Difference between revisions of "Squamous cell carcinoma of the uterine cervix"

Revision as of 14:00, 23 February 2014

Squamous cell carcinoma of the uterine cervix, also cervical squamous cell carcinoma, is the most common primary malignancy of the uterine cervix.

General

Most common type of cervical cancer.

Risk factors:

Low socioeconomic status.
Smoking.
Early first intercourse.
High risk partners.
Human papillomavirus (HPV) infection, esp. "high risk HPV".
- HPV 16 closely assoc. with SCC.^[1]

Microscopic

Features:

Squamous differentiation.
- +/-Intracellular bridges.
- Scant-to-moderate cytoplasm.
Penetration of basement membrane.
- May be challenging to determine.
Nuclear atypia.

SCC of the cervix versus CIN III: Invasive cancer look for:

Eosinophilia.
Extra large nuclei, i.e. nuclei 5x normal size.
Stromal inflammation (lymphocytes, plasma cells).
Long rete ridges.
Numerous beeds/blobs of epithelial cells that seem unlikely to be rete ridges.
Desmoplastic stroma - increased cellularity, spindle cell morphology.

DDx:

Squamous metaplasia of the uterine cervix - if you can trace the squamous cells from a gland to the surface it is less likely to be invasive cancer.^[2]
CIN III +/- endocervical gland involvement.

Images

SCC in situ. (WC)

www:

Grading

Divided into:^[5]

Well-differentiated (keratinizing).
Moderately differentiated (nonkeratinizing).
Poorly differentiated.

Depth measurement

Basement membrane (where it invades) to deepest point.

Note:

Stage Ib - clinical diagnosis.
- Definition of stage Ib: clinically visible.

FIGO

Microinvasive SCC as per FIGO:

Depth < 5 mm.
Width < 7 mm.
+/-Vascular invasion.

SGO

Microinvasive SCC as per The Society of Gynecologic Oncologists (SGO):

<= 3 mm.
Negative for vascular invasion.

Note:

The SGO criteria the prefered by North American gynecologists.

IHC

Factor VIII - to look for LVI.

Sign out

Early invasive SCC - things to report:

Depth of invasion.
Length of tumour.
Number of blocks with tumour.
LVI.
Margins.

UTERINE CERVIX, BIOPSY:
- FRAGMENTS OF INVASIVE SQUAMOUS CELL CARCINOMA.
-- DEPTH OF INVASION AND LENTH OF TUMOUR CANNOT BE ASSESSED.
-- LYMPHOVASCULAR INVASION NOT APPARENT.

References

↑ De Boer, MA.; Peters, LA.; Aziz, MF.; Siregar, B.; Cornain, S.; Vrede, MA.; Jordanova, ES.; Fleuren, GJ. (Apr 2005). "Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries.". Int J Cancer 114 (3): 422-5. doi:10.1002/ijc.20727. PMID 15551313.
↑ http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf
↑ ^3.0 ^3.1 URL: http://sunnybrook.ca/content/?page=dept-labs-apath-gynpath-imgat-cvx-mal-microiscc. Accessed on: 2 May 2013.
↑ URL: http://missinglink.ucsf.edu/lm/IDS_107_Cervix_Ovary_Uterus/homepage.htm. Accessed on: 2 May 2013.
↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1077. ISBN 0-7216-0187-1.

[pmid15551313-1] De Boer, MA.; Peters, LA.; Aziz, MF.; Siregar, B.; Cornain, S.; Vrede, MA.; Jordanova, ES.; Fleuren, GJ. (Apr 2005). "Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries.". Int J Cancer 114 (3): 422-5. doi:10.1002/ijc.20727. PMID 15551313.

[2] ttp://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf

[sb_cx_scc-3] 3.0 ^3.1 URL: http://sunnybrook.ca/content/?page=dept-labs-apath-gynpath-imgat-cvx-mal-microiscc. Accessed on: 2 May 2013.

[uscf-4] URL: http://missinglink.ucsf.edu/lm/IDS_107_Cervix_Ovary_Uterus/homepage.htm. Accessed on: 2 May 2013.

[5] Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1077. ISBN 0-7216-0187-1.

