Elsevier

Journal of Pediatric Surgery

Volume 42, Issue 12, December 2007, Pages 2035-2039
Journal of Pediatric Surgery

Squamous cell carcinomas in children and young adults: a new wave of a very rare tumor?

https://doi.org/10.1016/j.jpedsurg.2007.08.025Get rights and content

Abstract

Background

Squamous cell carcinomas (SCCs) seem to have become more common recently. This study aims to check whether the increase is real and to review possible etiologic factors and problems in diagnosis.

Methods

Patients with SCC were identified from anatomical pathology files over 30 years. The number and primary sites seen in the first 15 years were compared with those in the second. Histories were reviewed for predisposing factors. Mucosal tumors were tested for human papillomavirus (HPV) and Epstein-Barr virus by polymerase chain reaction.

Results

One cutaneous SCC and 2 nasopharyngeal carcinomas (NPCs) were seen in the first period, and 2 cutaneous SCCs and 3 nasopharyngeal carcinomas in the second. Another 9 patients with mucosal SCCs were seen in the second period, many with history of cancer treatment or immunosuppression. Two laryngeal SCCs were HPV16-positive. Histologic diagnosis was difficult in 3 patients.

Conclusion

Squamous cell carcinomas have become more common in the last 15 years. Causes include improved survival of cancer patients, therapeutic irradiation, immunosuppression, and possibly, increased prevalence of HPV in the community. Awareness of this increase in children, early biopsy in susceptible patients, repeat wider biopsy, and consultation with adult pathologists may reduce the diagnostic delay.

Section snippets

Materials and methods

The biopsy files in anatomical pathology were searched under the diseases SCC and carcinoma, and under the sites mouth, tongue, oral mucosa, buccal mucosa, palate, nasopharynx, larynx, bronchus, vulva, and skin. The histology of each identified patient with SCC was reviewed to confirm the diagnosis. Patients 20 years or older at diagnosis were excluded. The cases were divided into two 15-year periods, 1977 to 1991 and 1992 to 2006. Their histories were checked for factors, genetic and

Results

From 1977 to 1991, there were 3 patients with SCCs. From 1992 to 2006, there were 14.

During the first period, 1 patient had xeroderma pigmentosum with many SCCs of the skin. The other 2 had nasopharyngeal carcinomas (NPCs), with no obvious predisposing factors for malignancy.

During the second period, there were 2 patients with SCCs of the skin, arising in a sebaceous nevus in one and complicating autosomal recessive dystrophic epidermolysis bullosa in the other. Three patients had NPCs, also

Pathology

The pathologic diagnosis of SCC was straightforward in most patients. Difficulty was encountered in 3. In patient 7, the initial biopsy was tiny. Sections showed only a small cluster of squamous cell surrounded by fibrosis and a few skeletal muscle fibers (Fig. 1A). There was no consensus among several adult pathologists. In view of the extreme rarity of SCCs of the larynx in children, it was decided to observe with repeat biopsy 2 months later. This showed unequivocal SCC, which was clearly

Discussion

This study is from a tertiary teaching hospital providing pediatric oncology service to a population that increased from 3.8 million in 1977 to 5.1 million in 2006, a rise of 34% over 30 years. The referral pattern for children with cancer has changed little over this period. Although the numbers are small, the experience does suggest a significant increase in the prevalence of SCCs in children from the first period of 15 years when there were 3 cases, to the second period when there were 14.

Acknowledgment

We thank Drs John Chan, Malcolm Buchanan, Moira Finlay, and Christopher Angel for their help in the interpretation of some of the biopsies, and Dr Jonathan Akikusa for discussion on the relationship between immunosuppression in rheumatology patients and malignancies.

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Presented at the 40th annual meeting of the Pacific Association of Pediatric Surgeons, Queenstown, New Zealand, April 15-19, 2007.

This study has been approved by the Royal Children's Hospital Ethics and Human Research Committee.

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