DeCure for Adenosquamous Carcinoma

Adenosquamous carcinoma is an uncommon malignancy defined by the presence of both malignant glandular and malignant squamous elements. Across multiple anatomical sites, the disease is consistently described as aggressive. In a 2009 series of 27 cutaneous cases, the mean age was 74 years; 19 of 27 patients were men and 5 were immunosuppressed. Tumours were predominantly on the face and scalp (70%) or upper extremity (15%). All primary tumours showed extensive invasion of the reticular dermis, with thickness ranging from 1.2 to 9.2 mm. Perineural invasion was present in 4 of 27 primary cases (15%). Among 6 patients treated with Mohs micrographic surgery, 3 had subsequent locoregional recurrence, though no distant metastasis was observed after a mean follow-up of 2.3 years. The authors concluded that adenosquamous carcinoma is best considered a locally aggressive high-risk subtype of cutaneous squamous cell carcinoma.

For cervical adenosquamous carcinoma, a 2016 retrospective study of 135 patients with stage IB–IIB disease who had undergone primary surgery followed by adjuvant therapy reported that progression-free survival was significantly shorter in patients with adeno/adenosquamous carcinoma treated with adjuvant radiotherapy or concurrent chemoradiotherapy compared to patients with squamous cell carcinoma receiving the same treatment (P = 0.002). Adeno/adenosquamous histology and multiple lymph node metastasis were independent prognostic factors for shorter progression-free survival. Among patients with adeno/adenosquamous carcinoma, those who received adjuvant systemic chemotherapy had significantly longer progression-free survival than those who received radiotherapy or chemoradiotherapy (P = 0.026). The authors concluded that radiotherapy and concurrent chemoradiotherapy may be less effective for adeno/adenosquamous carcinoma than for squamous cell carcinoma, and that adjuvant systemic chemotherapy may be beneficial.

A 2014 case report of primary adenosquamous carcinoma of the ampulla of Vater described a 58-year-old man treated with pancreaticoduodenectomy. The authors noted that preoperative diagnosis is difficult because imaging lacks defining characteristics and biopsy may not capture both malignant components. They stated that early recurrence and distal metastasis may be encountered after surgery, and recommended frequent follow-up. A 1999 case report described a patient with adenosquamous carcinoma of the rectum with endocrine-cell differentiation and unresectable liver metastases at initial operation. After Hartmann colostomy, 5-fluorouracil was infused into the hepatic artery for 15 weeks. Computed tomography at 3 months showed disappearance of the liver metastases; the patient survived 18 months after the initial operation. Two 2023 case reports of lung adenosquamous carcinoma noted that the disease is an independent prognostic factor indicating poor prognosis; one of the two patients was diagnosed based on a skin lesion, and both were at different stages at the time of management.

What is still missing are prospective trials designed specifically for adenosquamous carcinoma rather than subgroup analyses of mixed-histology studies. No randomised data exist to confirm whether adjuvant systemic chemotherapy is superior to radiotherapy for cervical disease, and the single case of hepatic-artery infusion for rectal adenosquamous carcinoma cannot be generalised. Patient stratification by site, stage, and molecular features is absent, and funding for dedicated trials remains scarce.