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

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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>
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>


Grading system - as loosely defined by the CAP protocol (version 3.4.0.0):<ref name=cap_protocol_v3400/>
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 1 (well differentiated) -  extensive keratinization.
*Grade 2 (moderately differentiated) - some keratinization.
*Grade 2 (moderately differentiated) - some keratinization.

Revision as of 16:39, 23 March 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.

Sign out

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.
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