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Lymph Node
Published in Joseph Kovi, Hung Dinh Duong, Frozen Section In Surgical Pathology: An Atlas, 2019
Joseph Kovi, M.D. Hung Dinh Duong
A 54-year-old man was admitted to the hospital because of a cervical lymph node enlargement on the right side as well as weight loss. The patient was a heavy drinker and smoker. He complained of repeated sore throats and fever. On examination, a circumscribed white patch was seen on the pharyngeal mucosa above the right tonsil. Both the cervical lymph nodes and the tonsil were biopsied, and a frozen section was requested from the node. The lymph node measured 16 by 8 by 4 mm in diameter and was firm. On cut surface a 2 to 3 mm white zone was noted adjacent to the capsule, otherwise, the node was unremarkable. Microscopically, the lymphoreticular structure was obliterated and replaced by tumor tissue. The tumor cells formed large sheets and nests in which keratin-pearl formation was observed. The neoplastic cells possessed nuclei which varied markedly in size and shape. Large numbers of normal and abnormal mitotic figures were noted (Figure 92).
Endometrial malignant lesions
Published in T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng, Richard Wing-Cheuk Wong, Hao Chen, Diagnostic Endometrial Pathology, 2019
T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng
Approximately 20% of endometrioid carcinomas contain foci of squamous differentiation (Figure 9.22). Typical cytological and histological features of squamous epithelial, such as keratin pearl formation, intercellular bridge, dense eosinophilic cytoplasm, polygonal shaped and distinct cell border, can usually be seen in the area of squamous differentiation to aid the diagnosis. Of note, the area of squamous differentiation is not included in the estimation of solid growth for grading endometrioid carcinoma. Therefore, it is crucial to distinguish area of squamous differentiation from solid tumor growth pattern. Although usually it is easy to make the distinction by morphology, immunostaining of squamous markers such as p40, p63 and CK5/6 can be helpful in difficult cases.
Malignant Epithelial Neoplasms
Published in Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley, Diagnostic Pulmonary Pathology, 2008
Squamous cell carcinoma is recognized histologically by keratinization of tumor cells and/or presence of intercellular bridges (Fig. 1). These cancers frequently grow in rounded or angulated aggregates organized with more poorly differentiated anaplastic cells at the periphery and a central “keratin pearl” formed by layers of flattened keratinized epithelium with an anucleate keratin core. Single-cell keratinization is more difficult to recognize, and one may be deceived by solitary degenerating necrotic cells with eosinophilic cytoplasm. Proper identification requires recognition of a laminated or concentric ring of eosinophilia around a viable nucleus (3). Intercellular bridging is distinguished by relatively uniformly spaced linear connections spanning adjacent cells, resulting in a train-track appearance. This morphologic finding is the result of desmosomes connecting adjacent tumor cells. Uniform spacing of cells without direct connection is often noted in large cell carcinomas and should not be misinterpreted as bridging. It should be noted that the criteria for designation of squamous differentiation in these lesions is more strict than those used in some other organ systems. The presence of an “epithelioid” growth pattern in tumors showing distinct cell borders, eosinophilic cytoplasm, and a central nucleus is insufficient for classification as squamous cell carcinoma.
The prognostic value of squamous differentiation in endometrioid type endometrial cancer: a matched analysis
Published in Journal of Obstetrics and Gynaecology, 2022
Koray Aslan, Murat Öz, Burak Ersak, Hakan Kamil Müftüoğlu, Özlem Moraloğlu Tekin, Mehmet Mutlu Meydanli
The gynaecologic pathologists examined all removed specimens from the patients. The original pathology reports were used to extract the tumour characteristics of women; central pathology review was not performed for the current study. Histopathological classification of tumours was made based on the World Health Organisation (WHO) criteria (Tavassoli and Devilee 2003; Kurman et al. 2014). Squamous differentiation was defined as the presence of keratin pearl formation, intercellular bridges, or solid cell masses with polygonally shaped, dense eosinophilic cytoplasm with distinct cell membranes (Zaino et al. 1991; Kurman et al. 2014) (Figure 1). The architectural grade of the tumour was assigned according to the criteria defined by the FIGO as follows; grade 1 had solid growth pattern ≤5%, grade 2 had solid growth pattern between 6% and 50%, grade 3 had solid growth pattern >50% (Creasman et al. 2006; Creasman 2009). The areas showing squamous differentiation were not considered in determining the grade of the tumour (Creasman et al. 2006; Kurman et al. 2014). LVSI was described as the existence of tumour cells inside the lumen of the lymphatics or capillaries (Keys et al. 2004). The FIGO 2009 staging system was utilised to determine the stage of the disease (Creasman 2009). The patients who underwent surgery before 2009 were retrospectively adopted to the FIGO 2009 classification according to pathological and surgical reports.