra Halder, Jay Gopal Ray*, Santanu Patsa

Oral and Maxillofacial Pathology, Dr. R. Ahmed Dental College and Hospital, West Bengal University of Health Sciences, Kolkata
*Corresponding author:

Received November 01, 2014; Revised November 25, 2014; Accepted November 30, 2014
Abstract Adenosquamous carcinoma is a rare malignant tumor with poor prognosis that is characterized
histopathologically by the simultaneous presence of distinct areas of adenocarcinoma and squamous cell carcinoma.
Until 2004, only 59 cases of adenosquamous carcinoma have been documented in English literatures in the head and
neck region since the first one being reported in 1968. The present report is a case of adenosquamous carcinoma in a
75 years old man with a fast enlarging ulcerated lesion on right buccal mucosa. The patient developed trismus due to
local infiltration of tumor mass within the muscle with fixation of the skin and a small perforation on the right side
of the face. Adenosqamous carcinoma in the oral cavity is not seen frequently. All the reported cases are in the
tongue, floor of the mouth and tonsillar palatine region in descending order. This presentation in the buccal mucosa
with infiltration up to the skin is in itself significant and rare.
Keywords: Buccal mucosa, adenosquamous carcinoma, ulcerated lesion, infiltration
Cite This Article: Gopal Chandra Halder, Jay Gopal Ray, and Santanu Patsa, “Adenosquamous Carcinoma in
Buccal Mucosa-A Case Report.” International Journal of Dental Sciences and Research, vol. 2, no. 6 (2014):
158-160. doi: 10.12691/ijdsr-2-6-9.

Orthopantomogram of jaws showed no bony

1. Introduction involvement either in mandible or maxilla (Figure 3).
Patient had the habits of smoking and betel quid chewing
Adenosquamous carcinoma is a controversial neoplasm for long time. Medical history revealed no abnormality
which has been defined by the World Health Organization and the reports of routine blood examination were within
as a malignant tumor with histopathological features of normal limits. An incisional biopsy was done after taking
both adenocarcinoma and squamous cell carcinoma [1]. informed consent from the patient.
Adenosquamous carcinoma has been documented in
numerous epithelial tissues all over the body including
skin, colon, pancreas, thyroid gland, larynx etc. but it is
rare in oral cavity [2].
Histogenesis of the tumor is not completely understood,
but possibility of its origin by carcinomatous change of
basal layer of surface epithelium and excretory ductal
epithelium of minor salivary glands have been reported [3],
[2]. The present report is of a highly aggressive
adenosquamous carcinoma on the right buccal mucosa.

2. Case Report
A 75 years old man visited the out patient department Figure 1. A small perforation at right cheek
of R. Ahmed Dental College & Hospital in May 2014 with
complaints of pain, trismus and non-healing ulcer since Histological examination with hematoxylin and eosin
last 15 days (Figure 2). The clinical examination revealed staining revealed variable proportions of the squamous
a small perforation on the right cheek with fixation of skin and glandular components under an interrupted stratified
and the under lying structures adjoining the before said squamous epithelium (Figure 4). Deeper in connective
perforation (Figure 1). No cervical lymph node was tissue dysplastic epithelial cells arranged in islands or
palpable. sheets were present 9 Figure 5). Duct-like structures lined
Intra oral examination revealed 2 cm X 1 cm ulcer with by a single or double layer of atypical columnar epithelial
irregular border, rolled thickened margin and indurated cells showing pleomorphism and hyperchromatism
base. surrounding mucinous substance could be detected (Figure
International Journal of Dental Sciences and Research 159

6). Overall features were corroborative to adenosquamous


Figure 6. Ductual structure with mucin pool

3. Discussion
Figure 2. Ulcer with irregular border A malignant salivary tumor described by Gerughty and
his co-workers in 1968 had features of both squamous and
glandular components [4]. It is a rare type of controversial
malignant tumor because of its unknown histogenetic
origin. Several theories have been postulated by various
authors regarding the origin of the tumor. Some authors
believe that it is a variant of salivary gland tumor. Some
researchers opined that the origin of the tumor was from
basal cells layer of squamous epithelium. An experimental
model on adenosquamous carcinoma suggested that this
tumor dose not originate from salivary or seromucous
Figure 3. Orthpantamogram showed no boney involvement glands [5]. Hence this model provides a support in favor
of basal cell origin. However, in 1991 WHO classification
of salivary gland tumors did not include adenosquamous
carcinoma as a salivary gland tumor [6]. In 1997, WHO
defined adenosquamous carcinoma as a malignant tumor
with features of both adenocarcinoma and squamous cells
carcinoma in the same tumor mass in close proximity but
generally distinct [7].
Larynx is most common place of origin of the tumor
(44.8%) in the head-neck region. In oral cavity dominant
sites are floor of the mouth and tongue. First reported case
origin from buccal mucosa was published in 2009 [8]. The
literatures revealed that adenosquamous carcinoma is
characterized by local recurrence, cervical lymph node
metastasis, distant metastasis and poor prognosis. Males
Figure 4. Neoplastic squamous island (right arrow) and neoplastic ductul are most commonly affected than females (3.5:1, male to
component (left arrow) female ratio) and the age range is 22 to 80 years. Patient
reported with variable signs and symptoms but most
common features is pain in maximum cases which may be
due to the tendency of spreading by perineural invasion
Microscopic features of the present case were
confirmatory diagnosed as adenosquamous carcinoma and
so we did not go for immunohistochemical analysis.
However most literatures showed the glandular
differentiated area was positive for pancytokeratin,
epithelial membrane antigen, CK7/8 [10]. Squamous cell
component was positive for high molecular weight
cytokeratin (MNF116) & CEA and negative for CK7/8 &
In case of differential diagnosis for adenosquamous
Figure 5. dysplastic squamous cells in a sheet
carcinoma, mucoepidermoid carcinoma and adenoid
160 International Journal of Dental Sciences and Research

