Squamous Cell Carcinoma

Benign tumor of squamous epithelium is known as papilloma where as malignant tumor of stratified
squamous epithelium is known as squamous cell carcinoma.

Sites: It can arise in any area of squamous epithelium like skin, oral cavity, cervix and vagina. It also
arises from the areas of stratified squamous epithelium metaplasia e.g. in lungs and urinary tract.

Prevalence:

 Second most common tumor of skin arising on sun exposed area.

 More common in male than females.
 Common in above 40 years of age

Predisposing factors:

1. UV radiation (sunrays)
2. Ionizing radiation (x rays)
3. Industrial carcinogens
4. Chronic ulcers
5. Human papilloma virus
6. Skin conditions like xeroderma pigmentosa
7. Osteomylitis
8. Also presents in patients who are immuno-compromised as a result of chemotherapy or
immunosuppressant drugs.
9. Ingestion of bettle nut and tobacco

Morphology:

Gross:

 Grossly it begins as a small focus in epidermis. Sometimes it’s slightly elevated. There is plaque
formation. A plaque of 3-4 cm is formed but it may take upto many years.
 When tumor is limited to epidermis ad has not invaded the basement membrane then it is
called carcinoma in situ. (Red scaly plaque)
 On the other hand the incisive lesion is nodular and may ulcerated and produce variable amount
of keratin
 These invasive tumors have punched out margins.
 

Microscopic:

In site: it is characterized by atypical squamous cell composed of large hypochromatic and pleomorphic
cells. The tumor is made up of necrotic and group of necrotic neoplastic cells. Each cell mass is
surrounded by/ composed of neoplastic epithelium with a mass of keratin in centre.
 Invasive lesions involve both epidermis and dermis and this invasive tumor may be well differentiated,
moderately and poor. In well differentiated, tumors are composed of polygonal squamous cells arranged
in the form of sheets or lobules with area extracellular keratinization in form of keratin pearls.

On other hand poorly differentiated lesions are highly anaplsia rounded cell.

Types of squamous cell carcinoma:

Poorly differentiated:

Rounded, anaplastic cells arranged in the form of rounded sheets. It has intracellular keratinization with
no keratin pearls.

Well differentiated:

Squmous cell polygonal in shape in the form of tubules. The keratin is deposited extramedullary in the
form of keratin pearls.

In-situ carcinoma:

Grossly well defined red and scaly lesion. Microscopically; limited to epidermis, pleomorphic in shape

Invasive carcinoma:

Nodular ulcerated lesion with keratinization. it infiltrates basement membrane

*hypochromatic: Containing a small or abnormally low amount of pigment.
*pleomorphic: Occurring in various distinct forms. In terms of cells, having variation in the size and shape of cells
or their nuclei.
*neoplasm: A neoplasm is an abnormal growth of cells, also known as a tumor
*anaplasia: Anaplasia is a term used to describe cells that have lost the unique characteristics that define them as
a certain tissue type