SLIDE 1

REFERAT

SQUAMOUS CELL CARCINOMA

CERVIX

Yuktiana Kharisma

Pembimbing: Sri Suryanti, dr., MS., Sp.PA(K)

Opponent: DR. Hermin Aminah U, dr., Sp.PA(K)
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ANAT
OMI

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ANAT
OMI

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ECTOCERVIX 4

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ENDOCERVIX 5

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HISTOLOGY 6

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HISTOLOGY 7

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 HISTOLOGY
TRANSFORMATION ZONE 8

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 SQUAMOUS CELL CARCINOMA 9

Definit ion
An invasive epithelial tumour
composed of squamous cells of
varying degrees of differentiation.

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EPIDEMIOLOGY
10

According to the
GLOBOSCAN figures for 2012
published by the International
Agency for Research into
Cancer (IARC) for the WHO
2012, carcinoma of the
uterine cervix was the third
commonest form of cancer
recorded in women worldwide
and the fourth in terms of
cancer deaths (Figure 3.1).

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 EPIDEMIOLOGY 11

(INCIDENCE)

The lowest incidences (<5 per

100 000 women) were
in western Asia or the western
part of central-south Asia
(Iraq, Yemen, Iran, Palestine)

The highest incidences (>40 per 100 000) were all found in
Figure 1Geographical distribution of world age-
standardised incidence of cervical cancer by
countries from eastern, southern, or western Africa
country, estimated for 2018 (Zambia, Zimbabwe, Tanzania, Uganda)

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 INCIDENCE
(MORTALITY RATES)
12

the lowest mortality burden was observed in

Australia–New Zealand.

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ETIO 13

LOG
Y

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ETIO C

LOG
Y

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 RISK 15

FACTORS

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 SIGN & Small tumours 
16

SYMPTOMS asymptomatic

Direct extension into Large tumor size 

the bladder  urinary Abnormal vaginal
retention from bladder bleeding, contact
outlet obstruction & bleeding, discharge &
vesicovaginal fistula. pain

Anterior tumour Lateral growth of

growth urinary parametrium ureteral
frequency, bladder pain obstruction, anuria &
& haematuria. uraemia.

Pelvic sidewall
involvement sciatic
pain, Iymphoedema of
limb
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SIGN & SYMPTOMS

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 MACROSCOPY 22

On visual inspection, cervical cancer

may appear as a red, Iriable, exophytic
or ulcerated lesion. Palpation can
detect
induration or nodularity of the cervix or
the parametria in advanced lesions.

Squamous cell carcinoma may be

predominantly
exophytic , papillary or polypoid,
or else it may be mainly endophytic,

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 MACROSCOPY 23

On visual inspection, cervical

cancer may appear as a red,
Iriable, exophytic or
ulcerated lesion.
Palpation can detect
induration or nodularity of the
cervix or the parametria in
advanced lesions.

Squamous cell carcinoma

may be predominantly
exophytic , papillary or
polypoid,
or else it may be mainly
endophytic,

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SQUAMOUS INTRAEPITHELIAL LESIONS/CERVICAL 24

INTRAEPITHELIAL NEOPLASIA

Rosai & Ackerman. Surgical Pathology 11ed. 2018.

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SQUAMOUS INTRAEPITHELIAL LESIONS/CERVICAL
INTRAEPITHELIAL NEOPLASIA 25

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SQUAMOUS INTRAEPITHELIAL LESIONS/CERVICAL 26

INTRAEPITHELIAL NEOPLASIA

Rosai & Ackerman. Surgical Pathology 11ed. 2018.

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 Squamous Cell Carcinoma type
SUPERFICIAL INVASIVE
SCC
INVASIVE SCC Non- keratinizing SCC

Keratinizing SCC

Basaloid SCC

Verrucous Carcinoma
Warty/ Condylomatous
SCC
Papillary SCC

Squamotransisional SCC
Lymphoepithelial-Like
Carcinoma
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SUPERFICIAL INVASIVE SCC

Invasive squamous cell carcinomas in which the depth of
stromal invasion is minimal (3 mm or less, and <7 mm in
breadth, Stage Ia1)

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SUPERFICIAL INVASIVE SCC 30

Superficially invasive squamous cell

carcinoma. HSIL with budding off of
malignant cells downward into the
underlying stroma and significant
associated lymphocytic infiltrate.

