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Difference between revisions of "Squamous cell carcinoma of the head and neck"
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Squamous cell carcinoma of the head and neck (view source)
Revision as of 18:09, 5 March 2024
, 5 Marchno edit summary
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| Micro = | | Micro = | ||
| Subtypes = keratinizing type, undifferentiated type, nonkeratinizing type | | 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]] | | 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 = | | Stains = | ||
| IHC = p63 +ve, CK5/6, p16 -ve, EBER -ve | | IHC = p63 +ve, CK5/6, p16 -ve, EBER -ve | ||
| Line 15: | Line 15: | ||
| Gross = | | Gross = | ||
| Grossing = | | Grossing = | ||
| Site = [[head and neck pathology|head and neck]] | | Site = [[head and neck pathology|head and neck]] - [[Squamous cell carcinoma of the tongue|tongue (dealt with separately)]] | ||
| Assdx = | | Assdx = | ||
| Syndromes = | | Syndromes = | ||
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'''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]]. | '''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]]. | ||
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. | 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. | ||
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==Microscopic== | ==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. | ||
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==== | ====Invasion==== | ||
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Notes on invasion: | Notes on invasion: | ||
* | *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]]''. | ||
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*Need keratinization. (???) | *Need keratinization. (???) | ||
====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== | ==Sign out== | ||
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LESION, TONGUE/FLOOR OF MOUTH BORDER, BIOPSY: | LESION, TONGUE/FLOOR OF MOUTH BORDER, BIOPSY: | ||
- INVASIVE KERATINIZING SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED. | - 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> | </pre> | ||
===Micro=== | ===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. | 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. | ||