Malignancy with benign course – basaloid squamous cell carcinoma: A rare diagnosis

Abstract

A 45-year-old male presented with a 3 mm × 3 mm painless, slow-growing, gelatinous, freely mobile, benign-looking mass on the temporal side of the limbus in the conjunctiva of the right eye for 1 year. Other ophthalmic findings were unremarkable. Orbital computed tomography showed no orbital involvement or localized lymphadenopathy. The mass was excised with a healthy collar of 3 mm, and the sample was sent for histopathological examination (HPE). The patient was followed up with usual signs of healing. The case took a surprising turn when HPE showed areas of keratin pearls of squamous origin along with lobules of malignant cells displaying nuclear palisading and basal cell nests, thereby diagnosing basaloid squamous cell carcinoma of the conjunctiva. Positive staining for 34βE12 and negative for BCL-2 on immunohistochemistry confirmed it. Identification is extremely important due to its aggressive course with frequent recurrences and distant metastasis. It has been reported only thrice before in the literature.

Keywords

• basaloid squamous cell carcinoma
• keratin pearl
• no-touch technique