Gynecological and Breast Cytopathology Board Review and Self-Assessment by Walid E. Khalbuss & Marilee Means

Author:Walid E. Khalbuss & Marilee Means
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

A-43.(c) Squamous cell carcinoma

This is a case of invasive squamous cell carcinoma (SCC). Squamous cell carcinoma comes in two morphologic variants, keratinizing and nonkeratinizing. The Bethesda System (TBS) does not subdivide squamous cell carcinoma into these categories, but the cytomorphologic features are somewhat different. Nonkeratinizing variant shows cells with immature cytoplasm, high nuclear/cytoplasmic ratios, and nuclei with prominent nucleoli, irregular chromatin distribution, and irregular nuclear membranes. These cells may be seen in loose or syncytial groups or as single cells. Associated features may include a tumor diathesis composed of necrotic debris, old blood, and inflammation in conventional smear or clinging necrosis in liquid-based preparations. Keratinizing SCC displays all of the cellular characteristics of keratinizing HSIL with the addition of variable numbers of cells demonstrating nucleoli or the addition of a tumor diathesis. Features include marked cellular variation with tadpole, spindle, and caudate shapes (more seen in left image), dense eosinophilic cytoplasm, and markedly hyperchromatic, often opaque nuclei with high N/C ratios. Cells may be single or in loose or even thick groups.

The presence of a tumor diathesis suggests an invasive carcinoma. This finding is still noted on liquid samples but may be somewhat patchy.

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