|
|
Line 491: |
Line 491: |
|
| |
|
| ==Squamous cell carcinoma of the head and neck== | | ==Squamous cell carcinoma of the head and neck== |
| {{Main|Squamous cell carcinoma}} | | {{Main|Squamous cell carcinoma of the head and neck}} |
| ===General===
| |
| *Most common malignant tumour of the head & neck.
| |
| *Most common spindle cell tumour of the head & neck.
| |
| | |
| ===Microscopic===
| |
| ====Classification====
| |
| SCC is subdivided by the WHO into:<ref name=Ref_Sternberg4_975>{{Ref Sternberg4|975}}</ref>
| |
| *Keratinizing type (KT).
| |
| **Worst prognosis.
| |
| *Undifferentiated type (UT).
| |
| **Intermediate prognosis.
| |
| **EBV association.
| |
| *Nonkeratinizing type (NT).
| |
| **Good prognosis.
| |
| **EBV association.
| |
| | |
| Features based on classification:<ref name=Ref_Sternberg4_975>{{Ref Sternberg4|975}}</ref>
| |
| *KT subtype:
| |
| **Keratinization & intercellular bridges through-out most of the malignant lesion.
| |
| *UT:
| |
| **Non-distinct borders/syncytial pattern.
| |
| **Nucleoli.
| |
| *NT:
| |
| **Well-defined cell borders.
| |
| | |
| ====Invasion====
| |
| Features:
| |
| *Eosinophilia.
| |
| *Extra large nuclei/bizarre nuclei.
| |
| *Inflammation (lymphocytes, plasma cells).
| |
| *Long rete ridges.
| |
| *Numerous beeds/blobs of epithelial cells that seem unlikely to be rete ridges.
| |
| | |
| Pitfalls:
| |
| *Tangential cuts.
| |
| **If you can trace the squamous cells from a gland to the surface it is less likely to be invasive cancer.
| |
| | |
| 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>
| |
| *See ''[[SCC of the cervix versus CIN III]]''.
| |
| | |
| Image(s):
| |
| *[http://commons.wikimedia.org/wiki/File:Oral_cancer_(1)_squamous_cell_carcinoma_histopathology.jpg?uselang=de Invasive oral SCC (WC)].
| |
| | |
| ===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>
| |
| *Basaloid - poor prognosis, usu. diagnosed by recognition of typical SCC.
| |
| *Warty (Condylomatous).
| |
| *Verrucous - good prognosis, rare.
| |
| *Papillary.
| |
| *Lymphoepithelial, rare.
| |
| *Spindle cell, a common spindle cell lesion of the H&N.
| |
| | |
| ====Verrucous squamous cell carcinoma====
| |
| Features:
| |
| *Exophytic growth.
| |
| *Well-differentiated.
| |
| *"Glassy" appearance.
| |
| *Pushing border.
| |
| | |
| DDx: papilloma.
| |
| | |
| ====Spindle cell squamous carcinoma====
| |
| *Key to diagnosis is finding a component of conventional squamous cell carcinoma.
| |
| | |
| IHC:
| |
| *Typically keratin -ve.
| |
| *p63 +ve.
| |
| | |
| DDx:
| |
| *Spindle cell [[melanoma]].
| |
| *Mesenchymal neoplasm.
| |
| | |
| ====Basaloid squamous cell 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>
| |
| *Typically poor prognosis.
| |
| | |
| Features:
| |
| *Need keratinization. (???)
| |
| | |
| DDx:
| |
| *Neuroendocrine tumour.
| |
| | |
| ====Lymphoepithelial (squamous cell) carcinoma====
| |
| *Rare.
| |
| *+/-EBV.
| |
|
| |
|
| ==Small cell anaplastic carcinoma== | | ==Small cell anaplastic carcinoma== |