Squamous cell carcinoma of the head and neck

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Squamous cell carcinoma of the head and neck
Diagnosis in short

Squamous cell carcinoma of the head and neck (larynx). H&E stain.

Synonyms squamous cell carcinoma of the head and neck not otherwise specified
Subtypes keratinizing type, undifferentiated type, nonkeratinizing type
LM DDx squamous dysplasia of the head and neck, HPV-associated head and neck squamous cell carcinoma, nasopharyngeal carcinoma, malignant melanoma, metastatic squamous cell carcinoma
IHC p63 +ve, CK5/6, p16 -ve, EBER -ve
Site head and neck - tongue (dealt with separately)

Clinical history smoking, excessive drinking
Prevalence common
Prognosis moderate-to-poor
Treatment surgery, radiation

Squamous cell carcinoma of the head and neck, abbreviated head and neck SCC, is a common malignant epithelium neoplasm of the head and neck.

This is an overview article that deals only with the usual squamous cell carcinoma of the head and neck, or squamous cell carcinoma of the head and neck not otherwise specified (abbreviated SCC of the H&N NOS).

Tongue squamous cell carcinoma is dealt with in separate article.

The human papilloma virus-associated SCC is dealt with in HPV-associated head and neck squamous cell carcinoma. Nasopharyngeal carcinoma is also dealt with separately.

General

  • Most common malignant tumour of the head & neck.
  • Most common spindle cell tumour of the head & neck.

Classification

SCC is subdivided by the WHO into:[1]

  • Keratinizing type (KT).
    • Worst prognosis.
  • Undifferentiated type (UT).
    • Intermediate prognosis.
    • EBV association.
  • Nonkeratinizing type (NT).
    • Good prognosis.
    • EBV association.

Microscopic

Features based on classification:[1]

  • 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:

Images

Overview of subtypes

There are several subtypes:[3]

  • 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

Features:

  • Need keratinization. (???)

DDx:

  • Neuroendocrine tumour.

Lymphoepithelial (squamous cell) carcinoma

See nasopharyngeal carcinoma.

IHC

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LESION, TONGUE/FLOOR OF MOUTH BORDER, BIOPSY:
- INVASIVE KERATINIZING SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED.
LEFT NECK (LONG SUTURE LEVEL IA AND SHORT SUTURE LEVEL IIB), LEVEL
   I-IV, DISSECTION:
- LEVEL IA:
-- ONE LYMPH NODE WITH SQUAMOUS CELL CARCINOMA, AND FOUR LYMPH NODES
   NEGATIVE FOR MALIGNANCY (1 POSITIVE/5).
-- BENIGN SALIVARY GLAND.
-- SEE COMMENT.
- LEVEL IIA:
-- FIVE LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/5).
- LEVEL III:
-- FIVE LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/5).
- LEVEL IV:
-- TEN LYMPH NODES NEGATIVE FOR MALIGNANCY (0 POSITIVE/10).

COMMENT:
The squamous cell carcinoma is moderately differentiated and shows rare 
keratinization. The tumour lies adjacent to benign (submandibular) salivary 
gland which it does not involve.

Micro

Biopsy

The section shows atypical (squamous) cells with moderate grey cytoplasm, central nuclei with small nucleoli, infiltrating between fibrous tissue. Abundant keratin pearls are present. The nuclei are predominantly pale staining and focally have irregular nuclear membranes and irregular chromatin. Mitotic activity is not readily apparent. Necrosis is present focally.

See also

References

  1. 1.0 1.1 Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Oberman, Harold A; Reuter, Victor E (2004). Sternberg's Diagnostic Surgical Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 975. ISBN 978-0781740517.
  2. Wenig BM (March 2002). "Squamous cell carcinoma of the upper aerodigestive tract: precursors and problematic variants". Mod. Pathol. 15 (3): 229–54. doi:10.1038/modpathol.3880520. PMID 11904340. http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf.
  3. URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970297-2. Accessed on: March 9, 2010.
  4. URL: http://www.biomedcentral.com/1471-2407/6/146. Accessed on: March 9, 2010.
  5. Nichols AC, Finkelstein DM, Faquin WC, et al. (April 2010). "Bcl2 and human papilloma virus 16 as predictors of outcome following concurrent chemoradiation for advanced oropharyngeal cancer". Clin. Cancer Res. 16 (7): 2138–46. doi:10.1158/1078-0432.CCR-09-3185. PMID 20233885.