Difference between revisions of "Squamous cell carcinoma of the lung"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Squamous carcinoma lung cytology.gif
| Image      = Lung squamous carcinoma -- intermed mag.jpg
| Width      =
| Width      =
| Caption    = Squamous cell carcinoma of the lung. [[Pap stain]].
| Caption    = Squamous cell carcinoma of the lung. [[H&E stain]].
| Synonyms  =
| Synonyms  = squamous carcinoma of the lung
| Micro      =
| Micro      =
| Subtypes  =
| Subtypes  =
| LMDDx      = [[lung adenocarcinoma]], [[large cell lung carcinoma]], metastatic [[squamous cell carcinoma]]
| LMDDx      = [[lung adenocarcinoma]], [[non-small cell lung carcinoma]], metastatic [[squamous cell carcinoma]], others
| Stains    =
| Stains    =
| IHC        = p40 +ve, p63 +ve, TTF-1 -ve, CK7 -ve
| IHC        = [[p40]] +ve, [[p63]] +ve, [[TTF-1]] -ve, CK7 -ve
| EM        =
| EM        =
| Molecular  =
| Molecular  =
Line 15: Line 15:
| Gross      =
| Gross      =
| Grossing  =
| Grossing  =
| Staging    = [[lung cancer staging]]
| Site      = [[lung]] - see [[lung tumours]]
| Site      = [[lung]] - see [[lung tumours]]
| Assdx      =
| Assdx      =
Line 20: Line 21:
| Clinicalhx = [[smoking]]
| Clinicalhx = [[smoking]]
| Signs      =
| Signs      =
| Symptoms  =
| Symptoms  = +/-hemoptysis
| Prevalence = common
| Prevalence = common
| Bloodwork  = serum calcium elevated
| Bloodwork  = serum calcium elevated
| Rads      = large airway mass, +/-spiculated, +/-cavitation
| Rads      = typically a mass assoc. with a large airway, +/-spiculated, +/-cavitation
| Endoscopy  =
| Endoscopy  =
| Prognosis  =
| Prognosis  = usually poor
| Other      =
| Other      =
| ClinDDx    = other [[lung tumours]] - esp. [[small cell carcinoma of the lung]]
| ClinDDx    = other [[lung tumours]] - esp. [[small cell carcinoma of the lung]]
| Tx        =
| Tx        = surgical resection if possible
}}
}}
'''Squamous cell carcinoma of the lung''', also '''lung squamous cell carcinoma''', is a common [[cancer|malignant]] [[lung tumour]] that is associated with [[smoking]].


It is also known as '''squamous carcinoma of the lung''' and '''lung squamous carcinoma'''.


'''Squamous cell carcinoma of the lung''', also '''lung squamous cell carcinoma''', is a common [[cancer|malignant]] [[lung tumour]] that is associated with [[smoking]].
'''[[Squamous cell carcinoma]]''' can be abbreviated '''[[SCC]]'''; however, this can be confusing as ''[[small cell carcinoma]]'' is sometimes abbreviated as such.


==General==
==General==
Line 40: Line 43:
Clinical:
Clinical:
*May be associated with elevated serum calcium.<ref name=pmid1831917>{{Cite journal  | last1 = Campbell | first1 = JH. | last2 = Ralston | first2 = S. | last3 = Boyle | first3 = IT. | last4 = Banham | first4 = SW. | title = Symptomatic hypercalcaemia in lung cancer. | journal = Respir Med | volume = 85 | issue = 3 | pages = 223-7 | month = May | year = 1991 | doi =  | PMID = 1831917 }}</ref>
*May be associated with elevated serum calcium.<ref name=pmid1831917>{{Cite journal  | last1 = Campbell | first1 = JH. | last2 = Ralston | first2 = S. | last3 = Boyle | first3 = IT. | last4 = Banham | first4 = SW. | title = Symptomatic hypercalcaemia in lung cancer. | journal = Respir Med | volume = 85 | issue = 3 | pages = 223-7 | month = May | year = 1991 | doi =  | PMID = 1831917 }}</ref>
*+/-Hemoptysis.


