Certain histologic features of squamous cell carcinoma arising in the oropharynx can be combined to give a score which characterizes the tumor. A somewhat similar score termed the histologic malignancy score (HMS) by Woolgar et al is described in the next section.
Parameters:
(1) degree of keratinization
(2) nuclear differentiation
(3) mitotic rate
(4) inflammatory response
(5) vascular and/or lymphatic invasion
(6) pattern of invasion
|
Histologic Parameter |
Finding |
Points |
|
cytoplasmic keratinization |
highly degree, with well-formed pearls |
1 |
|
|
moderate, 20-50% of the cells, attempts at pearl formation |
2 |
|
|
poor, 5-20% of the cells with suggestion of keratinization |
3 |
|
|
no evidence of keratinization |
4 |
|
nuclear differentiation |
few enlarged nuclei, > 75% mature appearing |
1 |
|
|
50-75% mature appearing nuclei |
2 |
|
|
considerable nuclear pleomorphism, 25% mature appearing |
3 |
|
|
anaplastic tumor |
4 |
|
mitoses, average number per high power field |
0-1 |
1 |
|
|
2-3 |
2 |
|
|
4-5 |
3 |
|
|
> 5 |
4 |
|
inflammatory (lymphoplasmacytic) response |
continuous rim |
1 |
|
|
patchy rim |
2 |
|
|
occasional patch |
3 |
|
|
none |
4 |
|
vascular/lymphatic invasion |
not identified |
1 |
|
|
not identified |
2 |
|
|
not identified |
3 |
|
|
identified |
4 |
|
pattern of invasion |
pushing border |
1 |
|
|
solid cords |
2 |
|
|
thin irregular cords |
3 |
|
|
single cells |
4 |
where:
• The scoring of vascular-lymphatic invasion when it is "not identified" is confusing to me. The score of Jakobsson et al used responses none, possible, few, and numerous. I have used the latter in the spreadsheet.
total histologic score =
= (points for keratinization) + (points for nuclear differentiation) + (points for mitotic activity) + (points for inflammatory response)+ (points for vascular/lymphatic invasion pattern) + (points for invasion pattern)
Interpretation:
• minimum score: 6
• maximum score: 24
• The total score did not demonstrate prognostic value, but certain elements did.
Prognostic significance of elements:
• The pattern of invasion: for pushing margin (1) and solid cords, the 5 year survival (from Figure 6, page 2999, Crissman) was 62.5%; for thin, irregular cords (3) and single cells (4) it was 25%.
• If clinical parameters (tumor size, clinical node status, sex and age) were not included, then the mitotic rate became significant in predicting the patient survival rate.
• In T2 and T3 tumors, the mitotic rate and pattern of invasion were important in predicting which patients would die of their disease., while the presence of tumor in vascular spaces was a predictor of survival.
Specialty: Hematology Oncology, Surgery, general, Otolaryngology