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SUPERFICIAL INVASIVE SQUAMOUS 31

CELL CARCINOMA

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INVASIVE SCC

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INVASIVE SQUAMOUS CELL CARCINOMA 33

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NON-KERATINIZING SCC 34

Non-keratinizing SCCs are the most common, composed of

polygonal squamous cells without keratinization.

The cells grow in anastomosing cords or nests with a round,

angulated, or spiky appearance. The cells are oval to
polygonal, often with an eosinophilic cytoplasm; cell borders
may be indistinct and are sometimes prominent with
intercellular bridges. The nuclei may be uniform with a
coarse and granular chromatin with or without nucleoli but
may display considerable pleomorphism. The mitotic count
is variable.

There is typically a peritumoral stromal response, which

may vary with different invasive patterns.

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KERATINIZING SCC 36

Keratinizing SCC is less common than its non-

keratinizing counterpart. This is characterized by
morphological evidence of keratinization in the
form of keratin pearls

The cells & nuclei are usually larger &

hyperchromatic with a coarse chromatin &
lack easily seen nucleoli. There may be a
correlation with ectocervical localization &
the keratinizing form of CIN. It is possible, as
in vulval carcinomas, that keratinization may
indicate HPV-independent SCC.

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BASALOI 37

D SCC

-HPV related
-composed of nests of
immature small oval cells with
scanty cytoplasm & dark
nucleI..
-Brisk mitotic activity.
-Keratin pearls are not seen.
-Demonstrate geographical
comedo-like necrosis.
-Aggressive behavior 
high-grade tumor

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 PAPILLARY 38

SCC

This is a tumour in which thin or

broad papillae with connective tissue
stroma are covered by epithelium
showing the features of HSIL.

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 PAPILLAR 39

Y SCC

Papillary SCCs consist of

fibrovascular papillae
with different thickness,
covered by an epithelium
representing CIN 3-like
morphology.

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 PAPILLARY SCC 40

Exophytic papillary; Complex papillomatous Closer view of a papilla

low-grade keratinizing tumor with hyperkeratosis, cell maturation, and a poorly defined
central fibrovascular core. No koilocytosis is presen
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SQUAMOTRANSTITIONAL SCC 41

Squamotransitional/transitional
SCCs have a papillary architecture
with fibrovascular cores covered by
cells resembling CIN 3/HSIL.

Rare cases of pure transitional cell

carcinoma have been reported that
are indistinguishable from their
urological counterparts.

However, most of these tumors

represent malignant squamous
elements.

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SQUAMOTRANSTITIONAL SCC 42

Papillary formation with

squamotransitional cells having
polygonal shape, distinct cell
borders, abundant eosinophilic
cytoplasm, pleomorphic nuclei,
prominent nucleoli, and occasional
mitotic figures (H&E stain, 200x
magnifications).

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 LYMPHOEPITHELIOMA-LIKE CARCINOMA 43

The tumor cells have unclear cell

boundaries, pale eosinophilic
cytoplasms, large vacuole-like nuclei,
distinct nucleoli, and rich cytoplasms
and they form clusters.
Cancer cells are distributed in the
nest or scattered with rich infiltration
of lymphocytes and plasmacytes as
well as reactive lymphoid follicle-like
structures.

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LYMPHOEPITHELIOMA-LIKE CARCINOMA 44

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 WARTY/ CONDYLOMATOUS SCC 45

This lesion defined as a squamous

cell carcinoma with a warty surface
& low-power architecture
analogous to a condyloma or
Bowenoid lesion of the vulva.
In early invasive lesions the
epithelium may be keratinizing.