==Gross==
==Gross==
*Usually centrally located, i.e. large airways.
*Lung mass - usually centrally located, i.e. associated with a large airway.
 
===Image===
<gallery>
Image: Ca_bronchus.jpg | Squamous carcinoma of the lung. (WC)
</gallery>


==Microscopic==
==Microscopic==
Line 49: Line 58:
*Dense appearing cytoplasm, usu. eosinophilic.
*Dense appearing cytoplasm, usu. eosinophilic.
*+/-Small nucleolus.
*+/-Small nucleolus.
*Intracellular bridges - classic.
Note:
*[[Lymphovascular invasion]] (LVI) is relatively common in small tumours. In one series of NSLC tumours less than 2 cm the prevalence of LVI was 16%.<ref>{{cite journal |author=Tao H, Hayashi T, Sano F, ''et al.'' |title=Prognostic impact of lymphovascular invasion compared with that of visceral pleural invasion in patients with pN0 non-small-cell lung cancer and a tumor diameter of 2 cm or smaller |journal=J. Surg. Res. |volume=185 |issue=1 |pages=250–4 |year=2013 |month=November |pmid=23830361 |doi=10.1016/j.jss.2013.05.104 |url=}}</ref>
**Unlike in [[lung adenocarcinoma]], LVI in lung SCC does ''not'' seem to increase the risk of distant metastases and death.<ref name=pmid22617241>{{cite journal |author=Higgins KA, Chino JP, Ready N, ''et al.'' |title=Lymphovascular invasion in non-small-cell lung cancer: implications for staging and adjuvant therapy |journal=J Thorac Oncol |volume=7 |issue=7 |pages=1141–7 |year=2012 |month=July |pmid=22617241 |doi=10.1097/JTO.0b013e3182519a42 |url=}}</ref>


DDx:
DDx:
*Metastatic [[squamous cell carcinoma]].
*Metastatic [[squamous cell carcinoma]].
*[[Adenocarcinoma of the lung]].
*[[Adenocarcinoma of the lung]].
*[[Non-small cell lung carcinoma]] - diagnosis should be avoid if possible.
*[[Non-small cell lung carcinoma]] - diagnosis should be avoided if possible.
*[[Small cell carcinoma of the lung]] - for ''basaloid squamous cell carcinoma''.
 
===Grading===
There is no consensus on how grading of lung SCC should be done; however, a three tiered system is suggested in the CAP protocol,<ref name=cap_protocol_v3400>URL: [http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf]. Version: 3.4.0.0. Accessed on: 23 March 2016.</ref> and some older data is suggestive that such a system for lung SCC can be predictive.<ref name=pmid7092385>{{Cite journal  | last1 = Chung | first1 = CK. | last2 = Zaino | first2 = R. | last3 = Stryker | first3 = JA. | last4 = O'Neill | first4 = M. | last5 = DeMuth | first5 = WE. | title = Carcinoma of the lung: evaluation of histological grade and factors influencing prognosis. | journal = Ann Thorac Surg | volume = 33 | issue = 6 | pages = 599-604 | month = Jun | year = 1982 | doi =  | PMID = 7092385 }}</ref>
 
The grading system loosely defined by the CAP protocol (version 3.4.0.0):<ref name=cap_protocol_v3400/>
*Grade 1 (well differentiated) -  extensive keratinization.
*Grade 2 (moderately differentiated) - some keratinization.
*Grade 3 (poorly differentiated) - no/little keratinization.
 
===Images===
<gallery>
Image: Lung squamous carcinoma -- very low mag.jpg | Lung SCC - very low mag. (WC)
Image: Lung squamous carcinoma -- low mag.jpg | Lung SCC - low mag. (WC)
Image: Lung squamous carcinoma -- intermed mag.jpg | Lung SCC - intermed. mag. (WC)
Image: Lung squamous carcinoma -- high mag.jpg | Lung SCC - high mag. (WC)
Image: Lung squamous carcinoma - alt -- low mag.jpg | Lung SCC - low mag. (WC)
Image: Lung squamous carcinoma - alt -- intermed mag.jpg | Lung SCC - intermed. mag. (WC)
</gallery>
====Cytology====
<gallery>
Image: Squamous carcinoma lung cytology.gif | Lung SCC - cytology. (WC)
</gallery>


