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

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Squamous cell carcinoma of the lung (view source)

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


===Image===
===Image===
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*+/-Small nucleolus.
*+/-Small nucleolus.
*Intracellular bridges - classic.
*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:
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*[[Adenocarcinoma of the lung]].
*[[Adenocarcinoma of the lung]].
*[[Non-small cell lung carcinoma]] - diagnosis should be avoided 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==
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*TTF-1 -ve.
*TTF-1 -ve.
**Positive in [[adenocarcinoma of the lung]].
**Positive in [[adenocarcinoma of the lung]].
===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.'':<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==
Michael
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