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  = squamous carcinoma of the lung
| Synonyms  = squamous carcinoma of the lung
| Micro      =
| Micro      =
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| LMDDx      = [[lung adenocarcinoma]], [[non-small cell lung carcinoma]], metastatic [[squamous cell carcinoma]], others
| 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  =
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| Gross      =
| Gross      =
| Grossing  =
| Grossing  =
| Staging    = [[lung cancer staging]]
| Site      = [[lung]] - see [[lung tumours]]
| Site      = [[lung]] - see [[lung tumours]]
| Assdx      =
| Assdx      =
Line 23: Line 24:
| Prevalence = common
| Prevalence = common
| Bloodwork  = serum calcium elevated
| Bloodwork  = serum calcium elevated
| Rads      = typically a large airway mass, +/-spiculated, +/-cavitation
| Rads      = typically a mass assoc. with a large airway, +/-spiculated, +/-cavitation
| Endoscopy  =
| Endoscopy  =
| Prognosis  = usually poor
| 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        = surgical if possible resection
| 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]].
'''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]]''' can be abbreviated '''[[SCC]]'''; however, this can be confusing as ''[[small cell carcinoma]]'' is sometimes abbreviated as such.


==General==
==General==
Line 41: Line 46:


==Gross==
==Gross==
*Usually centrally located, i.e. large airways.
*Lung mass - usually centrally located, i.e. associated with a large airway.


===Image===
===Image===
Line 53: 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, also lung squamous cell carcinoma, is a common malignant lung tumour that is associated with smoking.

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

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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