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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.
Variants of Squamous Cell
Carcinoma UADT
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
Papillary Squamous Cell Carcinoma (PSCC)
Invasive SCC with a predominant exophytic (papillary) component
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
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)
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
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
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
PSCCDifferential Diagnosis
• Papilloma• Verrucous Carcinoma
Verrucous Carcinoma
• Highly differentiated variant of squamous cell carcinoma with locally destructive but not metastaticcapabilities
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
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
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
Verrucous CarcinomaDifferential Diagnosis
• “Conventional” squamous cell carcinoma
• Proliferative verrucous hyperplasia• Papilloma• Verruca vulgaris (cutaneous)• Keratoacanthoma (cutaneous)
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