2 cell type differentiation (pale ductal and dark basaloid)
Nuclear pleomorphism (at high magnification)
Uniform small hyperchromatic nuclei
Frequent mitotic figures
Mitotic figures infrequent
p63 diffuse positivity and smooth muscle actin usually negative
p63 and smooth muscle actin clearly define a surrounding myoepithelial component
Perineural invasion infrequent
Perineural invasion common
Grading / Staging
No widely accepted well described, tested grading scheme
Well differentiated – Large squamous differentiating cells predominate over small basaloid cells
Poorly differentiated - Small basaloid cells predominate over large squamous differentiating cells
Moderately differentiated – Intermediate mixtures, should make up about 2/3 of cases
Grading based on differentiation and cytologic features is not a good predictor of behavior
Following scheme has been proposed as predictive of 5 year survival (Sarbia 1995)
Points are allocated as indicated in the table
Pattern of invasion
Pushing, well defined margins
Infiltrating solid cords and bands
Small groups of dissociated cells
Marked cellular discohesion
Cases are then stratified based on the sum of the two scores
Group I – 2 or 3 points
Group II – 4 points
Group III – 5 or 6 points
Group IV – 7 or 8 points
If the complete scheme is not used, it is probably worthwhile to comment on the pattern of invasion and inflammatory response
Same TNM for esophageal squamous and adenocarcinomas
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