Human papillomavirus-associated head and neck squamous cell carcinoma

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Human papillomavirus-associated head and neck squamous cell carcinoma
Diagnosis in short

Poorly differentiated squamous cell carcinoma (SCC) that is p16 positive, compatible with HPV-associated head and neck SCC. H&E stain.
LM typically non-keratinizing squamous cell carcinoma
LM DDx squamous dysplasia of the head and neck, squamous cell carcinoma of the head and neck, nasopharyngeal carcinoma
IHC p16 +ve, EBV-ve, p63 +ve, CK5/6 +ve
Molecular EBER -ve
Gross palatine tonsil, lingual tonsil, oropharynx
Site head and neck
Clinical history typically male, younger than typical H&N SCC, +/-homosexual practices
Prevalence uncommon
Prognosis good compared to usu. head and neck SCC

Human papillomavirus-associated head and neck squamous cell carcinoma, abbreviated HPV-associated SCC and HPV-NHSCC, is a type of head and neck squamous cell carcinoma.

It has a unique epidemiology, when compared to conventional head and neck squamous cell carcinoma.

Human papillomavirus-associated head and neck cancer redirects here.

General

  • Tumours associated with high risk HPV, typically HPV 16.[1]
    • Thought to be different that tumours driven by alcohol and tobacco use.[2]
      • Patients tend to be male (male:female = 5:1[3]) and slightly younger (~4-10 years younger than typical H&N SCC[4]) - risk thought to be due to sexual practices.[5]
  • Lesions more radiosensitive and usually have a better prognosis.[1]

Gross

Classic locations:

  • Tonsil and base of tongue[6] (palatine tonsil, lingual tonsil, oropharynx).

Note:

  • Memory device:
    • Where the tip of the penis goes when someone is deep throating.

Microscopic

Features:[7]

  • Typically non-keratinizing squamous cell carcinoma.

DDx:

Images

Case 1

  • SCC p16 positive - very low mag.

  • SCC p16 positive - low mag.

  • SCC p16 positive - intermed. mag.

  • SCC p16 positive - intermed. mag.

  • SCC p16 positive - high mag.

  • SCC p16 positive - very high mag.

Case 2

  • c/w HPV-SCC - intermed. mag.

  • c/w HPV-SCC - high mag.

  • c/w HPV-SCC - p16 - high mag.

  • c/w HPV-SCC - p40 - high mag.

  • c/w HPV-SCC - low mag.

  • c/w HPV-SCC - intermed. mag.

  • c/w HPV-SCC - intermed. mag.

  • c/w HPV-SCC - high mag.

www

IHC

  • p16 +ve[6] - should be >70% of cells, strong, nuclear and cytoplasmic staining.
  • EBV -ve.
  • CK5/6 +ve.
  • p63 +ve.

Molecular

  • EBER -ve.

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BASE OF LEFT TONSIL, BIOPSY:
- INVASIVE SQUAMOUS CELL CARCINOMA, POORLY DIFFERENTIATED, SEE COMMENT.

COMMENT:
The tumour is p16 positive and EBV negative; this favours a HPV-associated 
squamous cell carcinoma. Clinical correlation is suggested.

The tumour stains as follows:
POSITIVE: p63, CK5/6, BCL2.
NEGATIVE: LCA, EBV, synaptophysin, chromogranin, CD56.
PROLIFERATION (Ki-67): 90% of tumour cells.

See also

References

  1. ↑ 1.0 1.1 Wang, XI.; Thomas, J.; Zhang, S. (Jan 2012). "Changing trends in human papillomavirus-associated head and neck squamous cell carcinoma.". Ann Diagn Pathol 16 (1): 7-12. doi:10.1016/j.anndiagpath.2011.07.003. PMID 22001331.
  2. ↑ Wittekindt, C.; Wagner, S.; Klussmann, JP. (Sep 2011). "[HPV-associated head and neck cancer. The basics of molecular and translational research].". HNO 59 (9): 885-92. doi:10.1007/s00106-011-2357-1. PMID 21769577.
  3. ↑ Ajila, V.; Shetty, H.; Babu, S.; Shetty, V.; Hegde, S. (2015). "Human Papilloma Virus Associated Squamous Cell Carcinoma of the Head and Neck.". J Sex Transm Dis 2015: 791024. doi:10.1155/2015/791024. PMID 26483987.
  4. ↑ Benson, E.; Li, R.; Eisele, D.; Fakhry, C. (Jun 2014). "The clinical impact of HPV tumor status upon head and neck squamous cell carcinomas.". Oral Oncol 50 (6): 565-74. doi:10.1016/j.oraloncology.2013.09.008. PMID 24134947.
  5. ↑ Vourexakis, Z.; Dulguerov, P. (Oct 2011). "[HPV associated head and neck cancers].". Rev Med Suisse 7 (311): 1919-22. PMID 22046680.
  6. ↑ 6.0 6.1 Heath, S.; Willis, V.; Allan, K.; Purdie, K.; Harwood, C.; Shields, P.; Simcock, R.; Williams, T. et al. (Feb 2012). "Clinically significant human papilloma virus in squamous cell carcinoma of the head and neck in UK practice.". Clin Oncol (R Coll Radiol) 24 (1): e18-23. doi:10.1016/j.clon.2011.05.007. PMID 21752613.
  7. ↑ Chernock, RD.; El-Mofty, SK.; Thorstad, WL.; Parvin, CA.; Lewis, JS. (Sep 2009). "HPV-related nonkeratinizing squamous cell carcinoma of the oropharynx: utility of microscopic features in predicting patient outcome.". Head Neck Pathol 3 (3): 186-94. doi:10.1007/s12105-009-0126-1. PMC 2811624. PMID 20596971. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811624/.
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