A 63-year-old male presented with a recurrent thickening and scaling lesion on his lower lip for two years that had recently ulcerated and enlarged progressively. A biopsy was performed and found a well-differentiated squamous cell carcinoma infiltrating the dermis and muscle tissue of the lip. Myeloid-derived suppressor cells were found to be promoting tumor progression and immunosuppression. Chronic inflammation from an initial infection or insult can lead to cellular transformation aided by myeloid-derived suppressor cells, allowing cancer to develop and invade surrounding tissues.
A 63-year-old male presented with a recurrent thickening and scaling lesion on his lower lip for two years that had recently ulcerated and enlarged progressively. A biopsy was performed and found a well-differentiated squamous cell carcinoma infiltrating the dermis and muscle tissue of the lip. Myeloid-derived suppressor cells were found to be promoting tumor progression and immunosuppression. Chronic inflammation from an initial infection or insult can lead to cellular transformation aided by myeloid-derived suppressor cells, allowing cancer to develop and invade surrounding tissues.
A 63-year-old male presented with a recurrent thickening and scaling lesion on his lower lip for two years that had recently ulcerated and enlarged progressively. A biopsy was performed and found a well-differentiated squamous cell carcinoma infiltrating the dermis and muscle tissue of the lip. Myeloid-derived suppressor cells were found to be promoting tumor progression and immunosuppression. Chronic inflammation from an initial infection or insult can lead to cellular transformation aided by myeloid-derived suppressor cells, allowing cancer to develop and invade surrounding tissues.
A 63-year-old male presented with a recurrent thickening and scaling lesion on his lower lip for two years that had recently ulcerated and enlarged progressively. A biopsy was performed and found a well-differentiated squamous cell carcinoma infiltrating the dermis and muscle tissue of the lip. Myeloid-derived suppressor cells were found to be promoting tumor progression and immunosuppression. Chronic inflammation from an initial infection or insult can lead to cellular transformation aided by myeloid-derived suppressor cells, allowing cancer to develop and invade surrounding tissues.
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7.
Lip Squamous Cell Carcinoma Case Study
Fig 1: Pre-op photograph of patient with ulcerated lesion on lip (arrow). Lip is also somewhat thickened. Area of surgical incision has been demarcated. The skin of the lips is stratified squamous epithelium The border between the lips and the surrounding skin is referred to as the vermillion border, or simply the vermilion. The vertical groove on the upper lip is known as the philtrum. The skin of the lip, with three to five cellular layers, is very thin compared to typical face skin, which has up to 16 layers. With light skin color, the lip skin contains fewer melanocytes (cells which produce melanin pigment , which give skin its color). Because of this, the blood vessels appear through the skin of the lips, which leads to their notable red coloring. With darker skin color this effect is less prominent, the skin of the lips contains more melanin and thus is visually darker. The skin of the lip forms the border between the exterior skin of the face, and the interior mucous membrane of the inside of the mouth. The lip skin is not hairy, and does not have sweat glands or sebaceous glands. Therefore it does not have the usual protection layer of sweat and body oils which keep the skin smooth, inhibit pathogens, and regulate warmth. For these reasons, the lips dry out faster and become chapped more easily.
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Case Study: Clinical Summary: 63 yr old white male had recurrent thickening and scaling of the lower lip for two years. In recent months it had undergone ulceration (sore on the skin or a mucous membrane, accompanied by the disintegration of tissue) and progressive enlargement. The lesion was excised by wedge resection. Autopsy findings: specimen was triangular in shape; upper part was covered by mucosa and the lower part by skin. At the junction of the mucosa and skin, there was a 2 x 1.4 cm oval shaped superficial lesion which was flat, firm and had raised borders. The base was orange.
Fig 2: LP of squamous cell carcinoma of the lip. Note focal ulceration (1) and tumor infiltration at the vermilion border (2)
Fig 3: Large area of ulceration (arrow) with underlying congestion and hemorrhage. Area of ulceration is adjacent to an area of tumor infiltration.
Fig 4: LP of well-differentiated squamous cell carcinoma and inflammatory cell infiltration The infiltration of tumors by inflammatory cells encompasses numerous cellular phenotypes, including macrophages, dendritic cells (DCs), myeloid derived suppressor cells (MDSCs), and T cells MDSCs can interact with T cells, macrophages, and natural killer cells to create an environment favorable for tumor progression. Tumor-induced immunosuppression plays a key role in tumor evasion of the immune system.
The role of myeloid-derived suppressor cells in promoting the spread of these malignant tumors: Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of early myeloid progenitors, immature granulocytes, macrophages, and dendritic cells at different stages of differentiation. These cells are of great interest because they have the capacity to suppress both the cytotoxic activities of natural killer cells, and the adaptive immune response mediated by CD4+ and CD8+ T cells
Fig 5: HP of infiltrating squamous cell carcinoma and inflammatory cells
Fig 6: HP of well differentiated lip squamous cell carcinoma. Note intracytoplasmic keratinization which gives the cells a glassy appearance. The focal accumulations of keratinized cells (structural cells making up the outer layer of human skin) are called keratin pearls (arrows) large keratin plaques surrounded by necrotic cells with pyknotic nuclei (irreversible condensation of chromatin in the nucleus of a cell undergoing programmed cell death or apoptosis)
Fig 7: HP of poorly differentiated tumor area. Note spindle shaped cells and irregular pattern of growth
Fig 8: Section of muscle tissue from lip biopsy. Note squamous cell carcinoma has infiltrated into the muscle tissue. There are also inflammatory cells within this area of tumor infiltration
Terminology: Vermillion border of the lip: the normally sharp demarcation between the lip and the adjacent normal skin www.medscape.com/.../slideshow/lip-laceration/. Pyknotic nuclei: irreversible condensation of chromatin in the nucleus of a cell undergoing programmed cell death or apoptosis http://www.rndsystems.com/molecule_group.aspx?g=2424&r=1; http://onlinelibrary.wiley.com/doi/10.1002/jbmr.154/pdf So if we consider inflammation as the beginning insult then the pathway through to transformation might look like this: Pathway: Pathogen/insult inflammatory response chronic inflammation (cytokines as well as reactive O2 species) cellular transformation plus MDSCs MDSCs secrete mutated TGF beta that no longer promotes apoptosis or anti proliferative characteristics but rather stimulates immune suppression and angiogenesis, by converting effector T-cells into MDSCs which interfere with MHC response and specific cell immunity transformed cells divide and cancer has the potential to invade.
DR SARMA'S DERMPATH: Common Spindle Cell Malignant Neoplasms of The Skin Differential Diagnosis and Review of The Literature. The Internet Journal of Dermatology 2009: Volume 7 Number 2
DR SARMA'S DERMPATH: Common Spindle Cell Malignant Neoplasms of The Skin Differential Diagnosis and Review of The Literature. The Internet Journal of Dermatology 2009: Volume 7 Number 2
