Histopathologic Malignancy Score of Jakobsson et al in Squamous Cell Carcinoma of the Head and Neck

Description

The prognosis for a patient with squamous cell carcinoma of the head and neck does not always correlate with the TNM stage. The histopathologic malignancy score of Jakobsson et al together with nodal status and DNA ploidy analysis can provide prognostic information for the patient.

Parameters used for the Histopathologic Malignancy Score (separated into tumor cell population and tumor-host relationship groups):

(1) structure

(2) differentiation

(3) nuclear polymorphism

(4) mitoses

(5) mode of invasion

(6) stage of invasion

(7) vascular invasion

(8) cellular response (lymphoplasmacytic)

Histologic Grading of Tumor Cell Population

Parameter	Finding	Points
structure (patterns)	solid cords and/or papillary growth	1
	strands and bands	2
	small groups of cells	3
	marked cellular dissociation	4
differentiation	highly keratinized	1
	moderately keratinized	2
	minimal keratinization	3
	no keratinization	4
nuclear polymorphism	few enlarged nuclei	1
	moderately enlarged nuclei	2
	numerous, irregular enlarged nuclei	3
	anaplastic, immature enlarged nuclei	4
mitoses per high power microscopic field	single (0-2)	1
	moderate (3-4)	2
	numerous (5-6)	3
	extremely numerous (> 6)	4

Histologic Grading of Tumor -Host Relationship

Parameter	Finding	Points
mode of invasion	well-defined basement membrane	1
	cords, with less defined basement membrane	2
	groups of cells with no distinct basement membrane	3
	diffuse invasion	4
stage of invasion	possibly invasive	1
	microcarcinoma (few cords)	2
	nodular into connective tissue	3
	massive	4
vascular invasion	none	1
	possibly (suspect)	2
	few (obvious in lymphatics and capillaries)	3
	numerous (larger vessels)	4
lymphoplasmacytic cellular response	marked	1
	moderate	2
	slight	3
	none	4

where:

• The findings in parentheses are those of Zatterstrom et al.

histopathologic malignancy score =

= SUM(points for all 8 parameters)

Interpretation:

• minimum histopathologic malignancy score: 8

• maximum histopathologic malignancy score: 32

• Zatterstrom et al found a score >= 20 indicated a worse survival than a score < 20 (5 year survival of about 72% vs 40%)

Additional prognostic factors:

(1) metastases to lymph nodes: patients without metastases to lymph nodes survived better than patients with metastases (5 year survival of about 66% vs 30%)

(2) DNA ploidy of the tumor: patients with diploid tumors survived better than patients with nondiploid tumors (5 year survival of about 72% vs 38%)

In Cox proportional hazard models

Finding	Proportional Hazard	95% Confidence Interval
histopathology malignancy score, <20 versus >= 20	3.3	1.3 to 8.3
DNA ploidy, diploid vs nondiploid	1.8	0.8 to 4.1
nodal status, negative vs positive	2.7	1.2 to 5.8

(Table 8, page 485, Zatterstrom et al)

To read more or access our algorithms and calculators, please log in or register.

Histopathologic Malignancy Score of Jakobsson et al in Squamous Cell Carcinoma of the Head and Neck

Description

Specialty