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Squamous cell carcinoma of the head and neck (view source)

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'''Squamous cell carcinoma of the head and neck''' is a common malignant epithelium neoplasm of the [[head and neck pathology|head and neck]].
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Laryngeal squamous carcinoma -- high mag.jpg
| Width      =
| Caption    = Squamous cell carcinoma of the head and neck (larynx). [[H&E stain]].
| Synonyms  = squamous cell carcinoma of the head and neck not otherwise specified
| Micro      =
| Subtypes  = keratinizing type, undifferentiated type, nonkeratinizing type
| LMDDx      = [[squamous dysplasia of the head and neck]], [[HPV-associated head and neck squamous cell carcinoma]], [[nasopharyngeal carcinoma]], [[malignant melanoma]], metastatic [[squamous cell carcinoma]] (esp. [[skin SCC]] of lateral head), [[NUT carcinoma]], [[pseudoepitheliomatous hyperplasia]]
| Stains    =
| IHC        = p63 +ve, CK5/6, p16 -ve, EBER -ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[head and neck pathology|head and neck]] - [[Squamous cell carcinoma of the tongue|tongue (dealt with separately)]]
| Assdx      =
| Syndromes  =
| Clinicalhx = [[smoking]], excessive drinking
| Signs      =
| Symptoms  =
| Prevalence = common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = moderate-to-poor
| Other      =
| ClinDDx    =
| Tx        = surgery, radiation
}}
'''Squamous cell carcinoma of the head and neck''', abbreviated '''head and neck SCC''', is a common [[malignant]] epithelium neoplasm of the [[head and neck pathology|head and neck]].


The article deals only with the unclassified [[squamous cell carcinoma]] of the head and neck; HPV-associated SCC is dealt with in ''[[HPV-associated squamous cell carcinoma of the head and neck]]'' and nasopharyngeal carcinoma is dealt with in ''[[nasopharyngeal carcinoma]]''.
This is an overview article that deals only with the usual [[squamous cell carcinoma]] of the head and neck, or ''squamous cell carcinoma of the head and neck not otherwise specified'' (abbreviated ''SCC of the H&N [[NOS]]'').
 
[[Squamous cell carcinoma of the tongue|Tongue squamous cell carcinoma]] is dealt with in separate article.
 
The [[human papilloma virus]]-associated SCC is dealt with in ''[[HPV-associated head and neck squamous cell carcinoma]]''. ''[[Nasopharyngeal carcinoma]]'' is also dealt with separately.


==General==
==General==
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*Most common spindle cell tumour of the head & neck.
*Most common spindle cell tumour of the head & neck.


==Microscopic==
===Classification===
===Classification===
SCC is subdivided by the WHO into:<ref name=Ref_Sternberg4_975>{{Ref Sternberg4|975}}</ref>
SCC is subdivided by the WHO into:<ref name=Ref_Sternberg4_975>{{Ref Sternberg4|975}}</ref>
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**EBV association.
**EBV association.


==Microscopic==
Features based on classification:<ref name=Ref_Sternberg4_975>{{Ref Sternberg4|975}}</ref>
Features based on classification:<ref name=Ref_Sternberg4_975>{{Ref Sternberg4|975}}</ref>
*KT subtype:  
*Keratinizing type (KT) subtype:  
**Keratinization & intercellular bridges through-out most of the malignant lesion.
**Keratinization & intercellular bridges through-out most of the malignant lesion.
*UT:
*Undifferentiated type (UT):
**Non-distinct borders/syncytial pattern.
**Non-distinct borders/syncytial pattern.
**Nucleoli.
**Nucleoli.
*NT:
*Nonkeratinizing (NT):
**Well-defined cell borders.
**Well-defined cell borders.


===Invasion===
DDx:
*[[SMARCB1-deficient sinonasal carcinoma]].
*[[Sinonasal undifferentiated carcinoma]].
*[[Human papillomavirus-related multiphenotypic sinonasal carcinoma]] - previously known as ''HPV-related carcinoma with adenoid cystic-like features''.
*[[NUT carcinoma]] - has well-differentiated squamous "islands" that are sharply demarcated from poorly differentiated surrounding tumour.
*[[Neuroendocrine tumour]].
*Metastatic [[skin SCC|squamous cell carcinoma of skin]] - esp. parotid lesions, history of skin SCC (esp. lateral aspect of head).<ref name=pmid16783833>{{cite journal |authors=Vauterin TJ, Veness MJ, Morgan GJ, Poulsen MG, O'Brien CJ |title=Patterns of lymph node spread of cutaneous squamous cell carcinoma of the head and neck |journal=Head Neck |volume=28 |issue=9 |pages=785–91 |date=September 2006 |pmid=16783833 |doi=10.1002/hed.20417 |url=}}</ref>
*[[Pseudoepitheliomatous hyperplasia]].
 
====Invasion====
Features:
Features:
*Eosinophilia.
*Eosinophilia.
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Notes on invasion:
Notes on invasion:
*Nice review paper by ''Wenig''.<ref name=pmid11904340>{{cite journal |author=Wenig BM |title=Squamous cell carcinoma of the upper aerodigestive tract: precursors and problematic variants |journal=Mod. Pathol. |volume=15 |issue=3 |pages=229–54 |year=2002 |month=March |pmid=11904340 |doi=10.1038/modpathol.3880520 |url=http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf}}</ref>
*Reviewed by ''Wenig''.<ref name=pmid11904340>{{cite journal |author=Wenig BM |title=Squamous cell carcinoma of the upper aerodigestive tract: precursors and problematic variants |journal=Mod. Pathol. |volume=15 |issue=3 |pages=229–54 |year=2002 |month=March |pmid=11904340 |doi=10.1038/modpathol.3880520 |url=http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf}}</ref>
*See ''[[SCC of the cervix versus CIN III]]''.
*See ''[[SCC of the cervix versus CIN III]]''.


