Squamous cell carcinoma of the lung

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Squamous cell carcinoma of the lung
Diagnosis in short

Squamous cell carcinoma of the lung. H&E stain.

Synonyms squamous carcinoma of the lung
LM DDx lung adenocarcinoma, non-small cell lung carcinoma, metastatic squamous cell carcinoma, others
IHC p40 +ve, p63 +ve, TTF-1 -ve, CK7 -ve
Staging lung cancer staging
Site lung - see lung tumours

Clinical history smoking
Symptoms +/-hemoptysis
Prevalence common
Blood work serum calcium elevated
Radiology typically a mass assoc. with a large airway, +/-spiculated, +/-cavitation
Prognosis usually poor
Clin. DDx other lung tumours - esp. small cell carcinoma of the lung
Treatment surgical resection if possible

Squamous cell carcinoma of the lung, also lung squamous cell carcinoma, is a common malignant lung tumour that is associated with smoking.

It is also known as squamous carcinoma of the lung and lung squamous carcinoma.

Squamous cell carcinoma can be abbreviated SCC; however, this can be confusing as small cell carcinoma is sometimes abbreviated as such.

General

  • Strong association with smoking.
  • May be treated with surgery.

Clinical:

  • May be associated with elevated serum calcium.[1]
  • +/-Hemoptysis.

Gross

  • Lung mass - usually centrally located, i.e. associated with a large airway.

Image

Microscopic

Features:

  • Central nucleus.
  • Dense appearing cytoplasm, usu. eosinophilic.
  • +/-Small nucleolus.
  • 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%.[2]
    • Unlike in lung adenocarcinoma, LVI in lung SCC does not seem to increase the risk of distant metastases and death.[3]

DDx:

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,[4] and some older data is suggestive that such a system for lung SCC can be predictive.[5]

The grading system loosely defined by the CAP protocol (version 3.4.0.0):[4]

  • Grade 1 (well differentiated) - extensive keratinization.
  • Grade 2 (moderately differentiated) - some keratinization.
  • Grade 3 (poorly differentiated) - no/little keratinization.

Images

Cytology

IHC

  • p40 +ve.[6]
    • p63 +ve -- less specific.
  • Calponin -ve.
  • CK5/6 +ve.

Others:[7]

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.:[8]

IHC Lung
SCC
Bladder
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

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Lung, Right Upper Lobe, Core Biopsy:
	- SQUAMOUS CELL CARCINOMA.

COMMENT:
The tumour stains as follows:
POSITIVE: p40, CK5/6.
NEGATIVE: TTF-1, napsin.

Block letters

LUNG, RIGHT UPPER LOBE, BIOPSY:
- INVASIVE SQUAMOUS CELL CARCINOMA.

COMMENT:
The tumour stains as follows:
POSITIVE: p40, CK5/6.
NEGATIVE: TTF-1, napsin.

Resection

LUNG, RIGHT UPPER LOBE, LOBECTOMY:
- SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED, pT2b, pN0.
-- MARGINS NEGATIVE.
-- PLEASE SEE TUMOUR SUMMARY.

See also

References

  1. Campbell, JH.; Ralston, S.; Boyle, IT.; Banham, SW. (May 1991). "Symptomatic hypercalcaemia in lung cancer.". Respir Med 85 (3): 223-7. PMID 1831917.
  2. Tao H, Hayashi T, Sano F, et al. (November 2013). "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". J. Surg. Res. 185 (1): 250–4. doi:10.1016/j.jss.2013.05.104. PMID 23830361.
  3. Higgins KA, Chino JP, Ready N, et al. (July 2012). "Lymphovascular invasion in non-small-cell lung cancer: implications for staging and adjuvant therapy". J Thorac Oncol 7 (7): 1141–7. doi:10.1097/JTO.0b013e3182519a42. PMID 22617241.
  4. 4.0 4.1 URL: 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.
  5. Chung, CK.; Zaino, R.; Stryker, JA.; O'Neill, M.; DeMuth, WE. (Jun 1982). "Carcinoma of the lung: evaluation of histological grade and factors influencing prognosis.". Ann Thorac Surg 33 (6): 599-604. PMID 7092385.
  6. Bishop, JA.; Teruya-Feldstein, J.; Westra, WH.; Pelosi, G.; Travis, WD.; Rekhtman, N. (Mar 2012). "p40 (ΔNp63) is superior to p63 for the diagnosis of pulmonary squamous cell carcinoma.". Mod Pathol 25 (3): 405-15. doi:10.1038/modpathol.2011.173. PMID 22056955.
  7. Montezuma, D.; Azevedo, R.; Lopes, P.; Vieira, R.; Cunha, AL.; Henrique, R. (Dec 2013). "A panel of four immunohistochemical markers (CK7, CK20, TTF-1, and p63) allows accurate diagnosis of primary and metastatic lung carcinoma on biopsy specimens.". Virchows Arch 463 (6): 749-54. doi:10.1007/s00428-013-1488-z. PMID 24126803.
  8. Gruver, AM.; Amin, MB.; Luthringer, DJ.; Westfall, D.; Arora, K.; Farver, CF.; Osunkoya, AO.; McKenney, JK. et al. (Nov 2012). "Selective immunohistochemical markers to distinguish between metastatic high-grade urothelial carcinoma and primary poorly differentiated invasive squamous cell carcinoma of the lung.". Arch Pathol Lab Med 136 (11): 1339-46. doi:10.5858/arpa.2011-0575-OA. PMID 23106579.