Incisional and Excisional Biopsy

Histologic examination revealed surface epithelial cells exhibiting changes and invading (Fig 4) the connective tissue, muscle, nerve and one lymphatic space in the form of cords, islands and clusters of cells.  The epithelial cells are large with hyperchromatic nuclei and prominent nucleoli, and show high mitotic activity (Fig 5).  The epithelial cells are also producing and releasing keratin in the form of individual cell keratinization and keratin pearls (Fig 4).  However, the latter is not prominent.  These changes are present in both the incisional biopsy specimen and the surgical specimen.   All the excised lymph nodes are negative for the presence of neoplastic cells.


Low power histological view.


Figure 4. H & E stained section at 100X magnification demonstrating neoplastic epithelial cells of variable sizes invading the connective tissue with keratin pearls.

Figure 5. H & E stained section at 200x magnification demonstrating sheets of neoplastic epithelial exhibiting moderate nuclear and cellular pleomorphism and large cells with hyperchromatic nuclei and prominent nucleoli.