Background: Early invasive squamous cell carcinomas of the cervix can be easily missed on colposcopic and histologic examination. Moreover, histological determination of early stromal invasion is at times very difficult, especially in small biopsy specimens. Aim: Although several histologic features...
Background: Early invasive squamous cell carcinomas of the cervix can be easily missed on colposcopic and histologic examination. Moreover, histological determination of early stromal invasion is at times very difficult, especially in small biopsy specimens. Aim: Although several histologic features have been proposed as the evidence of stromal invasion, none of the features was verified. To find helpful histologic features for the recognition of early stromal invasion in squamous cell carcinoma of uterine cervix, we compared the incidences of various histopathologic findings in the unequivocal cases of HSIL and invasive squamous cell carcinomas of the uterine cervix. In addition, density of newly formed blood vessels defined by endoglin immunopositivity, and the vascular pattern such as coated and uncoated blood vessels, and complete and incomplete blood vessels were compared between the two groups. Methods: Unequivocal cases of 112 invasive squamous cell carcinomas (SCC) and 26 high grade squamous intraepithelial lesion (HSIL) diagnosed on the hysterectomy specimens were retrieved, and six histopathological parameters were compared, which include (1) presence of desmoplastic change, (2) presence of irregular epithelial tongues of malignant cells, (3) focal squamous differentiation with eosinophilic cytoplasm, (4) blurring of interface by lymphoplasma cell infiltration, (5) pseudoglands with central necrosis, (6) Scalloped contours of malignant epithelial nests and (7) random axis of rete pegs. In addition, microvascular density and vascular pattern and newly formed blood vessels using endoglin (CD105) immunostaining were compared in 17 cases of HSIL and 27 cases of invasive SCC. Results: Histologic findings of (1) presence of desmoplastic change (p <0.001), (2) focal squamous differentiation with eosinophilic cytoplasm (p=0.021) (3) blurring of interface by lympoplasma cell infiltrates (p<0.001), (4) pseudogland formed by tumor necrosis (p=0.006), (5) scalloped contours of malignant epithelial nests (p=0.021), and (6) random axis of the expansile tumor cell nests (p<0.001) were significantly more frequent in the invasive squamous cell carcinoma compared to HSIL. Density of microvessels was significantly higher in the invasive carcinoma compared to the HSIL (10.4±8.8 vs. 4.8±4.4, p=0.015), however, vascular patterns did not reveal any significant difference between the HSIL and invasive SCC. Conclusions: There was no significant difference in vascular pattern between preinvasive and invasive SCC. However, microvessel density is increased significantly in invasive SCC than HSIL. Thus, during the cervical neoplastic growth, an angiogenic switching process occurs prior to the stromal invasion, however, angiogenic process is more predominant in invasive carcinoma than in the preinvasive lesion. Histologically, presence of desmoplastic reaction, blurring of interface by lympoplasma cell infiltration, pseudoglands formed by tumor necrosis and random axis of the expansile tumor cell nests were crucial in the recognition of early stromal invasion in cervical squamous cell carcinoma
Background: Early invasive squamous cell carcinomas of the cervix can be easily missed on colposcopic and histologic examination. Moreover, histological determination of early stromal invasion is at times very difficult, especially in small biopsy specimens. Aim: Although several histologic features have been proposed as the evidence of stromal invasion, none of the features was verified. To find helpful histologic features for the recognition of early stromal invasion in squamous cell carcinoma of uterine cervix, we compared the incidences of various histopathologic findings in the unequivocal cases of HSIL and invasive squamous cell carcinomas of the uterine cervix. In addition, density of newly formed blood vessels defined by endoglin immunopositivity, and the vascular pattern such as coated and uncoated blood vessels, and complete and incomplete blood vessels were compared between the two groups. Methods: Unequivocal cases of 112 invasive squamous cell carcinomas (SCC) and 26 high grade squamous intraepithelial lesion (HSIL) diagnosed on the hysterectomy specimens were retrieved, and six histopathological parameters were compared, which include (1) presence of desmoplastic change, (2) presence of irregular epithelial tongues of malignant cells, (3) focal squamous differentiation with eosinophilic cytoplasm, (4) blurring of interface by lymphoplasma cell infiltration, (5) pseudoglands with central necrosis, (6) Scalloped contours of malignant epithelial nests and (7) random axis of rete pegs. In addition, microvascular density and vascular pattern and newly formed blood vessels using endoglin (CD105) immunostaining were compared in 17 cases of HSIL and 27 cases of invasive SCC. Results: Histologic findings of (1) presence of desmoplastic change (p <0.001), (2) focal squamous differentiation with eosinophilic cytoplasm (p=0.021) (3) blurring of interface by lympoplasma cell infiltrates (p<0.001), (4) pseudogland formed by tumor necrosis (p=0.006), (5) scalloped contours of malignant epithelial nests (p=0.021), and (6) random axis of the expansile tumor cell nests (p<0.001) were significantly more frequent in the invasive squamous cell carcinoma compared to HSIL. Density of microvessels was significantly higher in the invasive carcinoma compared to the HSIL (10.4±8.8 vs. 4.8±4.4, p=0.015), however, vascular patterns did not reveal any significant difference between the HSIL and invasive SCC. Conclusions: There was no significant difference in vascular pattern between preinvasive and invasive SCC. However, microvessel density is increased significantly in invasive SCC than HSIL. Thus, during the cervical neoplastic growth, an angiogenic switching process occurs prior to the stromal invasion, however, angiogenic process is more predominant in invasive carcinoma than in the preinvasive lesion. Histologically, presence of desmoplastic reaction, blurring of interface by lympoplasma cell infiltration, pseudoglands formed by tumor necrosis and random axis of the expansile tumor cell nests were crucial in the recognition of early stromal invasion in cervical squamous cell carcinoma
주제어
#: squamous cell carcinoma cervical carcinoma uterine cervix stromal invasion angiogenesis
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