Image(s):
===Images===
*[http://commons.wikimedia.org/wiki/File:Oral_cancer_(1)_squamous_cell_carcinoma_histopathology.jpg?uselang=de Invasive oral SCC (WC)].
<gallery>
Image:Oral_cancer_(1)_squamous_cell_carcinoma_histopathology.jpg | Invasive oral SCC. (WC)
</gallery>
<gallery>
Image: Laryngeal squamous carcinoma -- intermed mag.jpg | Laryngeal SCC - intermed. mag.
Image: Laryngeal squamous carcinoma -- high mag.jpg | Laryngeal SCC - high mag.
Image: Laryngeal squamous carcinoma -- very high mag.jpg | Laryngeal SCC - very high mag.
</gallery>


==Overview of subtypes==
===Overview of subtypes===
There are several subtypes:<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970297-2 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970297-2]. Accessed on: March 9, 2010.</ref>
There are several subtypes:<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970297-2 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970297-2]. Accessed on: March 9, 2010.</ref>
*Basaloid - poor prognosis, usu. diagnosed by recognition of typical SCC.
*Basaloid - poor prognosis, usu. diagnosed by recognition of typical SCC.
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*Spindle cell, a common spindle cell lesion of the H&N.
*Spindle cell, a common spindle cell lesion of the H&N.


===Verrucous squamous cell carcinoma===
====Verrucous squamous cell carcinoma====
Features:
Features:
*Exophytic growth.
*Exophytic growth.
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DDx: papilloma.
DDx: papilloma.


===Spindle cell squamous carcinoma===
====Spindle cell squamous carcinoma====
*Key to diagnosis is finding a component of conventional squamous cell carcinoma.
*Key to diagnosis is finding a component of conventional squamous cell carcinoma.


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*Mesenchymal neoplasm.
*Mesenchymal neoplasm.


===Basaloid squamous cell carcinoma===
====Basaloid squamous cell carcinoma====
*May mimic ''[[adenoid cystic carcinoma]]''.
*May mimic ''[[adenoid cystic carcinoma]]''.
*Classically base of tongue.<ref>URL: [http://www.biomedcentral.com/1471-2407/6/146 http://www.biomedcentral.com/1471-2407/6/146]. Accessed on: March 9, 2010.</ref>
*Classically base of tongue.<ref>URL: [http://www.biomedcentral.com/1471-2407/6/146 http://www.biomedcentral.com/1471-2407/6/146]. Accessed on: March 9, 2010.</ref>
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*Need keratinization. (???)
*Need keratinization. (???)


DDx:
*Neuroendocrine tumour.


===Lymphoepithelial (squamous cell) carcinoma===
====Lymphoepithelial (squamous cell) carcinoma====
See ''[[nasopharyngeal carcinoma]]''.
See ''[[nasopharyngeal carcinoma]]''.
==IHC==
*[[p63]] +ve.
*[[p16]] -ve.
**Positive suggests [[HPV-associated head and neck squamous cell carcinoma]].
*Bcl2 +ve/-ve.
**Positive = poor prognosis.<ref name=pmid20233885>{{cite journal |author=Nichols AC, Finkelstein DM, Faquin WC, ''et al.'' |title=Bcl2 and human papilloma virus 16 as predictors of outcome following concurrent chemoradiation for advanced oropharyngeal cancer |journal=Clin. Cancer Res. |volume=16 |issue=7 |pages=2138–46 |year=2010 |month=April |pmid=20233885 |doi=10.1158/1078-0432.CCR-09-3185 |url=}}</ref>
==Molecular==
*[[EBER]] -ve.
**Positive suggests [[nasopharyngeal carcinoma]].
==Sign out==
<pre>
LESION, TONGUE/FLOOR OF MOUTH BORDER, BIOPSY:
- INVASIVE KERATINIZING SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED.
</pre>
<pre>
LEFT NECK (LONG SUTURE LEVEL IA AND SHORT SUTURE LEVEL IIB), LEVEL
  I-IV, DISSECTION:
- LEVEL IA:
-- ONE LYMPH NODE WITH SQUAMOUS CELL CARCINOMA, AND FOUR LYMPH NODES
  NEGATIVE FOR MALIGNANCY (1 POSITIVE/5).
-- BENIGN SALIVARY GLAND.
-- SEE COMMENT.
- LEVEL IIA:
-- FIVE LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/5).
- LEVEL III:
-- FIVE LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/5).
- LEVEL IV:
-- TEN LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/10).
COMMENT:
The squamous cell carcinoma is moderately differentiated and shows rare
keratinization. The tumour lies adjacent to benign (submandibular) salivary
gland which it does not involve.
</pre>
===Micro===
====Biopsy====
The section shows atypical (squamous) cells with moderate grey cytoplasm, central nuclei with small nucleoli, infiltrating between fibrous tissue.  Abundant keratin pearls are present.  The nuclei are predominantly pale staining and focally have irregular nuclear membranes and irregular chromatin.  Mitotic activity is not readily apparent.  Necrosis is present focally.


==See also==
==See also==
Michael
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