Case No.: J-001

Diagnosis: Squamous cell carcinoma, non-keratinizing

Organ: Lung, left upper lobe

Last Updated: 12/21/2010

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Hematoxylin & eosin

Area 1: The tumor cells form squamous cell nests with central necrosis (N) in some of them. The nuclei of the carcinoma cells are large and with prominent nucleoli. Mitoses are common (arrow).

Hematoxylin & eosin

Area 2: This image is taken at the periphery of the tumor. Note that a segment of residual bronchus is still present. Note that the bronchus is lined by ciliated columnar epithelium (arrow).

Area 3: This image is taken from the areas uninvolved by the carcinoma. Note the anthracotic pigment depositions (arrow).

History: The patient was an 81 year-old man with a mass in the right upper lobe. The lesion was excised through a lobectomy and yielded the current specimen. On gross examination, the mass was a roughly round to oval nodule, 2.6 cm in greatest dimension. It was well demarcated from the lung parenchyma and did not involve the overlying visceral pleura.

 

Histologic Highlights of this Case:

  • Histologically, the tumor is well demarcated. The tumor cells histologically resemble squmous cells and definitive histological bridges are present which is diagnostic feature of squamous cell carcinoma. In contrast to the normal squamous cells, however, the tumor cells have very large nuclei and prominent nucleoli. There is also large variation in nuclear size (pleomorphism). Necrotic foci are also presnt (area 1). In contrast to adenocarcinoma, there is no gland formation.

  • Although there are some dyskeratotic cells scattered around, there is no definitive keratin pearl formation. Click here to see a squamous cell carcinoma of lung without keratin pear formation.

  • Residual bronchial mucosa are present in some area (area 2). However, there is no in situ component present in this case. In situ component is rather uncommonly see in large resection specimen like this one.

Immunohistochemistry:

  • This case is immunoreactive for p63 and cytokeratin 5/6 and negative for cytokeratin 7, cytokeratin 20, and thryoid transcription factor 1 (TTF-1). This profile is classic for squamous cell carcinoma.

Bonus Images:

Hematoxylin & eosin

High magnification image: This image is taken at high magnification. The intercellular bridges (black arrow) is well illustrated. There are also dyskeratotic cells (white arrow). Both are features of squamous cell carcinoma. There is, however, no true keratin pearl formation in this case. Note the large nuclei and their prominent nucleoli.

Cytokeratin 5/6

 Cytokeratin 5/6: Cytokeratin 5/6 is often expressed in squamous cell carcinoma but not adenocarcinoma. It offers a way to differentiate the two in difficult cases.

P63

 P63: P63 is often expressed in squamous cell carcinoma but not adenocarcinoma. It offers a way to differentiate the two in difficult cases.

Original slide is contributed by Dr. Kar-Ming Fung, University of Oklahoma Health Sciences Center, Oklahoma, U.S.A.

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