Squamous Cell Carcinoma of the Head and Neck (SCCHN)

Transcription

1 Squamous Cell Carcinoma of the Head and Neck (SCCHN) Part 1 Bruce M. Wenig, M.D. Dept. of Pathology & Laboratory Medicine Continuum Health Partners New York, NY College of American Pathologists Materials are used with the permission of Bruce M. Wenig, MD. 1

2 SCCHN Objectives Diagnose and identify the clinical importance of epithelial dysplasia of the UADT Diagnose and identify the clinical importance of early invasive SCCHN List key prognostic predictors of SCCHN Detail key issues in the intraoperative consultation of squamous cell lesions UADT Identify the diagnostic criteria and clinical importance of variants of SCCHN 2

3 SCCHN Outline Premalignant Lesions & Intraepithelial Neoplasia Squamous cell carcinoma: Microinvasive and Invasive Look-alike lesions Intraoperative consultation Variants 3

4 SCCHN Agenda 8:30 10:20: Premalignant Lesions & Intraepithelial Neoplasia Microinvasive SCC Look-alike lesions Intraoperative consultation 10:40 12:00: SCCHN Variants 4

5 Epithelial Alterations Clinical Leukoplakia Speckled Leukoplakia Erythroplakia 5

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7 Epithelial Alterations Histopathology Keratosis Hyperplasia Dysplasia Abnormality in epithelial maturation 7

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12 Squamous Cell Carcinoma Dysplastic Epithelium Cellular abnormalities: Nuclear pleomorphism, hyperchromasia increased mitotic activity prominent nucleoli Maturation abnormalities: Loss of maturation, polarity Increased nuclear-to-cytoplasmic ratio Abnormal keratosis (dyskeratosis) 12

13 Upper Aerodigestive Tract Epithelial Dysplasia Classic or Non-Keratinizing: Mild dysplasia Moderate dysplasia Severe dysplasia = Carcinoma in situ 13

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17 Upper Aerodigestive Tract Epithelial Dysplasia Keratinizing: Mild dysplasia Moderate dysplasia Severe dysplasia 17

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22 Upper Aerodigestive Tract Keratinizing Dysplasia Is the use of the term CIS justified? What is severe dysplasia? 22

23 Upper Aerodigestive Tract Epithelial Dysplasia Goal of any grading system is: Reproducible and Applicable Convey to the clinician the potential risk for progression of disease 23

24 Upper Aerodigestive Tract Grading Epithelial Dysplasia Squamous Intraepithelial Neoplasia (SIN) Laryngeal Intraepithelial Neoplasia (LIN) Epithelial Hyperplastic Laryngeal Lesions (EHLL) 24

25 Upper Aerodigestive Tract Grading Epithelial Dysplasia Imprecise and subjective Preferred grading based on degree and extent of cellular and maturation alterations mild dysplasia moderate dysplasia severe dysplasia 25

26 CIS/Severe Dysplasia Mucosal alterations confined to the surface epithelium; includes extension into seromucinous glands Persist or progress to invasive carcinoma if left untreated Synchronous CIS and invasive squamous carcinoma 26

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31 Squamous Cell Carcinoma Early or Microinvasive Carcinoma Neoplastic cells that have penetrated the basement membrane with invasion into the submucosa Develops as a continuum from CIS CIS is not a prerequisite: drop off carcinoma 31

32 Squamous Cell Carcinoma Microinvasive Carcinoma (MIC) No uniformity in defining MIC: small number of cells below BM invasion through the BM invasion through the BM limited to 1-2mm of BM without angioinvasion invasion no more than 0.5mm from epithelial BM with no angioinvasion 32

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36 Squamous Cell Carcinoma Microinvasive Carcinoma (MIC) Treatment for T1 SCC: Conservative management: stripping laser ablation Careful follow-up; at risk for recurrence or new primary carcinoma Radiotherapy in selective settings Prognosis is excellent: VC: early presentation, relative absence of lymph-vascular spaces 36

37 Squamous Cell Carcinoma Diagnostic Pitfalls Inadequate sampling Look alikes: Pseudoepitheliomatous hyperplasia Necrotizing sialometaplasia Juxtaoral organ of Chievitz Radiation atypia 37

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47 SCCHN Factors Associated with Prognosis Adequacy of resection (surgical margins) Pattern of invasion: cohesive v dyscohesive Tumor size, thickness, location LVI, neurotropism and soft tissue invasion Regional metastasis - Extranodal Extension Distant metastasis Angiogenesis; Host immune response Second malignancy 47

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