Squamous cell carcinoma of the uterine cervix: Difference between revisions

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#redirect [[Uterine_cervix#Squamous_cell_carcinoma_of_the_uterine_cervix]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Cervical squamous cell carcinoma in situ.jpg
| Width      =
| Caption    = Cervical squamous cell carcinoma in situ. [[H&E stain]].
| Synonyms  =
| Micro      =
| Subtypes  =
| LMDDx      = [[squamous metaplasia of the uterine cervix]], [[high-grade squamous intraepithelial lesion]]
| Stains    =
| IHC        = p16 +ve
| EM        =
| Molecular  =
| IF        =
| Gross      = white lesion ~ usu. close to transformation zone
| Grossing  =
| Site      = [[uterine cervix]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = most common cervical malignancy
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = usu. good, dependent on stage
| Other      =
| ClinDDx    =
| Tx        = cervical cone, radical hysterectomy
}}
'''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>
==Gross==
*White lesion.
*Firm.
===Images===
<gallery>
Image:Squamous carcinoma of the cervix.jpg | SCC of cervix. (WC)
</gallery>
==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 [[high-grade squamous intraepithelial lesion]] (carcinoma in situ):
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>
*[[High-grade squamous intraepithelial lesion]] +/- endocervical gland involvement.
===Images===
<gallery>
Image:Cervical squamous cell carcinoma in situ.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==
*CK7, p63, p16 +ve (except verrucous variant)
*Factor VIII - to look for [[LVI]].
==Sign out==
===Biopsy===
Early invasive SCC - things to report:
*Depth of invasion.
*Length of tumour.
*Number of blocks with tumour.
*[[Lymphovascular invasion]] (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>
<pre>
LESION, UTERINE CERVIX, BIOPSY:
- INVASIVE SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED, FRAGMENTED.
- PLEASE SEE TUMOUR SUMMARY.
TUMOUR SUMMARY - UTERINE CERVIX
Specimen: Cervix.
Procedure: Biopsy.
Tumour Site: Cannot be determined.
Tumour Size: Cannot be determined - see comment.
Histologic Type: Squamous cell carcinoma, keratinizing.
Histologic Grade: G2: Moderately differentiated.
Stromal Invasion: Extent cannot be assessed - see comment.
Lymph-Vascular Invasion: Not identified.
Comment:
The tissue submitted is essentially all tumour. The largest fragment measures 1.2 x 1.4 cm
in the plane of section. Fragmentation and lack of normal histology preclude orientation.
As both the in plane dimensions exceed 0.7 cm, this is at least a pT1b.
</pre>
===TAH-BSO===
<pre>
UTERUS, CERVIX, RIGHT AND LEFT OVARIES AND BILATERAL UTERINE TUBES, TOTAL HYSTERECTOMY AND
BILATERAL SALPINGO-OOPHORECTOMY:
- INVASIVE SQUAMOUS CELL CARCINOMA, pT1a1, pNx.
-- MARGINS NEGATIVE FOR MALIGNANCY.
-- PLEASE SEE TUMOUR SUMMARY.
- PROLIFERATIVE ENDOMETRIUM.
- UTERINE LEIOMYOMAS.
- UTERINE TUBES WITH CHANGES COMPATIBLE WITH LIGATION, NO SIGNIFICANT PATHOLOGY.
- OVARIES WITHOUT SIGNIFICANT PATHOLOGY.
</pre>
==See also==
*[[Uterine cervix]].
*[[Squamous cell carcinoma]].
==References==
{{Reflist|2}}
[[Category:Uterine cervix]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]
Retrieved from "https://librepathology.org/wiki/Squamous_cell_carcinoma_of_the_uterine_cervix"