==IHC==
==IHC==
*p40 +ve.<ref name=pmid22056955>{{Cite journal  | last1 = Bishop | first1 = JA. | last2 = Teruya-Feldstein | first2 = J. | last3 = Westra | first3 = WH. | last4 = Pelosi | first4 = G. | last5 = Travis | first5 = WD. | last6 = Rekhtman | first6 = N. | title = p40 (ΔNp63) is superior to p63 for the diagnosis of pulmonary squamous cell carcinoma. | journal = Mod Pathol | volume = 25 | issue = 3 | pages = 405-15 | month = Mar | year = 2012 | doi = 10.1038/modpathol.2011.173 | PMID = 22056955 }}</ref>
*p40 +ve.<ref name=pmid22056955>{{Cite journal  | last1 = Bishop | first1 = JA. | last2 = Teruya-Feldstein | first2 = J. | last3 = Westra | first3 = WH. | last4 = Pelosi | first4 = G. | last5 = Travis | first5 = WD. | last6 = Rekhtman | first6 = N. | title = p40 (ΔNp63) is superior to p63 for the diagnosis of pulmonary squamous cell carcinoma. | journal = Mod Pathol | volume = 25 | issue = 3 | pages = 405-15 | month = Mar | year = 2012 | doi = 10.1038/modpathol.2011.173 | PMID = 22056955 }}</ref>
**p63 +ve -- less specific.
**p63 +ve -- less specific.
*Calponin -ve.
*CK5/6 +ve.
Others:<ref name=pmid24126803>{{Cite journal  | last1 = Montezuma | first1 = D. | last2 = Azevedo | first2 = R. | last3 = Lopes | first3 = P. | last4 = Vieira | first4 = R. | last5 = Cunha | first5 = AL. | last6 = Henrique | first6 = R. | title = A panel of four immunohistochemical markers (CK7, CK20, TTF-1, and p63) allows accurate diagnosis of primary and metastatic lung carcinoma on biopsy specimens. | journal = Virchows Arch | volume = 463 | issue = 6 | pages = 749-54 | month = Dec | year = 2013 | doi = 10.1007/s00428-013-1488-z | PMID = 24126803 }}</ref>
*CK7 -ve.
*CK20 -ve.
*TTF-1 -ve.
*TTF-1 -ve.
**Positive in adenocarcinoma.
**Positive in [[adenocarcinoma of the lung]].
*Calponin -ve.
 
===SCC versus adenocarcinoma===
*p40 +ve.
*CK5/6 +ve.
*CK5/6 +ve.
*TTF-1 -ve.
*[[Napsin]] -ve.
===Lung SCC versus metastatic bladder urothelial carcinoma===
As per Gruver ''et al.'':<ref name=pmid23106579>{{Cite journal  | last1 = Gruver | first1 = AM. | last2 = Amin | first2 = MB. | last3 = Luthringer | first3 = DJ. | last4 = Westfall | first4 = D. | last5 = Arora | first5 = K. | last6 = Farver | first6 = CF. | last7 = Osunkoya | first7 = AO. | last8 = McKenney | first8 = JK. | last9 = Hansel | first9 = DE. | title = Selective immunohistochemical markers to distinguish between metastatic high-grade urothelial carcinoma and primary poorly differentiated invasive squamous cell carcinoma of the lung. | journal = Arch Pathol Lab Med | volume = 136 | issue = 11 | pages = 1339-46 | month = Nov | year = 2012 | doi = 10.5858/arpa.2011-0575-OA | PMID = 23106579 }}</ref>
{| class="wikitable sortable"
! IHC
! Lung <Br>SCC
! Bladder <br>[[urothelial carcinoma|UCC]]
|-
| CK7
| 33% +ve
| 100% +ve
|-
| CK20
| 7% +ve
| 54% +ve
|-
| GATA-3
| 23% +ve
| 78% +ve
|-
| Desmoglein-3
| 87% +ve
| 11% +ve
|-
| CK14
| 77% +ve
| 32% +ve
|-
| Uroplakin III
| 0% +ve
| 14% +ve
|}
==Sign out==
<pre>
Lung, Right Upper Lobe, Core Biopsy:
- SQUAMOUS CELL CARCINOMA.
COMMENT:
The tumour stains as follows:
POSITIVE: p40, CK5/6.
NEGATIVE: TTF-1, napsin.
</pre>
===Block letters===
<pre>
LUNG, RIGHT UPPER LOBE, BIOPSY:
- INVASIVE SQUAMOUS CELL CARCINOMA.
COMMENT:
The tumour stains as follows:
POSITIVE: p40, CK5/6.
NEGATIVE: TTF-1, napsin.
</pre>
===Resection===
<pre>
LUNG, RIGHT UPPER LOBE, LOBECTOMY:
- SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED, pT2b, pN0.
-- MARGINS NEGATIVE.
-- PLEASE SEE TUMOUR SUMMARY.
</pre>


