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)