Assessment of Histological Features in Squamous Cell Carcinoma Involving Head and Neck Skin and Mucosa

Abstract

Background: squamous cell carcinoma (SCC) is the second most common type of malignancy worldwide. Skin and mucosa of the head and neck areas are the most frequently affected. An aggressive behavior in SCC is not easily detected, and despite all efforts, mortality in these types of cancer did not show major improvements during recent decades. In this study, we aim to determine the role of histological features available through standard pathology assessment in SCC and their relation with tumor behavior and patients' survival.

Method: in a group of one hundred patients diagnosed with SCC involving the head and neck areas, we assessed the presence of four histological features (tumor/stroma ratio, immune infiltration at the front of invasion, tumor-budding activity, and tumor necrosis), their correlations with tumor type (mucosal or cutaneous), tumor clinicopathological characteristics, and their prognostic potential.

Results: the comparison between histological features in cutaneous versus mucosal SCC reveals no significant differences for any of the four parameters assessed. We found significant correlations between tumor/stroma ratio and lymphatic metastasis (p = 0.0275), perineural invasion (p = 0.0006), and clinical staging (p = 0.0116). Immune infiltration at the front of invasion revealed similar correlations with lymph node involvement (p = 0.002), perineural invasion (p = 0.0138), and clinical staging (p = 0.0043). Tumor budding and tumor necrosis correlated with the size of the tumor (p = 0.0077 and p = 0.0004) and the clinical staging (p = 0.0039 and p = 0.0143). In addition, tumor budding was significantly correlated with perineural invasion (p = 0.0454). In mucosal SCC, patients with improved outcome revealed high values for the tumor/stroma ratio (p = 0.0159) and immune infiltration at the front of invasion (p = 0.0274). However, the multivariate analysis did not confirm their independent prognostic roles.

Conclusions: extended histological assessments that include features such as tumor/stroma ratio, immune infiltration at the front of invasion, tumor budding, and tumor necrosis can be an easy, accessible method to collect additional information on tumor aggressiveness in skin and mucosa SCC affecting the head and neck areas.

Keywords: head and neck; histopathology; immune infiltration; necrosis; prognostic; squamous cell carcinoma; tumor budding; tumor/stroma ratio.

Figure 1

Histological features in SCC: (a) intense desmoplastic reaction (tumor/stroma ratio < 1) in non-keratinizing SCC; HE, original magnification 20×; (b) poor desmoplastic reaction (tumor/stroma ≥1) in moderately differentiated SCC; HE, original magnification 10×; (c) abundant immune infiltrate in keratinizing, well-differentiated SCC; HE, original magnification თ; (d) absence of tumor-infiltrating lymphocytes in moderately differentiated SCC, HE, and original magnification 4×; (e) high tumor-budding activity in moderately differentiated SCC; HE, original magnification 10×; (f) low tumor-budding activity in moderately differentiated SCC; HE, original magnification 10×; (g) extended necrotic areas in moderately differentiated SCC; HE, original magnification 20×; and (h) absence of necrotic areas in moderately differentiated SCC, keratinizing SCC; HE, original magnification 20×. SCC: Squamous cell carcinoma; HE: hematoxylin-eosin.

Figure 2

Survival curves in OSCC for (a) tumor/stroma ratio, (b) immune infiltration at the front of invasion, (c) tumor necrosis, and (d) tumor budding.

Figure 3

Survival curves in total SCC for (a) tumor/stroma ratio, (b) immune infiltration at the front of invasion, (c) tumor necrosis, and (d) tumor budding.