==See also==
==See also==
*[[Squamous cell carcinoma]].
*[[Squamous cell carcinoma]].
*[[Lung tumours]].
*[[Lung tumours]].
*[[Lung cytopathology]].


==References==
==References==

Latest revision as of 17:22, 20 December 2016

Squamous cell carcinoma of the lung
Diagnosis in short

Squamous cell carcinoma of the lung. H&E stain.
Synonyms squamous carcinoma of the lung
LM DDx lung adenocarcinoma, non-small cell lung carcinoma, metastatic squamous cell carcinoma, others
IHC p40 +ve, p63 +ve, TTF-1 -ve, CK7 -ve
Staging lung cancer staging
Site lung - see lung tumours
Clinical history smoking
Symptoms +/-hemoptysis
Prevalence common
Blood work serum calcium elevated
Radiology typically a mass assoc. with a large airway, +/-spiculated, +/-cavitation
Prognosis usually poor
Clin. DDx other lung tumours - esp. small cell carcinoma of the lung
Treatment surgical resection if possible

Squamous cell carcinoma of the lung, also lung squamous cell carcinoma, is a common malignant lung tumour that is associated with smoking.

It is also known as squamous carcinoma of the lung and lung squamous carcinoma.

Squamous cell carcinoma can be abbreviated SCC; however, this can be confusing as small cell carcinoma is sometimes abbreviated as such.

General

  • Strong association with smoking.
  • May be treated with surgery.

Clinical:

  • May be associated with elevated serum calcium.[1]
  • +/-Hemoptysis.

Gross

  • Lung mass - usually centrally located, i.e. associated with a large airway.

Image

  • Squamous carcinoma of the lung. (WC)

Microscopic

Features:

  • Central nucleus.
  • Dense appearing cytoplasm, usu. eosinophilic.
  • +/-Small nucleolus.
  • Intracellular bridges - classic.

Note:

  • Lymphovascular invasion (LVI) is relatively common in small tumours. In one series of NSLC tumours less than 2 cm the prevalence of LVI was 16%.[2]
    • Unlike in lung adenocarcinoma, LVI in lung SCC does not seem to increase the risk of distant metastases and death.[3]

DDx:

Grading

There is no consensus on how grading of lung SCC should be done; however, a three tiered system is suggested in the CAP protocol,[4] and some older data is suggestive that such a system for lung SCC can be predictive.[5]

The grading system loosely defined by the CAP protocol (version 3.4.0.0):[4]

  • Grade 1 (well differentiated) - extensive keratinization.
  • Grade 2 (moderately differentiated) - some keratinization.
  • Grade 3 (poorly differentiated) - no/little keratinization.

Images

  • Lung SCC - very low mag. (WC)

  • Lung SCC - low mag. (WC)

  • Lung SCC - intermed. mag. (WC)

  • Lung SCC - high mag. (WC)

  • Lung SCC - low mag. (WC)

  • Lung SCC - intermed. mag. (WC)

Cytology

  • Lung SCC - cytology. (WC)

IHC

  • p40 +ve.[6]
    • p63 +ve -- less specific.
  • Calponin -ve.
  • CK5/6 +ve.

