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Pathology for Urologists

Squamous Cell Carcinoma

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Image B
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  • Uncommon in US (3-6% of bladder cancers) but accounts for up to 73% of bladder cancers in areas where schistosomiasis is endemic.
  • Strongly associated with schistosomiasis infection.
  • Chronic bladder irritation is a risk factor, such as with indwelling catheter, stones and neurogenic bladder.
  • Cystoscopy usually shows large necrotic mass that is typically invasive (image A).

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  • Histology:
    • Reserved for tumors with pure squamous histology (don't confuse them with urothelial carcinoma showing squamous differentiation) (image B) & (image C).
    • Grading is based on degree of differentiation, which roughly correlates with the amount of keratin produced by the tumor cells (image D).
    • Verrucous carcinoma is well differentiated with "pushing" border in lamina propria.
    • Staging is similar to urothelial carcinoma.
  • Prognosis is poor with 5-year survival of 7% to 50%.
  • Pure verrucous carcinoma has better prognosis with no metastatic risk.


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