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
-#redirect [[Uterine_cervix#Squamous_cell_carcinoma_of_the_uterine_cervix]]
+'''Squamous cell carcinoma of the uterine cervix''', also '''cervical squamous cell carcinoma''', is the most common primary malignancy of the [[uterine cervix]].
+==General==
+*Most common type of cervical cancer.
+Risk factors:
+*Low socioeconomic status.
+*Smoking.
+*Early first intercourse.
+*High risk partners.
+*[[Human papillomavirus]] (HPV) infection, esp. "high risk HPV".
+**HPV 16 closely assoc. with SCC.<ref name=pmid15551313>{{Cite journal  | last1 = De Boer | first1 = MA. | last2 = Peters | first2 = LA. | last3 = Aziz | first3 = MF. | last4 = Siregar | first4 = B. | last5 = Cornain | first5 = S. | last6 = Vrede | first6 = MA. | last7 = Jordanova | first7 = ES. | last8 = Fleuren | first8 = GJ. | title = Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries. | journal = Int J Cancer | volume = 114 | issue = 3 | pages = 422-5 | month = Apr | year = 2005 | doi = 10.1002/ijc.20727 | PMID = 15551313 }}</ref>
+==Microscopic==
+Features:
+*Squamous differentiation.
+**+/-Intracellular bridges.
+**Scant-to-moderate cytoplasm.
+*Penetration of basement membrane.
+**May be challenging to determine.
+*Nuclear atypia.
+SCC of the cervix versus CIN III:
+Invasive cancer look for:
+*Eosinophilia.
+*Extra large nuclei, i.e. nuclei 5x normal size.
+*Stromal inflammation (lymphocytes, plasma cells).
+*Long rete ridges.
+*Numerous beeds/blobs of epithelial cells that seem unlikely to be rete ridges.
+*[[Desmoplastic stroma]] - increased cellularity, spindle cell morphology.
+DDx:
+* [[Squamous metaplasia of the uterine cervix]] - if you can trace the squamous cells from a gland to the surface it is less likely to be invasive cancer.<ref>[http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf]</ref>
+*[[CIN III]] +/- endocervical gland involvement.
+===Images===
+<gallery>
+Image:Ca_in_situ,_cervix_2.jpg|SCC in situ. (WC)
+</gallery>
+www:
+*[http://sunnybrook.ca/uploads/cx_microinv_scc_S10-5249_6.jpg Microinvasive cervical SCC - low mag. (sunnybrook.ca)].<ref name=sb_cx_scc/>
+*[http://sunnybrook.ca/uploads/cx_microinv_scc_S10-5249_7.jpg Microinvasive cervical SCC - high mag. (sunnybrook.ca)].<ref name=sb_cx_scc>URL: [http://sunnybrook.ca/content/?page=dept-labs-apath-gynpath-imgat-cvx-mal-microiscc http://sunnybrook.ca/content/?page=dept-labs-apath-gynpath-imgat-cvx-mal-microiscc]. Accessed on: 2 May 2013.</ref>
+*[http://missinglink.ucsf.edu/lm/IDS_107_Cervix_Ovary_Uterus/ASSETS/Slide329SCClp_small.JPG Cervical SCC - low mag. (ucsf.edu)].<ref name=uscf>URL: [http://missinglink.ucsf.edu/lm/IDS_107_Cervix_Ovary_Uterus/homepage.htm http://missinglink.ucsf.edu/lm/IDS_107_Cervix_Ovary_Uterus/homepage.htm]. Accessed on: 2 May 2013.</ref>
+*[http://missinglink.ucsf.edu/lm/IDS_107_Cervix_Ovary_Uterus/ASSETS/Slide329SCChp.JPG Cervical SCC - high mag. (uscf.edu)].
+===Grading===
+Divided into:<ref>{{Ref PBoD|1077}}</ref>
+#Well-differentiated (keratinizing).
+#Moderately differentiated (nonkeratinizing).
+#Poorly differentiated.
+===Depth measurement===
+*Basement membrane (where it invades) to deepest point.
+Note:
+*Stage Ib - clinical diagnosis.
+**Definition of stage Ib: clinically visible.
+====FIGO====
+Microinvasive SCC as per FIGO:
+*Depth < 5 mm.
+*Width < 7 mm.
+*+/-Vascular invasion.
+====SGO====
+Microinvasive SCC as per The Society of Gynecologic Oncologists (SGO):
+*<= 3 mm.
+*Negative for [[vascular invasion]].
+Note:
+*The SGO criteria the prefered by North American gynecologists.
+==IHC==
+*Factor VIII - to look for [[LVI]].
+==Sign out==
+Early invasive SCC - things to report:
+*Depth of invasion.
+*Length of tumour.
+*Number of blocks with tumour.
+*LVI.
+*Margins.
+<pre>
+UTERINE CERVIX, BIOPSY:
+- FRAGMENTS OF INVASIVE SQUAMOUS CELL CARCINOMA.
+-- DEPTH OF INVASION AND LENTH OF TUMOUR CANNOT BE ASSESSED.
+-- LYMPHOVASCULAR INVASION NOT APPARENT.
+</pre>
+==See also==
+*[[Uterine cervix]].
+*[[Squamous cell carcinoma]].
+==References==
+{{Reflist|2}}
+[[Category:Uterine cervix]]
 [[Category:Diagnosis]]