8070/3 Squamous cell epithelioma



Definitions

Esophagus
ICD-O-3 topography code: C15
ICD10: C15
           

Squamous cell carcinoma (SCC) of the oesophagus is a malignant epithelial tumour with squamous-cell differentiation, microscopically characterized by keratinocyte-like cells with intercellular bridges and/or keratinization 1
 
Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010



.
World-wide, SCC is the predominant type of oesophageal carcinoma, affecting preferentially adult men, with tobacco smoking and consumption of hot beverages as major risk factors. In some high incidence regions the occurrrence is declining while in low incidence countries with a Western lifestyle there is a sharp rise in the incidence of oesophageal adenocarcinoma.



Anus and anal canal
ICD-O-3 topography code: C21
ICD10: C21
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic
2
 
Madeleine MM, Newcomer LM (2007). Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner JM, eds.
Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. SEER Program: Bethesda, MD, pp. 43-48.
National Cancer Institute
2007



cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells. Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.

Squamous cell carcinoma (SCC) of the anal canal
It is a malignant epithelial neoplasm that is frequently associated with chronic infection with human papillovirus (HPV). Other risk factors include HIV infection, other causes of immunosuppresion and sexual pratices; other risk factors reported include smoking, haemorrhoids, fissures, fistulae and abscesses in the anal region, and potentially longstanding Crohn disease. Most anal cancers occur among patients in the sixth or seventh decade of life
3
Click to access Pubmed
Frisch M, Melbye M, Møller H (1993)
Trends in incidence of anal cancer in Denmark.
BMJ 306: 419-22



. However, in individuals with cellular immune incompetence, anal cancer may occur at a young age 4
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Melbye M, Coté TR, Kessler L, Gail M, Biggar RJ (1994)
High incidence of anal cancer among AIDS patients. The AIDS/Cancer Working Group.
Lancet 343: 636-9



. The incidence is higher in females than in males 5
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Cook MB, Dawsey SM, Freedman ND, Inskip PD, Wichner SM, Quraishi SM, Devesa SS, McGlynn KA (2009)
Sex disparities in cancer incidence by period and age.
Cancer Epidemiol Biomarkers Prev 18: 1174-82



6
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Frisch M, Melbye M, Møller H (1993)
Trends in incidence of anal cancer in Denmark.
BMJ 306: 419-22



7
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Melbye M, Rabkin C, Frisch M, Biggar RJ (1994)
Changing patterns of anal cancer incidence in the United States, 1940-1989.
Am J Epidemiol 139: 772-80



, and urban than in rural areas 8
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Frisch M, Melbye M, Møller H (1993)
Trends in incidence of anal cancer in Denmark.
BMJ 306: 419-22



9
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Melbye M, Rabkin C, Frisch M, Biggar RJ (1994)
Changing patterns of anal cancer incidence in the United States, 1940-1989.
Am J Epidemiol 139: 772-80



. Racial differences also exist. In the USA, the SEER survival monograph 10
 
Madeleine MM, Newcomer LM (2007). Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner JM, eds.
Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. SEER Program: Bethesda, MD, pp. 43-48.
National Cancer Institute
2007



reports a relative 5-year survival rate of 60.2 for Caucasian men and 47.0 for African-American men and of 69.5 and 58.5 for Caucasian women and African-American women, respectively11
 
Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010



.





Lip, Oral Cavity and Oropharynx
ICD-O-3 topography code: C00-C06, C09-C10, C14
ICD10: C00-C06, C09-C10, C14
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.



Skin
ICD-O-3 topography code: C44
ICD10: C44
           

Squamous cell carcinoma (SCC) arises from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells. Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.

Squamous cell carcinoma of the skin is a malignant neoplasm of epidermal and mucous membrane keratinocytes characterized by variable degrees of squamous differentiation. The tumour may arise on all cutaneous surfaces and mucous membranes, but it most commonly develops in areas of direct exposure to the sun. The lesions present as shallow ulcers, often with a keratinous crust and elevated, indurated surrounds, or as plaques or nodules. Actinic damage to the surrounding skin is typical. Histologically, cutaneous squamous cell carcinomas are characterized by nests, sheets and strands of squamous epithelial cells which arise from the epidermis and extend into the dermis.
Sqamous cell carcinoma of the skin most commonly affects elderly people, but may also arise in younger patients. The risk is particularly high for fair-skinned individuals who tan poorly. The most important causative factor is ultraviolet-B radiation. The majority of tumours are only locally aggressive
12
 
LeBoit PE, Burg G, Weedon D, Sarasin A (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Skin Tumours
3rd Edition
IARC Press: Lyon 2005



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Cervix uteri
ICD-O-3 topography code: C53
ICD10: C53
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.

