Análise clinicopatológica, imunoistoquímica e hibridização in situ de variantes histopatológicas de carcinomas espinocelulares de cabeça e pescoço: um estudo multicêntrico colaborativo
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2023-02-27
Autores
Silveira, Heitor Albergoni da
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Universidade Estadual Paulista (Unesp)
Resumo
O carcinoma espinocelular (CEC) da região de cabeça e pescoço (CECCP) é um grupo heterogêneo de neoplasias malignas se originando da pele e mucosas, representando 95% de todos os cânceres nesta região anatômica. A etiologia do CECCP é multifatorial, apresenta variações por regiões geográficas e é frequentemente associado ao consumo crônico de tabaco, álcool ou ambos, bem como à infecção pelo papilomavírus humano (HPV), este último notavelmente associado com o CEC orofaríngeo (CECorof). O diagnóstico microscópico da grande maioria dos CECCP corresponde ao CEC convencional; no entanto, entre 5% e 15% dos casos corresponde a variantes histopatológicas do CECCP, as quais precisam ser reconhecidas e diagnosticadas corretamente, pelo seu impacto terapêutico e prognóstico. Microscopicamente, as variantes histopatológicas do CECCP podem simular neoplasias benignas ou malignas, ou até mesmo processos inflamatórios ou reativos. Diante disto, no presente trabalho, por meio de um estudo colaborativo multicêntrico, foram avaliados retrospectivamente 1.415 casos de CECCP, visando a caracterização de variantes histopatológicas, seguindo os critérios propostos pela Organização Mundial da Saúde (OMS, 2022). Adicionalmente, as variantes histopatológicas foram analisadas por meio de histoquímica, imunoistoquímica e hibridização in situ. Sessenta e sete (67/1.415; 4,7%) variantes foram identificadas, incluindo carcinoma verrucoso (n=21), CEC basalóide (n=13 casos), CEC de células fusiformes (n=08 casos), carcinoma adenoescamoso (n=06), CEC de células claras (n=04), carcinoma cuniculado (n=4), carcinoma linfoepitelial (n=3), CEC papilar (n=2), CEC acantolítico (n=2), CEC pigmentado (n=2), assim como 2 raros casos, de carcinoma com diferenciação neuroendócrina (n=1) e carcinoma com fenótipo rabdóide (n=1). Nossos resultados mostram que variantes histopatológicas do CECCP em centros de referência na população brasileira tem uma prevalência de 4,7%. Relevantemente, algumas dessas variantes ainda não estão consideradas na classificação proposta pela OMS 2022. Consideramos que nossos achados servirão base para propostas de classificação futuras, ampliando o espectro clinicopatológico das variantes histopatológicas do CECCP, bem como auxiliarão nos critérios diagnósticos, especialmente para patologistas, visando o correto diagnóstico, com impacto terapêutico e prognóstico de uma doença com altas taxas de morbimortalidade.
Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous group of malignant neoplasms originating from the skin and mucous membranes, representing 95% of all cancers in this anatomical region. The etiology of HNSCC is multifactorial, varies by geographic region and is often associated with chronic consumption of tobacco, alcohol or both, as well as human papillomavirus (HPV) infection, the latter notably associated with oropharyngeal SCC (oroSCC). The microscopic diagnosis of the vast majority of HNSCC corresponds to conventional SCC; however, between 5% and 15% of cases correspond to histopathological variants of HNSCC, which need to be recognized and correctly diagnosed, due to their therapeutic and prognostic impact. Microscopically, the histopathological variants of HNSCC can simulate benign or malignant neoplasms, or even inflammatory or reactive processes. In view of this, in the present study, through a multicenter collaborative study, 1,415 cases of HNSCC were retrospectively evaluated, aiming at the characterization of histopathological variants, following the criteria proposed by the World Health Organization (WHO, 2022). Additionally, the histopathological variants were analyzed using histochemistry, immunohistochemistry and in situ hybridization. Sixty-seven (67/1,415; 4.7%) variants were identified, including verrucous carcinoma (n=21), basaloid SCC (n=13 cases), spindle cell SCC (n=08 cases), adenosquamous carcinoma (n =06), clear cell SCC (n=04), cuniculatum carcinoma (n=4), lymphoepithelial carcinoma (n=3), papillary SCC (n=2), acantholytic SCC (n=2), pigmented SCC (n =2), as well as 2 rare cases of carcinoma with neuroendocrine differentiation (n=1) and carcinoma with rhabdoid phenotype (n=1). Our results show that histopathological variants of HNSCC in reference centers in the Brazilian population have a prevalence of 4.7%. Relevantly, some of these variants are not yet considered in the classification proposed by WHO 2022. We believe that our findings will serve as a basis for future classification proposals, expanding the clinicopathological spectrum of histopathological variants of HNSCC, as well as helping in diagnostic criteria, especially for pathologists, aiming at the correct diagnosis, with therapeutic and prognostic impact of a disease with high morbidity and mortality rates.
Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous group of malignant neoplasms originating from the skin and mucous membranes, representing 95% of all cancers in this anatomical region. The etiology of HNSCC is multifactorial, varies by geographic region and is often associated with chronic consumption of tobacco, alcohol or both, as well as human papillomavirus (HPV) infection, the latter notably associated with oropharyngeal SCC (oroSCC). The microscopic diagnosis of the vast majority of HNSCC corresponds to conventional SCC; however, between 5% and 15% of cases correspond to histopathological variants of HNSCC, which need to be recognized and correctly diagnosed, due to their therapeutic and prognostic impact. Microscopically, the histopathological variants of HNSCC can simulate benign or malignant neoplasms, or even inflammatory or reactive processes. In view of this, in the present study, through a multicenter collaborative study, 1,415 cases of HNSCC were retrospectively evaluated, aiming at the characterization of histopathological variants, following the criteria proposed by the World Health Organization (WHO, 2022). Additionally, the histopathological variants were analyzed using histochemistry, immunohistochemistry and in situ hybridization. Sixty-seven (67/1,415; 4.7%) variants were identified, including verrucous carcinoma (n=21), basaloid SCC (n=13 cases), spindle cell SCC (n=08 cases), adenosquamous carcinoma (n =06), clear cell SCC (n=04), cuniculatum carcinoma (n=4), lymphoepithelial carcinoma (n=3), papillary SCC (n=2), acantholytic SCC (n=2), pigmented SCC (n =2), as well as 2 rare cases of carcinoma with neuroendocrine differentiation (n=1) and carcinoma with rhabdoid phenotype (n=1). Our results show that histopathological variants of HNSCC in reference centers in the Brazilian population have a prevalence of 4.7%. Relevantly, some of these variants are not yet considered in the classification proposed by WHO 2022. We believe that our findings will serve as a basis for future classification proposals, expanding the clinicopathological spectrum of histopathological variants of HNSCC, as well as helping in diagnostic criteria, especially for pathologists, aiming at the correct diagnosis, with therapeutic and prognostic impact of a disease with high morbidity and mortality rates.
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Palavras-chave
Carcinoma de Células Escamosas de Cabeça e Pescoço, Histocitoquímica, Imuno-Histoquímica, Hibridização in situ, Patologia Cirúrgica