3.a.iii.1 Invasive Squamous Cell Carcinoma, NOS

Invasive Squamous Cell Carcinomas (SCC)

Invasive Squamous Cell Carcinomas (SCC)

Invasive Squamous Cell Carcinomas (SCC)

Invasive Squamous Cell Carcinomas (SCC)

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In the last decades, the incidence of cervical cancer and its mortality rate has been decreasing, but cervical cancer still remains a relatively prevalent disease. With improvement of cervical cancer screening programs in North America, most cervical cancer patients are now diagnosed at early stage. As North American women tend to delay more and more childbearing, cervical cancer is also often diagnosed in patients who still have a desire for fertility. For these two reasons, cervical cancer management has evolved to offer conservative and fertility-sparing treatments for patients with early stage cancers. Radical trachelectomy is now recognized as a safe and successful fertility-sparing alternative performed in a limited number of centres in the world. Sunnybrook Health Sciences Centre has emerged as one of the leading centres worldwide for trachelectomies (Ref. 1, 2.). To learn more about trachelectomies and the challenges they offer to pathologists, see our tutorial (coming soon).

Most cervical cancers are invasive squamous cell carcinomas (SCC) which precursor is squamous intraepithelial lesion and the causative agent is the human papilloma virus (HPV). In most cases, the diagnosis of invasive SCC is straightforward. Sheets of malignant cells with variable amount of eosinophilic cytoplasm invade the stroma in a destructive way. Intercellular bridges can usually be identified and keratinization is sometimes present. Micro-invasion arising from a high grade squamous intraepithelial lesion (squamous cell carcinoma in situ) can be more challenging to diagnose (More information on how to diagnose micro-invasive SCC).

Important prognostic features for cervical SCC include depth of invasion, tumor size, and presence of capillary-space invasion. Also, some variants of SCC may have a different prognosis. Grading on a scale from 1 to 3 is usually applied to invasive SCC even though it has not been clearly shown to carry any prognostic significance. Grade 1 SCC shows well differentiated tumor cells with keratinization. Grade 2 SCC corresponds to a large cell non keratinizing SCC and grade 3 to non-keratinizing small cell SCC which is composed of cells with a high nuclear-cytoplasmic ratio. The latter should be distinguished from small cell neuroendocrine carcinoma of the cervix which has a dismal prognosis and is treated with chemotherapy regimen rather than surgery. Another important entity to consider in the differential diagnosis of cervical SCC is an adenosquamous carcinoma which tends to be under recognized.

References:
1. Ismiil N, Ghorab Z, Covens A, Nofech-Mozes S, Saad R, Dubé V, Khalifa MA. Intraoperative margin assessment of the radical trachelectomy specimen. Gynecol Oncol. 2009 Apr;113(1):42-6. PMID: 19174307.

2. Beiner ME, Hauspy J, Rosen B, Murphy J, Laframboise S, Nofech-Mozes S, Ismiil N, Rasty G, Khalifa MA, Covens A. Radical vaginal trachelectomy vs. radical hysterectomy for small early stage cervical cancer: a matched case-control study. Gynecol Oncol. 2008 Aug;110(2):168-71. PMID: 18539313.