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'''Squamous dysplasia of the head and neck''', often '''squamous dysplasia''', is a | '''Squamous dysplasia of the head and neck''', often '''[[squamous dysplasia]]''', is a precursor to [[head and neck squamous cell carcinoma]]. | ||
==General== | ==General== | ||
*Similar to squamous dysplasia elsewhere. | *Similar to squamous dysplasia elsewhere. | ||
*Precursor to [[head and neck squamous cell carcinoma]]. | |||
==Gross== | ==Gross== | ||
Features:<Ref name=pmid20596993>{{Cite journal | last1 = Eversole | first1 = LR. | title = Dysplasia of the upper aerodigestive tract squamous epithelium. | journal = Head Neck Pathol | volume = 3 | issue = 1 | pages = 63-8 | month = Mar | year = 2009 | doi = 10.1007/s12105-009-0103-8 | PMID = 20596993 }}</ref> | |||
*[[Erythroplakia]]. | *[[Erythroplakia]]. | ||
*[[Leukoplakia]]. | *[[Leukoplakia]]. | ||
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DDx: | DDx: | ||
*Squamous hyperplasia. | |||
*[[Benign leukoplakia]]. | *[[Benign leukoplakia]]. | ||
*[[Head and neck squamous cell carcinoma]]. | *[[Head and neck squamous cell carcinoma]]. | ||
===Grading=== | |||
*Numerous grading systems exist.<ref name=pmid24595419>{{Cite journal | last1 = Gale | first1 = N. | last2 = Zidar | first2 = N. | last3 = Poljak | first3 = M. | last4 = Cardesa | first4 = A. | title = Current views and perspectives on classification of squamous intraepithelial lesions of the head and neck. | journal = Head Neck Pathol | volume = 8 | issue = 1 | pages = 16-23 | month = Mar | year = 2014 | doi = 10.1007/s12105-014-0530-z | PMID = 24595419 }}</ref> | |||
====WHO system==== | |||
The 2005 "blue book" system - as summarized by Gale ''et al.'':<ref name=pmid24595419/> | |||
*Mild dysplasia. | |||
*Moderate dysplasia. | |||
*Severe dysplasia. | |||
*Carcinoma in situ. | |||
====Ljubljana system==== | |||
As per ''Gale et al.'':<ref name=pmid24689850>{{Cite journal | last1 = Gale | first1 = N. | last2 = Blagus | first2 = R. | last3 = El-Mofty | first3 = SK. | last4 = Helliwell | first4 = T. | last5 = Prasad | first5 = ML. | last6 = Sandison | first6 = A. | last7 = Volavšek | first7 = M. | last8 = Wenig | first8 = BM. | last9 = Zidar | first9 = N. | title = Evaluation of a new grading system for laryngeal squamous intraepithelial lesions-a proposed unified classification. | journal = Histopathology | volume = 65 | issue = 4 | pages = 456-64 | month = Oct | year = 2014 | doi = 10.1111/his.12427 | PMID = 24689850 }}</ref> | |||
*Low-grade SIL. | |||
*High-grade SIL. | |||
*Carcinoma in situ. | |||
Low-grade squamous intraepithelial lesion:<ref name=pmid24689850/> | |||
*Increased prickle cell layer. | |||
*+/-Thickening of basal and/or parabasal cell layers. | |||
*No significant [[nuclear atypia]]. | |||
*Rare mitotic figures. | |||
*Dyskeratotic cells - rare. | |||
*Must show maturation to surface. | |||
High-grade squamous intraepithelial lesion:<ref name=pmid24689850/> | |||
*Long axis perpendicular to basement membrane. | |||
*Lower half or more abnormal. | |||
*[[Nuclear pleomorphism]] present. | |||
**Irregular nuclear contours. | |||
**Hyperchromasia. | |||
**Nucleoli increased in size and number. | |||
*Increased [[NC ratio]]. | |||
*Mitotic activity in predominantly in the lower 2/3 of the epithelium. | |||
*Dyskeratotic cell common. | |||
Carcinoma in situ:<ref name=pmid24689850/> | |||
*"Full thickness" loss of stratification. | |||
**May have thin layer of compressed-appearing cells (3-5 cells thick) with their long axes parallel to the basement membrane. | |||
*[[Nuclear pleomorphism]] present. | |||
**Irregular nuclear contours. | |||
**Hyperchromasia. | |||
**Nucleoli increased in size and number. | |||
*Increase mitotic activity. | |||
**Atypical mitoses common. | |||
*Dyskeratotic/apoptotic cells typically very common. | |||
Negatives: | |||
*Basement membrane intact. | |||
**Smooth contour between epithelial layer and underlying stroma. | |||
*No [[stromal desmoplastic response]]. | |||
Subtypes: | |||
*Basal cell type. | |||
**Non-eosinophilic cytoplasm. | |||
**No apparent intercellular bridges (prickles). | |||
**Long axis of cells perpendicular to the basement membrane. | |||
**Typically non-keratinizing. | |||
*Spinous cell type. | |||
**Intercellular bridges (prickles) present. | |||
**Eosinophilic cytoplasm. | |||
**Typically keratinizing. | |||
===Images=== | |||
www: | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807542/figure/Fig1/ Squamous dysplasia - WHO grading system (nih.gov)]. | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807542/figure/Fig2/ Squamous dysplasia (nih.gov)].<Ref name=pmid20596993/> | |||
==Sign out== | ==Sign out== | ||
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==See also== | ==See also== | ||
*[[Head and neck pathology]]. | *[[Head and neck pathology]]. | ||
==References== | |||
{{Reflist|1}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Head and neck pathology]] | [[Category:Head and neck pathology]] | ||
==External links== | |||
*[https://wiki.uiowa.edu/display/protocols/Moderate+squamous+dysplasia+causing+laryngeal+leukoplakia Squamous dysplasia (wiki.uiowa.edu)]. |
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