Histological Grade

Histological grade has been repeatedly reported as an important prognostic factor. 53,55,58,136,139,140,143,144,148-150 High-grade tumors tend to metastasize and disseminate much more frequently than low-grade tumors, even if superficially located.56 For consistency we propose the use of a simple 3-tier system which emphasizes both ends of the spectrum55: grade 1, tumors composed of neoplastic cells almost indistinguishable from normal squamous cells, except for a minimal basal/parasabal aty-pia (see Fig. 3.5a); grade 3, tumors composed by any proportion of anaplastic cells (nuclear pleomorphism, coarse chromatin, prominent nucleolus, irregular and thickened nuclear membrane, abundant and atypical mitoses, see Fig. 3.15); and grade 2, the remainder of cases not ffitting the criteria for grades 1 or 3, with neoplastic cells showing evident but not extreme nuclear atypia and ample eosinophilic cytoplasm with a clear tendency toward squamous maturation (see Fig. 3.5b). Up to one-half of all cases of SCC are heterogeneous, meaning that they harbor more than one histological grade.58 These heterogeneous cases should be graded according to the highest grade found in the tumor, regardless of its proportion.

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