Squamous cell carcinoma of the uterine cervix may be either predominantly exophytic and grow out from the surface, or it may be mainly endophytic and infiltrate the surrounding structures without much surface growth. Infiltrating tumours typically appear as irregular islands of anastomosing strands of neoplastic cells separated by cervical stroma. The stroma is usually invaded by a variety of cell types, especially lymphocytes and plasma cells. Cervical intraepithelial neoplasia (CIN) is frequently found on the surface and at the edge of the invasive carcinoma, particularly in small tumours
13
 
Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003



.



Colon and rectum
ICD-O-3 topography code: C18-C20
ICD10: C18-C20
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.



Stomach
ICD-O-3 topography code: C16
ICD10: C16
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells. Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.

Squamous cell carcinoma of the stomach is very rare
14
 
Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010



.



Hypopharynx, Larynx and Trachea
ICD-O-3 topography code: C13, C32, C33
ICD10: C13, C32, C33
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.



Small intestine
ICD-O-3 topography code: C17
ICD10: C17
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.



Bronchus and lung
ICD-O-3 topography code: C34
ICD10: C34
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.



Thyroid gland
ICD-O-3 topography code: C73
ICD10: C73
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells. Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix. Distant metastases occur in approximately 20% of cases.

Squamous cell carcinoma of the thyroid is a disease of the elderly and more common in women, with a female to male ratio of 2:1
15
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Lam KY, Lo CY, Liu MC (2001)
Primary squamous cell carcinoma of the thyroid gland: an entity with aggressive clinical behaviour and distinctive cytokeratin expression profiles.
Histopathology 39: 279-86



. The prognosis in most cases is similar to that of undifferentiated carcinoma 16
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Cook AM, Vini L, Harmer C (1999)
Squamous cell carcinoma of the thyroid: outcome of treatment in 16 patients.
Eur J Surg Oncol 25: 606-9



17
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Lam KY, Lo CY, Liu MC (2001)
Primary squamous cell carcinoma of the thyroid gland: an entity with aggressive clinical behaviour and distinctive cytokeratin expression profiles.
Histopathology 39: 279-86



18
 
Ronald A. DeLellis, Ricardo V. Lloyd, Philipp U. Heitz, Charis Eng
World Health Organization Classification of Tumours. Pathology and Genetics of Tumors of Endocrine Organs
IARC Press: Lyon 2004



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Region of the ampulla of Vater
ICD-O-3 topography code: C24.1
ICD10: C24.1
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells. Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.

Squamous cell carcinoma of the ampulla of Vater
This exceedingly rare ampullary carcinoma is composed entirely of cells with squamous differentiation. Keratinizing and nonkeratinizing types exist
19
 
Albores-Saavedra J, Henson DE, and Klimstra DS eds.
Tumors of the Gallbladder, Extrahepatic Bile Ducts, and Ampulla of Vater
Armed Forces Institute of Pathology: Washington, DC 2000



. Most ampullary carcinomas with predominant squamous features prove to be adenosquamous carcinomas when extensively sampled and stained for mucin 20
 
Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010



.



Breast
ICD-O-3 topography code: C50
ICD10: C50
           

Squamous cell carcinoma belongs to the 'Metaplastic carcinoma' group of tumours.

Metaplastic squamous cell carcinoma may be pure or mixed with coexisting invasive carcinoma NST
21
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Fisher ER, Palekar AS, Gregorio RM, Paulson JD (1983)
Mucoepidermoid and squamous cell carcinomas of breast with reference to squamous metaplasia and giant cell tumors.
Am J Surg Pathol 7: 15-27



22
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Jones EL (1969)
Primary squamous-cell carcinoma of breast with pseudosarcomatous stroma.
J Pathol 97: 383-5



23
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Wargotz ES, Norris HJ (1990)
Metaplastic carcinomas of the breast. IV. Squamous cell carcinoma of ductal origin.
Cancer 65: 272-6



.

See Metaplastic carcinoma of no special type for general discussion on metaplastic breast carcinomas.








