squamous cell carcinoma of the head and neck - …...squamous cell carcinoma of the head and neck...
TRANSCRIPT
![Page 1: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/1.jpg)
Squamous Cell Carcinoma of the Head and Neck (SCCHN)
Part 3
Bruce M. Wenig, M.D.Dept. of Pathology & Laboratory Medicine
Continuum Health PartnersNew York, NY
© College of American Pathologists 2004. Materials are used with the permission of Bruce M. Wenig, MD.
![Page 2: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/2.jpg)
Variants of Squamous Cell
Carcinoma UADT
![Page 3: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/3.jpg)
Squamous Cell Carcinoma Variants• Papillary (Exophytic) SCC• Verrucous Carcinoma• Spindle Cell Squamous Carcinoma• Basaloid Squamous Cell Carcinoma• Undifferentiated Carcinoma• Adenoid SCC (angiosarcoma-like or
acantholytic) • Adenosquamous Carcinoma
![Page 4: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/4.jpg)
Papillary Squamous Cell Carcinoma (PSCC)
Invasive SCC with a predominant exophytic (papillary) component
![Page 5: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/5.jpg)
PSCCClinical Features
• Demographics are similar to those of conventional SCC: – men more than women – occur in adults with a mean age in the
7th decade of life • Predilect to the larynx, oral cavity, oro- and
hypopharynx, and sinonasal tract:– larynx is the most common site of
occurrence
![Page 6: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/6.jpg)
PSCCClinical Features Cont’d
• Symptoms vary according to the site of involvement
• HPV (by ISH and PCR) have been detected in papillary SCC; preexisting papilloma has been reported in up to 34% of patients (Suarez et al)
![Page 7: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/7.jpg)
PSCCPathologic Features
• Solid exophytic or papillary lesion measuring from 2mm – 4cm
• Filiform growth with finger-like projections or a broad-based bulbous to exophytic growth with rounded projections; fibrovascular cores can be seen but tend to be limited to absent
![Page 8: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/8.jpg)
PSCCPathologic Features Cont’d
• Squamous epithelium is cytologicallymalignant
• Surface keratinization limited or absent • Definitive invasion may be difficult to
demonstrate; these tumors should be considered as being invasive even in the absence of definitive stromal invasion
• De novo or pre-existing papilloma
![Page 9: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/9.jpg)
![Page 10: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/10.jpg)
![Page 11: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/11.jpg)
![Page 12: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/12.jpg)
![Page 13: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/13.jpg)
![Page 14: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/14.jpg)
PSCCTreatment and Prognosis
• Surgery is the treatment of choice• Majority are low clinical stage (T2) • Overall behavior similar to conventional
SCC of similar stage; some authors report a better overall prognosis for papillary SCC than for conventional SCC when matched for T-stage
![Page 15: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/15.jpg)
PSCCDifferential Diagnosis
• Papilloma• Verrucous Carcinoma
![Page 16: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/16.jpg)
![Page 17: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/17.jpg)
![Page 18: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/18.jpg)
![Page 19: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/19.jpg)
![Page 20: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/20.jpg)
Verrucous Carcinoma
• Highly differentiated variant of squamous cell carcinoma with locally destructive but not metastaticcapabilities
![Page 21: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/21.jpg)
Verrucous CarcinomaClinical Features
• M > F; generally occurs in older age groups (6th – 7th decades of life)
• Sites: – oral cavity (4%) > larynx (1-3%) >
other (sinonasal tract; nasopharynx)• Symptoms vary according to site
![Page 22: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/22.jpg)
![Page 23: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/23.jpg)
![Page 24: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/24.jpg)
![Page 25: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/25.jpg)
![Page 26: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/26.jpg)
![Page 27: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/27.jpg)
Verrucous CarcinomaEtiology
• Tobacco (smoking, chewing) use• Virally-induced (HPV):
– in-situ hybridization – PCR
• HPV may play an active role in the multistepprogression to cancer by binding (via protein products) to the RB gene product removing regulatory block in the cell cycle
Science 1989;243:934-7
![Page 28: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/28.jpg)
![Page 29: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/29.jpg)
![Page 30: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/30.jpg)
![Page 31: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/31.jpg)
![Page 32: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/32.jpg)
Verrucous CarcinomaTreatment and Prognosis
• Surgery is the treatment of choice• Radiotherapy can be used in select
clinical settings • Excellent prognosis• Local recurrence but no metastases
![Page 33: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/33.jpg)
Verrucous CarcinomaDifferential Diagnosis
• “Conventional” squamous cell carcinoma
• Proliferative verrucous hyperplasia• Papilloma• Verruca vulgaris (cutaneous)• Keratoacanthoma (cutaneous)
![Page 34: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/34.jpg)
![Page 35: Squamous Cell Carcinoma of the Head and Neck - …...Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 3 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum](https://reader034.vdocuments.mx/reader034/viewer/2022043016/5f388cf189370352dd734d7e/html5/thumbnails/35.jpg)