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. 2014 Mar;8(1):16-23.
doi: 10.1007/s12105-014-0530-z. Epub 2014 Mar 5.

Current views and perspectives on classification of squamous intraepithelial lesions of the head and neck

Nina Gale  1 , Nina Zidar, Mario Poljak, Antonio Cardesa
Affiliations

Current views and perspectives on classification of squamous intraepithelial lesions of the head and neck

Nina Gale et al. Head Neck Pathol. 2014 Mar.

Abstract

The current state in the field of classifying oral and laryngeal precursor lesions, as proposed in the WHO 2005 Blue Book is not ideal. The results of various inter-observer studies have shown that the currently used grading systems, with different basic concepts and different terminology, cannot continue to be reliably used in the future. The different etiology of cervical and head and neck precursor lesions requires a classification designed to cater to the specificities of the head and neck region. Trying to harmonize different classifications of the oral and laryngeal precursor lesions, we have proposed four crucial steps to set up a unified classification of squamous intraepithelial lesions (SILs): (a) the classification should contain two grades, low-grade and high-grade lesions and, specifically for the larynx, an additional grade-carcinoma in situ (CIS) which must be separated from high-grade laryngeal SILs; (b) the terminology should be unified; our preference is for the term SIL over squamous intraepithelial neoplasia; (c) all leading morphological criteria for low- and high-grade lesions, as well as for CIS, should be clearly defined; (d) agreement between clinicians and pathologists should be achieved on the most appropriate choice of treatment of different grades of SILs in separate head and neck areas.

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Figures

Fig. 1
Fig. 1
Low-grade squamous intraepithelial lesion. Hyperplasic squamous epithelium with augmented parabasal cells extend up to the midportion of the epithelial thickness. The upper part of the epithelium is unchanged
Fig. 2
Fig. 2
High-grade squamous intraepithelial lesion. The thickened epithelium is entirely occupied by moderately polymorphic epithelial cells, which show preserved perpendicular orientation to the basement membrane
Fig. 3
Fig. 3
Carcinoma in situ. Pronounced architectural disorder of the epithelium with severe cellular and nuclear atypias and increased number of mitoses and dyskeratotic cells are evident in the lower two-thirds of the epithelium. The upper third shows partially preserved epithelial maturation
Fig. 4
Fig. 4
High-grade squamous intraepithelial lesion. Thickened epithelium with drop-shaped rete pegs, two-thirds of the epithelium is occupied by moderately atypical epithelial cells with partially preserved perpendicular orientation to the basement membrane. Mitotic activity is evident in the lower part of the epithelium
Fig. 5
Fig. 5
Carcinoma in situ. a Thickened epithelium with entire architectural disorder over the whole epithelial thickness. Epithelial atypias are evident. b Higher magnification of Fig. 5a. Complete architectural disorder of atypical epithelial cell; a pronounced number of atypical mitoses are present
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References

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