Gallbladder and extrahepatic biliary tract
ICD-O-3 topography code: C23-C24.0
ICD10: C23-C24
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells. Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.

Squamous cell carcinoma of the gallbladder and extrahepatic bile ducts
This malignant epithelial neoplasm is composed entirely of squamous cells with highly variable degrees of differentiation. Keratinizing and nonkeratinizing types exist
25
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Aranha GV, Reyes CV, Greenlee HB, Field T, Brosnan J (1980)
Squamous cell carcinoma of the proximal bile duct--a case report.
J Surg Oncol 15: 29-35



26
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Gatof D, Chen YK, Shah RJ (2004)
Primary squamous cell carcinoma of the bile duct diagnosed by transpapillary cholangioscopy: case report and review.
Gastrointest Endosc 60: 300-4



27
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Suster S, Huszar M, Herczeg E, Bubis JJ (1987)
Adenosquamous carcinoma of the gallbladder with spindle cell features. A light microscopic and immunocytochemical study of a case.
Histopathology 11: 209-14



. Spindle cells predominate in some poorly differentiated squamous cell carcinomas, which may be confused with sarcomas 28
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Suster S, Huszar M, Herczeg E, Bubis JJ (1987)
Adenosquamous carcinoma of the gallbladder with spindle cell features. A light microscopic and immunocytochemical study of a case.
Histopathology 11: 209-14



. Immunolabelling for keratin and p63 may clarify the diagnosis in these spindle-cell cases. The carcinoma may arise from areas of squamous metaplasia or high-grade intraepithelial neoplasia 29
 
Albores-Saavedra J, Henson DE, and Klimstra DS eds.
Tumors of the Gallbladder, Extrahepatic Bile Ducts, and Ampulla of Vater
Armed Forces Institute of Pathology: Washington, DC 2000



. Most gallbladder carcinomas with squamous differentiation represent adenosquamous carcinomas, and the glandular component may be very focal; thorough examination is required before a diagnosis of pure squamous cell carcinoma can be established30
 
Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010



.



Corpus uteri
ICD-O-3 topography code: C54
ICD10: C54
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.

Primary squamous cell carcinoma of the uterine corpus is a rare tumour arising from the endometrium. It usually affects postmenopausal women and is frequently associated with cervical stenosis and pyometra. The prognosis is poor
31
 
Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003



.



Vulva
ICD-O-3 topography code: C51
ICD10: C51
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.

In the vulva, squamous cell carcinoma is the most common malignant tumour. Older women are more frequently affected. Known risk factors are HPV infection and cigarette smoking. The tumour is typically solitary and may present as an ulcer, nodule, macule, or pedunculated mass, most commonly in on the labia minora or majora; approximately 10% of cases arise on the clitoris.
Poor prognostic factors include advanced stage, tumour diameter >2.5 cm, multifocality, capillary-like space involvement, associated squamous intraepithelial neoplasia (VIN) 2 or 3, and involved margins of resection
32
 
Tavassoli FA, Devilee P (Eds.)
World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs.
3rd Edition
IARC Press: Lyon 2003



.



Salivary glands
ICD-O-3 topography code: C07-C08
ICD10: C07-C08
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.



Ovary
ICD-O-3 topography code: C56
ICD10: C56
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.



Penis
ICD-O-3 topography code: C60
ICD10: C60
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.



Prostate gland
ICD-O-3 topography code: C61
ICD10: C61
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.



Fallopian tube and Uterine ligaments
ICD-O-3 topography code: C57
ICD10: C57
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.



Urinary system: Renal pelvis, ureter, bladder, urethra
ICD-O-3 topography code: C65-C68
ICD10: C65-C68
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.



Nasal cavity and Sinuses
ICD-O-3 topography code: C30-C31
ICD10: C30-C31
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.



Vagina
ICD-O-3 topography code: C52
ICD10: C52
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.



Thymus
ICD-O-3 topography code: C37
ICD10: C37
           

A carcinoma arising from squamous epithelial cells, morphologically characterized by the proliferation of atypical, often pleomorphic squamous cells. Squamous cell carcinomas are graded as well, moderately, or poorly differentiated. Well differentiated carcinomas are usually associated with keratin production and the presence of intercellular bridges between adjacent cells.
Typical sites of squamous cell carcinomas include the head and neck region, repiratory tract, skin and cervix.