What is scirrhous carcinoma?

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Scirrhous Carcinoma: Definition and Characteristics

Scirrhous carcinoma is a histological subtype of malignant epithelial tumor characterized by dense, hyaline fibrous (desmoplastic) stroma that compresses and infiltrates between scanty, pleomorphic cancer cells, creating a firm, rigid tumor with minimal glandular formation. 1, 2

Core Histological Features

The defining pathological characteristics include:

  • Dense fibrous stroma: Hyaline, collagenous connective tissue that is evenly distributed throughout the tumor and at its borders 2
  • Compressed cancer cells: Pleomorphic malignant cells that are scanty and compressed by the abundant stroma 2
  • Minimal duct formation: Almost complete absence of glandular or ductal structures 2
  • Desmoplastic reaction: Extensive fibrosis resulting from tumor-stromal interactions 1, 3

Organ-Specific Manifestations

Gastric Scirrhous Carcinoma (Linitis Plastica)

Fluoroscopic examination is essential for diagnosing scirrhous gastric carcinoma because endoscopy and biopsy have poor sensitivity for this entity. 1

  • Manifests as diffuse, long-segment, or short-segment narrowing of the stomach 1
  • Tumor cells invade the gastric wall causing desmoplastic reaction that narrows the gastric lumen 1
  • Creates rigid, nondistensible wall at fluoroscopy with obliteration of gastric peristalsis 1
  • Characterized by poorly differentiated carcinoma cells spreading through submucosa and muscularis propria with marked desmoplastic reaction 3
  • Endoscopic ultrasound shows localized irregular hypoechoic enlargement of the third (submucosal) and fourth (muscularis propria) layers with threefold thickness increase 3

Hepatocellular Carcinoma (Scirrhous Variant)

The scirrhous subtype of HCC is recognized in the WHO classification as one of eight morphological subtypes 1:

  • Demonstrates abundant fibrous stroma with extensive fibrosis 1, 4
  • Associated with similar or worse prognosis compared to conventional HCC 1
  • Shows hypoxia-driven tumor stromal remodeling and immunosuppressive microenvironment 5
  • More abundant cancer-associated fibroblasts (CAFs) and tumor-infiltrating macrophages compared to other HCC subtypes 4
  • Frequently expresses K19 stemness marker, suggesting aggressive biological behavior 4
  • Typically occurs in background of chronic liver disease (88.2% of cases) 4

Breast Scirrhous Carcinoma

  • Represents a special form of infiltrating duct carcinoma 2
  • Incidence of approximately 3.5% among breast cancers 2
  • Commonly confused with infiltrating lobular carcinoma, which is the most frequent diagnostic error 2

Diagnostic Challenges

The key diagnostic pitfall is distinguishing true scirrhous carcinoma from pseudo-scirrhous cancers and other entities with prominent stromal components. 2

  • Radiological studies cannot reliably differentiate scirrhous HCC from intrahepatic cholangiocarcinoma or metastatic adenocarcinoma 1
  • The abundant fibrous stroma can obscure malignant cells on biopsy, leading to false-negative results 1, 3
  • Requires integration of imaging findings (particularly fluoroscopy for gastric lesions), endoscopic ultrasound, and histopathological confirmation 1, 3

Clinical Significance

The extensive desmoplastic stromal reaction in scirrhous carcinomas:

  • Creates a rigid, firm tumor consistency 1, 2
  • Impairs tissue distensibility and normal organ function 1
  • Contributes to an immunosuppressive tumor microenvironment in HCC variants 5
  • May influence treatment response and prognosis, particularly in hepatocellular variants 1, 4

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Scirrhous carcinoma of the female breast.

Investigative & cell pathology, 1980

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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