Squamous Cell Neoplasia and Precursor Lesions

Transcription

1 Squamous Cell Neoplasia and Precursor Lesions Jennifer L. Hunt, MD, MEd Aubrey J. Hough Jr, MD, Endowed Professor of Pathology Chair of Pathology and Laboratory Medicine University of Arkansas for Medical Sciences 1

2 Agenda Squamo-proliferative lesions Squamous dysplasia Keratosis Keratinizing dysplasia Pitfalls and Mimics Lichen planus Pseudoepitheliomatous hyperplasia Identifying superficial invasion 2

3 Squamous Dysplasia Architectural features Organization Maturation Mitotic activity 3

4 Normal Organization

5 Normal Maturation

6 Poor Organization and Maturation Reactive Dysplastic

7 Abnormal Mitoses

8 Squamous Dysplasia Cytologic features Hyperchromasia Higher N:C ratio (basaloid) Nuclear membrane irregularities 8

9 Abnormal Cytology Reactive Atypia Dysplasia

10 Dysplasia Continuum Normal Mild Dysplasia Moderate Dysplasia Severe Dysplasia 10

11 Mild dysplasia

12 Moderate dysplasia

13 Severe dysplasia

14 Mild-moderate dysplasia

15 Moderate to severe dysplasia

16 Keratinizing Squamous Lesions Keratin = abnormal (nearly always) Surface keratinization Dyskeratosis Pink Cell Change 16

17 Keratinizing Lesions Diagnostic terminology: Keratosis Clinical terminology: Leukoplakia Reaction to irritation Denture rub Bite lines Tobacco 17

18 Keratosis

19 Keratosis

20 Dyskeratosis

21 Pink cell change

22 Pink cell change

23 Diagnosing Keratosis Keratosis with dysplasia If you can, grade the dysplasia If you can t, consider Keratinizing dysplasia Risk of carcinoma does not correlate with classical features of dysplasia Early lesions may be reversible Some lesions look much better than they behave 23

24 Keratosis without dysplasia

25 Keratosis with severe dysplasia

26 Keratosis with severe dysplasia

27 Inflammatory Atypia vs. Dysplasia Is there a reason for atypia or reactive patterns? Inflammation Ulceration or ulcer debris Organisms Metaplasia Tangential sectioning 27

28 Lichenoid Inflammation

29 Hyperplastic Candidiasis

30 Neutrophils in the epithelium

31 Candidiasis

32 Squamous Metaplasia 32

33 Tangential sectioning 33

34 Normal Reactive 34 Mild dysplasia

35 Dysplasia 35 Reactive Atypia

36 Agenda Squamo-proliferative lesions Squamous dysplasia Keratosis Keratinizing dysplasia Pitfalls and Mimics Lichen planus Pseudoepitheliomatous hyperplasia Identifying superficial invasion 36

37 Oral (Mucosal) Lichen Planus Clinical 1-2% of the general population; 50-77% of lichen planus patients Often asymptomatic and bilateral Demographics Female to male = 2:1 Ages: Types Reticular Atrophic Erosive Others: plaque, papular, bullous 37

38 Huber MA, Clinics in Dermatology 28, 262,

39 Courtesy of Dr. Sook-Bin Woo,

40 Histology Oral (Mucosal) Lichen Planus Hyperkeratosis Saw-tooth rete Vacuolar degeneration of the basal cells Lichenoid chronic inflammation Apoptosis of epithelial cells (civatte bodies) Secondary fungal hyphae (after steroids) 40

41 Lichen planus 41

42 Lichen planus 42

43 Lichen planus 43

44 Lichen planus 44

45 Pseudoepitheliomatous hyperplasia Reactive pattern Associated with granular cell tumor Fungal infections Trauma Histology Down-ward finger-like proliferation Can resemble carcinoma 45

46 Pseudoepitheliomatous hyperplasia 46

47 Granular cell tumor 47

48 Agenda Squamo-proliferative lesions Squamous dysplasia Keratosis Keratinizing dysplasia Pitfalls and Mimics Lichen planus Pseudoepitheliomatous hyperplasia Identifying superficial invasion 48

49 Superficial Invasion Nomenclature Superficially invasive squamous cell carcinoma Microinvasive squamous cell carcinoma Tumor has breached the basement membrane Access to lymphatics Potential to metastasize 49

50 Superficial Invasion: Definition Miller cells present just below the basement membrane Friedman Padovan Crissman Barnes Scattered tongues or discrete foci of invasion through the basement membrane 2 mm or less of invasion 1-2 mm of invasion (no angiolymphatic invasion) 0.5 mm of invasion, measured from basement membrane (no angiolymphatic invasion) 50

51 Identifying Superficial Invasion Deep keratinization Keratin pearls Dyskeratosis Breach of basement membrane Ragged borders Single dropping off cells Desmoplasia Reaction around tumor cells 51

52 In situ Carcinoma 52

53 Superficial invasion 53

54 Superficial invasion 54

55 Superficial invasion

56 Suspicious for superficial invasion 56

57 Summary Squamo-proliferative lesions Squamous dysplasia Keratosis Keratinizing dysplasia Pitfalls and Mimics Lichen planus Pseudoepitheliomatous hyperplasia Identifying superficial invasion 57