Patholines - Pathology Guidelines

Invasive squamous cell carcinoma of the cervix

Author: Mikael Häggström [note 1]

Microscopic evaluation

Infiltration as irregular anastomosing nests or single cells.[1] In contrast to tangentially cut projections of glands involved by HSIL, the invasive nests of tumor cells are irregular and accompanied by a distinct stromal reaction of edema and chronic inflammatory cells.

  • Invasive SCC of the cervix
    Invasive SCC of the cervix
  • Invasive SCC of the cervix[image 1]
    Invasive SCC of the cervix[image 1]

Staging

As per AJCC 9:[2]

T CATEGORY FIGO STAGE T CRITERIA
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 I Carcinoma is strictly confined to the cervix (extension to the corpus should be disregarded)
T1a IA Invasive carcinoma that can be diagnosed only by microscopy with maximum depth of invasion ≤5 mm
T1a1 IA1 Measured stromal invasion ≤3 mm in depth
T1a2 IA2 Measured stromal invasion >3 mm and ≤5 mm in depth
T1b IB Invasive carcinoma with measured deepest invasion >5 mm (greater than stage IA); lesion limited to the cervix uteri with size measured by maximum tumor diameter; note: the involvement of vascular/lymphatic spaces should not change the staging, and the lateral extent of the lesion is no longer considered
T1b1 IB1 Invasive carcinoma >5 mm depth of stromal invasion and ≤2 cm in greatest dimension
T1b2 IB2 Invasive carcinoma >2 cm and ≤4 cm in greatest dimension
T1b3 IB3 Invasive carcinoma >4 cm in greatest dimension
T2 II Carcinoma invades beyond the uterus but has not extended onto the lower one-third of the vagina or to the pelvic wall
T2a IIA Involvement limited to the upper two-thirds of the vagina without parametrial invasion
T2a1 IIA1 Invasive carcinoma ≤4 cm in greatest dimension
T2a2 IIA2 Invasive carcinoma >4 cm in greatest dimension
T2b IIB With parametrial invasion but not up to the pelvic wall
T3 III Carcinoma involves the lower one-third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney; note: the pelvic wall is defined as the muscle, fascia, neurovascular structures, and skeletal portions of the bony pelvis; cases with no cancer-free space between the tumor and pelvic wall by rectal examination are FIGO stage III
T3a IIIA Carcinoma involves the lower one-third of the vagina, with no extension to the pelvic wall
T3b IIIB Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney (unless known to be due to another cause)
T4 IVA Carcinoma has involved (biopsy-proven) the mucosa of the bladder or rectum or has spread to adjacent organs (bullous edema, as such, does not permit a case to be assigned to stage IVA)

Microscopy report

Example:

Cervix, uterus, bilateral tubes, ovaries and parametria,
hysterectomy and bilateral salpingo-oophorectomy:
  • Residual squamous cell carcinoma on anterior cervix, 3 mm in greatest dimension, with up to 2 mm invasion, with associated biopsy site changes, and high-grade squamous intraepithelial lesion (CIN III).
  • Inactive endometrium

SYNOPTIC REPORT:
Based on Hysterectomy (current specimen) and previous cone biopsy:

  • Procedure: Cone (previous procedure) and hysterectomy with bilateral salpingo-oophorectomy
  • Tumor site: Anterior cervix
  • Histologic type: Squamous cell carcinoma, HPV-associated
  • Histologic grade: G2, moderately differentiated (based on current hysterectomy and previous cone biopsy
  • Tumor size: Estimated tumor size is 2.6 cm in greatest dimension (based on previous cone biopsy)
  • Depth of stromal invasion: 7 mm (based on previous cone biopsy)
  • Lymphovascular invasion: Present (based on previous cone biopsy)
  • Margin(s): Negative for invasive carcinoma
  • Additional Findings:
  • High-grade squamous intraepithelial lesion (CIN 3)
  • Previous biopsy site changes
  • p16 Immunohistochemistry: Positive (based on the previous cone biopsy)
  • Pathologic stage: pT1b2, Invasive carcinoma greater than 2 cm and less than or equal to 4 cm in greatest dimension (based on current specimen and previous cone biopsy)
  • FIGO Stage: IB2

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ Author: Gulisa Turashvili, M.D., Ph.D.. Cervix - Squamous cell carcinoma and variants. Pathology Outlines. Last author update: 24 September 2020. Last staff update: 13 December 2022
  2. ↑ Olawaiye AB, Baker TP, Washington MK, Mutch DG (2021). "The new (Version 9) American Joint Committee on Cancer tumor, node, metastasis staging for cervical cancer. ". CA Cancer J Clin 71 (4): 287-298. doi:10.3322/caac.21663. PMID 33784415. Archived from the original. . 

Image sources

  1. ↑ Invasive Squamous Carcinoma of the Cervix. Cold Knife Cone (6076190079).jpg by Ed Uthman, MD. Creative Commons Attribution 2.0 Generic (CC BY 2.0) license