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 WARTY/ CONDYLOMATOUS SCC 46

Tumor surface with hyper- Higher view showing

parakeratosis and pleomorphic koilocytosis pleomorphic HPV-related changes: clear cell, binucleation,
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 VERRUCOUS SCC 47

A closer view reveals hyperkeratosis and hypergranulosis. There is a “pushing

border.”Atypias are minimal. The stroma shows a chronic lymphocytic infiltration

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SPINDLE CELL CARCINOMA 48

Squamous cell carcinoma of the cervix,

spindle cell type. Elongated tumor cells
are arranged in bundles simulating
spindle cell sarcoma.
Immunohistochemical stain for
cytokeratin was positive, confirming the
diagnosis of carcinoma (not shown).

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DIFFERENTIAL
DIAGNOSE

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 TREATMENT 51

Early lesions can be treated conservatively with radical vaginal

trachelectomy, a fertility-preserving procedure where the cervix is
excised at the level of the upper endocervix or lower uterine segment
along with a vaginal cuff and parametria, and pelvic lymph nodes

Invasive carcinomas of the cervix that are more advanced than stage Ia1
can be treated with curative intent by surgery or irradiation with or
without chemosensitization. The choice depends on the extent of the
tumor, the general condition of the patient, and the expertise available at
the institution where the patient is treated

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PROGNOSIS 52

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 CONCLUSION 53

Definit ion of SCC

An invasive epithelial tumour composed of squamous cells of varying degrees of
differentiation.

Type of SCC: Non- keratinizing SCC, Keratinizing SCC, Basaloid SCC, Verrucous
Carcinoma, Warty/ Condylomatous SCC, Papillary SCC, Squamotransisional SCC,
Lymphoepithelial-Like Carcinoma
Differential diagnoses: TCC, Poorly differentiated adenosquamous carcinoma, Large cell
neuroendocrine carcinomas, Melanoma Maligna, GTD, Metastatic ductal carcinoma of the
breast, Small cell neuroendocrine carcinomas, lymphoma, Embryonal
Rhabdomyosarcoma.

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 SLIDE 10

TERIMAKASIH
TERIMA
KASIH
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ANAT
OMI

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ANAT
OMI

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ECTOCERVIX 58

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ENDOCERVIX 59

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HISTOLOGY 60

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HISTOLOGY 61

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 HISTOLOGY
TRANSFORMATION ZONE 62

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Morpholog
y
Of
CIN
Grade

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Morpholog
y
Of
CIN
Grade

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HPV
TYPE

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HP
V
TY
PE

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HPV - STRUCTURE 76

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 STRO
MAL 81

REM
ODE
LING

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DIFFERENTIAL
DIAGNOSE OF INVASIVE
SCC

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NEUROENDOCRINE TUMOR 88

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NEUROENDOCRINE TUMOR 89

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GESTATIONAL TROPHOBLASTIC DISEASE 90

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GESTATIONAL TROPHOBLASTIC DISEASE 91

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 EMBRYONAL RHABDOMYOSARCOMA 93

These present as polypoid lesions with small

round or spindle cells with hyperchromatic
dense nuclei. The cells typically show subepithelial
condensation (cambium layer). Tumor
cells are positive for vimentin and myogenic
markers but negative for cytokeratins and p16.
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MEASURING STROMAL INVASION 97

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MEASURING TUMOR WIDTH 98

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(CHEMO)
RADIATION-
INDUCED CHANGES

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CONE
BIOPSY
BIOPSY

LOOP
ELECTROCA
CURRETAG
UTION
E
EXCITION
(leep)

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GROSS SECTIONING 103

5%

20%
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50%
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25%

Lorem ipsum dolor sit amet, consectetur adipiscing

elit. Pellentesque sit amet feugiat mi.

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SURGICAL CUT UP
OF CERVICAL
SPECIMENS

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SURGICAL CUT UP
OF CERVICAL
SPECIMENS

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REPORTING 106

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ADENOSQUAMOUS
CARCINOMA 107

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PA
T 108

H
O
G
E
N
ES
IS

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AJCC TNM STAGGING 114

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AJCC TNM STAGGING 115

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AJCC TNM STAGGING 116

Rosai & Ackerman. Surgical Pathology

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AJCC TNM STAGGING 117

Rosai & Ackerman. Surgical Pathology

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