Squamous cell carcinoma of the uterine cervix

From Libre Pathology
Jump to: navigation, search
Squamous cell carcinoma of the uterine cervix
Diagnosis in short

Cervical squamous cell carcinoma in situ. H&E stain.
LM DDx squamous metaplasia of the uterine cervix, high-grade squamous intraepithelial lesion
IHC p16 +ve
Gross white lesion ~ usu. close to transformation zone
Site uterine cervix

Prevalence most common cervical malignancy
Prognosis usu. good, dependent on stage
Treatment cervical cone, radical hysterectomy

Squamous cell carcinoma of the uterine cervix, also cervical squamous cell carcinoma, is the most common primary malignancy of the uterine cervix.

General

  • Most common type of cervical cancer.

Risk factors:

  • Low socioeconomic status.
  • Smoking.
  • Early first intercourse.
  • High risk partners.
  • Human papillomavirus (HPV) infection, esp. "high risk HPV".
    • HPV 16 closely assoc. with SCC.[1]

Gross

  • White lesion.
  • Firm.

Images

Microscopic

Features:

  • Squamous differentiation.
    • +/-Intracellular bridges.
    • Scant-to-moderate cytoplasm.
  • Penetration of basement membrane.
    • May be challenging to determine.
  • Nuclear atypia.

SCC of the cervix versus high-grade squamous intraepithelial lesion (carcinoma in situ): Invasive cancer look for:

  • Eosinophilia.
  • Extra large nuclei, i.e. nuclei 5x normal size.
  • Stromal inflammation (lymphocytes, plasma cells).
  • Long rete ridges.
  • Numerous beeds/blobs of epithelial cells that seem unlikely to be rete ridges.
  • Desmoplastic stroma - increased cellularity, spindle cell morphology.

DDx:

Images

www:

Grading

Divided into:[5]

  1. Well-differentiated (keratinizing).
  2. Moderately differentiated (nonkeratinizing).
  3. Poorly differentiated.

Depth measurement

  • Basement membrane (where it invades) to deepest point.

Note:

  • Stage Ib - clinical diagnosis.
    • Definition of stage Ib: clinically visible.

FIGO

Microinvasive SCC as per FIGO:

  • Depth < 5 mm.
  • Width < 7 mm.
  • +/-Vascular invasion.

SGO

Microinvasive SCC as per The Society of Gynecologic Oncologists (SGO):

Note:

  • The SGO criteria the prefered by North American gynecologists.

IHC

  • CK7, p63, p16 +ve (except verrucous variant)
  • Factor VIII - to look for LVI.

Sign out

Biopsy

Early invasive SCC - things to report:

UTERINE CERVIX, BIOPSY:
- FRAGMENTS OF INVASIVE SQUAMOUS CELL CARCINOMA.
-- DEPTH OF INVASION AND LENTH OF TUMOUR CANNOT BE ASSESSED.
-- LYMPHOVASCULAR INVASION NOT APPARENT.
LESION, UTERINE CERVIX, BIOPSY:
- INVASIVE SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED, FRAGMENTED.
- PLEASE SEE TUMOUR SUMMARY.

TUMOUR SUMMARY - UTERINE CERVIX
Specimen: Cervix.
Procedure: Biopsy.
Tumour Site: Cannot be determined.
Tumour Size: Cannot be determined - see comment.
Histologic Type: Squamous cell carcinoma, keratinizing.
Histologic Grade: G2: Moderately differentiated.
Stromal Invasion: Extent cannot be assessed - see comment.
Lymph-Vascular Invasion: Not identified.

Comment:
The tissue submitted is essentially all tumour. The largest fragment measures 1.2 x 1.4 cm
in the plane of section. Fragmentation and lack of normal histology preclude orientation.
As both the in plane dimensions exceed 0.7 cm, this is at least a pT1b.

TAH-BSO

UTERUS, CERVIX, RIGHT AND LEFT OVARIES AND BILATERAL UTERINE TUBES, TOTAL HYSTERECTOMY AND
BILATERAL SALPINGO-OOPHORECTOMY:
- INVASIVE SQUAMOUS CELL CARCINOMA, pT1a1, pNx.
-- MARGINS NEGATIVE FOR MALIGNANCY.
-- PLEASE SEE TUMOUR SUMMARY.
- PROLIFERATIVE ENDOMETRIUM.
- UTERINE LEIOMYOMAS.
- UTERINE TUBES WITH CHANGES COMPATIBLE WITH LIGATION, NO SIGNIFICANT PATHOLOGY.
- OVARIES WITHOUT SIGNIFICANT PATHOLOGY.

See also

References

  1. De Boer, MA.; Peters, LA.; Aziz, MF.; Siregar, B.; Cornain, S.; Vrede, MA.; Jordanova, ES.; Fleuren, GJ. (Apr 2005). "Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries.". Int J Cancer 114 (3): 422-5. doi:10.1002/ijc.20727. PMID 15551313.
  2. http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf
  3. 3.0 3.1 URL: http://sunnybrook.ca/content/?page=dept-labs-apath-gynpath-imgat-cvx-mal-microiscc. Accessed on: 2 May 2013.
  4. URL: http://missinglink.ucsf.edu/lm/IDS_107_Cervix_Ovary_Uterus/homepage.htm. Accessed on: 2 May 2013.
  5. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1077. ISBN 0-7216-0187-1.