Benign Proliferative Reactions, Intraepithelial Neoplasia, and Invasive cancer of the Uterine cervix
Fig. 8.112 Nonkeratinizing squamous cell cancer. Singly lying tumor
cells with a relatively large cytoplasmic body causing an intermediate
nucleocytoplasmic ratio. Coarsely granular, unevenly distributed
nuclear chromatin and conspicuous nucleoli that vary in size and shape
(Papanicolaou x OI).
Cells usually have a relatively large amount of cytoplasm,
which often is abundant in the large, bizarre cells (Figs 8.118 and
8.119). The cytoplasm commonly stains eosinophilic. Together
with the presence of numerous large irregular cells, cytoplasmic
eosinophilia is characteristic of keratinizing cancer. Nuclei may
be round to oval but more frequently are elongated or irregular
in shape. Bizarre nuclear forms may be present. Nuclear chro-
matin is hyperchromatic and coarsely granular. Nuclei with a
very dense hyperchromatic—opaque—chromatin are especially
frequent in highly keratinized cancers.
Key features of keratinizing squamous cell carcinoma
• Round-to-oval cells predominantly arranged in
syncytial aggregates with indistinct cell boundaries;
• Singly lying cells with densely eosinophilic cytoplasm
and bizarre shapes;
• Fibrillar cytoplasmic strands can be seen;
• Cells in syncytia have cyanophilic cytoplasm;
• Round-to-oval nuclei, with considerable variation in
Fig. 8.113 Nonkeratinizing squamous cell cancer. Tumor cells with
variable amounts of cytoplasm and irregular nuclei. Coarsely granular
irregularly distributed hyperchromatic nuclear chromatin. Phagocytosis of
tumor cell (Papanicolaou x HP).
• Bizarre shaped and elongated nuclei;
• N/C ratio is lower than in CIS due to larger volume of
• Unevenly distributed, coarsely granular densely hyper-
chromatic nuclear chromatin; and
• Micro- and macronucleoli are frequently found in cells
in syncytia.
Verrucous Carcinoma
Verrucous carcinoma is an uncommon variant of keratinizing
squamous cell carcinoma.226 This unusual, locally invasive,
slow-growing tumor is characterized by its warty appearance.
Histologically, the tumor is composed of papillary excrescences
of well-differentiated, only minimally atypical squamous cells,
often with surface keratinization (Fig. 8.120). Invasive parts of
the tumor lack the atypia characteristic of keratinizing squamous
cell carcinoma, and it may be difficult to prove frank invasion.208
In view of the very high recurrence rate of verrucous carci-
noma, wide excision is necessary. The reaction of the tumor to
radiotherapy is doubtful.227
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