squamous cell carcinoma should be considered very Tushar Deb, Asst. Prof. (Dr.) Sila Datta, and Clinical
carefully. Mucoepidermoid carcinoma and Tutor (Dr.) Sandip Ghose of the same institution.
adenosquamous carcinoma, both manifest epidermoid and
glandular features. However, separated and definitive
areas of adenosquamous carcinoma and squamous cell References
carcinoma are not seen in mucoepidermoid carcinoma.
High grade mucoepidermoid carcinoma consists of [1] Thackray AC, Sabin LH: “Histologic typing of salivary gland
tumor”, Geneva, World Health Organization, 16, 1972.
intermediate or epidermoid cells without keratin formation.
[2] Gary L. Ellis, Aault L. Auclair, Douglas R. Gnepp, “surgical
Adenosquamous carcinoma shows the features of pathology of salivary gland”, volume-25, W.B Saunders company,
squamous cell carcinoma viz infiltrative pattern, nuclear page-455.
pleomorphism, mitotic figures and keratin pearls [3] Keelawat S, Liu CZ, Roehm PC, Barnes L. “Adenosquamous
formation without intermediate cells. carcinoma of the upper aerodigestive tract: a clinicopathologic
study of 12 cases and review of the literature”, Am J Otolaryngol,
Adenosquamous carcinoma is highly aggressive, locally 23 (3), 160-8, May-Jun 2002.
recurrent and highly metastatic lesion. In our case, there [4] Gerughty RM, Hennigar GR, Brown FM, “Adenosquamous
was no regional lymph node metastasis. Also, a similar carcinoma of the nasal, oral, and laryngeal cavities: a
type of case has been reported in 2009 without lymph clinicopathological survery of ten cases”, Cancer, 22, 1140-55,
node involvement and prognosis of the patient was greater
[5] Cadesa A, Bombi JA, Pera M, Fernander PL, Campo E, Pera C,
than 5 years [8]. Mohr U, “Spectrum of glandular differentiation in experimental
carcinoma of the esophagus induced by 2,6-
dimethylintrosomorpholine under the influence of
4. Conclusion esophagojejuostomy” Exp Toxic Pathol, 46, 41-4, 1994.
[6] Seifert G, Sabin LH, “WHO histological typing of salivery gland
tumors”, Springer-Vertag, Berlin, 1991, 2nd Ed.
Adenosquamous carcinoma is a controversial neoplasm [7] Pindborg JJ, Reichart PA, Smith CJ, Van der Wall I, “Histological
and the histogenesis of the tumor is not completely typing of cancer and precancer of the oral mucosa. World Health
understood, but possibility of its origin by carcinomatous Organization international histological classification of tumors”,
change of basal layer of surface epithelium remains [8]. Springer New York Heidelberg Berlin, 1997, 16, 2nd Ed.
The first reported case in the buccal mucosa is in 2009 [8]. [8] Kam-wing Leung, Kuo-Chung Yang, Chia-Jung Chen,
“Adenosquamous carcinoma of buccal mucosa- A case report”
We report this case because of its rarity. Taiwan J Oral Maxillofac Surg, 20, 19-28, March 2009.
[9] Yoshimura Y, Mishima K, Obara S, Yoshimura H, Marayama R,
“Clinical characteristic of oral adenosquamous carcinoma: report
Acknowledgement of a case and an analysis of the reported Japanese cases”, Oral
Oncol, 39, 309-15, 2003.
This article could not have been possible without the [10] Sheahan P, Fitzgibbon J, Lee G, O’Leary G, “Adenosquamous
carcinoma of the tongue in a 22 years old female: report of a case
help of the staffs of the Department of Oral and with immunohistochemistry”, Eur Arch Otorhinolaryngol, 206,
Maxillofacial Pathology, R. Ahmed Dental College & 509-12, 2003.
Hospital. I offer our sincere thanks to Assoc. Prof. (Dr.)