Difference between revisions of "Squamous cell carcinoma of the lung"

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

Revision as of 17:31, 16 December 2016

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

Squamous carcinoma of the lung. (WC)

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:

Metastatic squamous cell carcinoma.
Adenocarcinoma of the lung.
Non-small cell lung carcinoma - diagnosis should be avoided if possible.
Small cell carcinoma of the lung - for basaloid squamous cell carcinoma.

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

Lung SCC - very low mag. (WC)
Lung SCC - low mag. (WC)
Lung SCC - intermed. mag. (WC)
Lung SCC - high mag. (WC)
Lung SCC - low mag. (WC)
Lung SCC - intermed. mag. (WC)

Cytology

Lung SCC - cytology. (WC)

IHC

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

Others:^[7]

CK7 -ve.
CK20 -ve.
TTF-1 -ve.
- Positive in adenocarcinoma of the lung.

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

Sign out

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.

References

↑ Campbell, JH.; Ralston, S.; Boyle, IT.; Banham, SW. (May 1991). "Symptomatic hypercalcaemia in lung cancer.". Respir Med 85 (3): 223-7. PMID 1831917.
↑ 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.
↑ 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.
↑ ^4.0 ^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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.

[pmid1831917-1] 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.

[pmid22617241-3] 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.

[cap_protocol_v3400-4] 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.

[pmid7092385-5] 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.

[pmid22056955-6] 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.

[pmid24126803-7] 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.

[pmid23106579-8] 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.

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