Others:[7]

SCC versus adenocarcinoma

  • p40 +ve.
  • CK5/6 +ve.
  • TTF-1 -ve.
  • Napsin -ve.

Lung SCC versus metastatic bladder urothelial carcinoma

As per Gruver et al.:[8]

IHC Lung
SCC 		Bladder
UCC
CK7 33% +ve 100% +ve
CK20 7% +ve 54% +ve
GATA-3 23% +ve 78% +ve
Desmoglein-3 87% +ve 11% +ve
CK14 77% +ve 32% +ve
Uroplakin III 0% +ve 14% +ve

Sign out

Lung, Right Upper Lobe, Core Biopsy:
	- SQUAMOUS CELL CARCINOMA.

COMMENT:
The tumour stains as follows:
POSITIVE: p40, CK5/6.
NEGATIVE: TTF-1, napsin.

Block letters

LUNG, RIGHT UPPER LOBE, BIOPSY:
- INVASIVE SQUAMOUS CELL CARCINOMA.

COMMENT:
The tumour stains as follows:
POSITIVE: p40, CK5/6.
NEGATIVE: TTF-1, napsin.

Resection

LUNG, RIGHT UPPER LOBE, LOBECTOMY:
- SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED, pT2b, pN0.
-- MARGINS NEGATIVE.
-- PLEASE SEE TUMOUR SUMMARY.

See also

References

  1. ↑ Campbell, JH.; Ralston, S.; Boyle, IT.; Banham, SW. (May 1991). "Symptomatic hypercalcaemia in lung cancer.". Respir Med 85 (3): 223-7. PMID 1831917.
  2. ↑ Tao H, Hayashi T, Sano F, et al. (November 2013). "Prognostic impact of lymphovascular invasion compared with that of visceral pleural invasion in patients with pN0 non-small-cell lung cancer and a tumor diameter of 2 cm or smaller". J. Surg. Res. 185 (1): 250–4. doi:10.1016/j.jss.2013.05.104. PMID 23830361.
  3. ↑ Higgins KA, Chino JP, Ready N, et al. (July 2012). "Lymphovascular invasion in non-small-cell lung cancer: implications for staging and adjuvant therapy". J Thorac Oncol 7 (7): 1141–7. doi:10.1097/JTO.0b013e3182519a42. PMID 22617241.
  4. ↑ 4.0 4.1 URL: http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-lung-16protocol-3400.pdf. Version: 3.4.0.0. Accessed on: 23 March 2016.
  5. ↑ Chung, CK.; Zaino, R.; Stryker, JA.; O'Neill, M.; DeMuth, WE. (Jun 1982). "Carcinoma of the lung: evaluation of histological grade and factors influencing prognosis.". Ann Thorac Surg 33 (6): 599-604. PMID 7092385.
  6. ↑ Bishop, JA.; Teruya-Feldstein, J.; Westra, WH.; Pelosi, G.; Travis, WD.; Rekhtman, N. (Mar 2012). "p40 (ΔNp63) is superior to p63 for the diagnosis of pulmonary squamous cell carcinoma.". Mod Pathol 25 (3): 405-15. doi:10.1038/modpathol.2011.173. PMID 22056955.
  7. ↑ Montezuma, D.; Azevedo, R.; Lopes, P.; Vieira, R.; Cunha, AL.; Henrique, R. (Dec 2013). "A panel of four immunohistochemical markers (CK7, CK20, TTF-1, and p63) allows accurate diagnosis of primary and metastatic lung carcinoma on biopsy specimens.". Virchows Arch 463 (6): 749-54. doi:10.1007/s00428-013-1488-z. PMID 24126803.
  8. ↑ Gruver, AM.; Amin, MB.; Luthringer, DJ.; Westfall, D.; Arora, K.; Farver, CF.; Osunkoya, AO.; McKenney, JK. et al. (Nov 2012). "Selective immunohistochemical markers to distinguish between metastatic high-grade urothelial carcinoma and primary poorly differentiated invasive squamous cell carcinoma of the lung.". Arch Pathol Lab Med 136 (11): 1339-46. doi:10.5858/arpa.2011-0575-OA. PMID 23106579.
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