Difference between revisions of "Human papillomavirus-associated head and neck squamous cell carcinoma"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Squamous cell carcinoma - p16 positive -- high mag.jpg
| Width      =
| Caption    = Poorly differentiated squamous cell carcinoma (SCC) that is p16 positive, compatible with HPV-associated head and neck SCC. [[H&E stain]].
| Synonyms  =
| Micro      = typically non-keratinizing squamous cell carcinoma
| Subtypes  =
| LMDDx      = [[squamous dysplasia of the head and neck]], [[squamous cell carcinoma of the head and neck]], [[nasopharyngeal carcinoma]]
| Stains    =
| IHC        = p16 +ve, EBV-ve, p63 +ve, CK5/6 +ve
| EM        =
| Molecular  = EBER -ve
| IF        =
| Gross      = palatine tonsil, lingual tonsil, oropharynx
| Grossing  =
| Site      = [[head and neck pathology|head and neck]]
| Assdx      =
| Syndromes  =
| Clinicalhx = typically male, younger than typical H&N SCC, +/-homosexual practices
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = good compared to usu. head and neck SCC
| Other      =
| ClinDDx    =
| Tx        =
}}
'''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]].  
'''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]].
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==
==General==
*Tumours associated with high risk HPV, typically [[HPV]] 16.<ref name=pmid22001331 >{{Cite journal  | last1 = Wang | first1 = XI. | last2 = Thomas | first2 = J. | last3 = Zhang | first3 = S. | title = Changing trends in human papillomavirus-associated head and neck squamous cell carcinoma. | journal = Ann Diagn Pathol | volume = 16 | issue = 1 | pages = 7-12 | month = Jan | year = 2012 | doi = 10.1016/j.anndiagpath.2011.07.003 | PMID = 22001331 }}</ref>
*Tumours associated with high risk HPV, typically [[HPV]] 16.<ref name=pmid22001331 >{{Cite journal  | last1 = Wang | first1 = XI. | last2 = Thomas | first2 = J. | last3 = Zhang | first3 = S. | title = Changing trends in human papillomavirus-associated head and neck squamous cell carcinoma. | journal = Ann Diagn Pathol | volume = 16 | issue = 1 | pages = 7-12 | month = Jan | year = 2012 | doi = 10.1016/j.anndiagpath.2011.07.003 | PMID = 22001331 }}</ref>
**Thought to be different that tumours driven by [[alcohol]] and [[smoking|tobacco]] use.<ref name=pmid21769577>{{Cite journal  | last1 = Wittekindt | first1 = C. | last2 = Wagner | first2 = S. | last3 = Klussmann | first3 = JP. | title = [HPV-associated head and neck cancer. The basics of molecular and translational research]. | journal = HNO | volume = 59 | issue = 9 | pages = 885-92 | month = Sep | year = 2011 | doi = 10.1007/s00106-011-2357-1 | PMID = 21769577 }}</ref>
**Thought to be different that tumours driven by [[alcohol]] and [[smoking|tobacco]] use.<ref name=pmid21769577>{{Cite journal  | last1 = Wittekindt | first1 = C. | last2 = Wagner | first2 = S. | last3 = Klussmann | first3 = JP. | title = [HPV-associated head and neck cancer. The basics of molecular and translational research]. | journal = HNO | volume = 59 | issue = 9 | pages = 885-92 | month = Sep | year = 2011 | doi = 10.1007/s00106-011-2357-1 | PMID = 21769577 }}</ref>
***Patients tend to be male and slightly younger - risk thought to be due to sexual practices.<ref name=pmid22046680>{{Cite journal  | last1 = Vourexakis | first1 = Z. | last2 = Dulguerov | first2 = P. | title = [HPV associated head and neck cancers]. | journal = Rev Med Suisse | volume = 7 | issue = 311 | pages = 1919-22 | month = Oct | year = 2011 | doi =  | PMID = 22046680 }}</ref>
***Patients tend to be male (male:female = 5:1<ref name=pmid26483987>{{Cite journal  | last1 = Ajila | first1 = V. | last2 = Shetty | first2 = H. | last3 = Babu | first3 = S. | last4 = Shetty | first4 = V. | last5 = Hegde | first5 = S. | title = Human Papilloma Virus Associated Squamous Cell Carcinoma of the Head and Neck. | journal = J Sex Transm Dis | volume = 2015 | issue =  | pages = 791024 | month =  | year = 2015 | doi = 10.1155/2015/791024 | PMID = 26483987 }}</ref>) and slightly younger (~4-10 years younger than typical H&N SCC<ref name=pmid24134947>{{Cite journal  | last1 = Benson | first1 = E. | last2 = Li | first2 = R. | last3 = Eisele | first3 = D. | last4 = Fakhry | first4 = C. | title = The clinical impact of HPV tumor status upon head and neck squamous cell carcinomas. | journal = Oral Oncol | volume = 50 | issue = 6 | pages = 565-74 | month = Jun | year = 2014 | doi = 10.1016/j.oraloncology.2013.09.008 | PMID = 24134947 }}</ref>) - risk thought to be due to sexual practices.<ref name=pmid22046680>{{Cite journal  | last1 = Vourexakis | first1 = Z. | last2 = Dulguerov | first2 = P. | title = [HPV associated head and neck cancers]. | journal = Rev Med Suisse | volume = 7 | issue = 311 | pages = 1919-22 | month = Oct | year = 2011 | doi =  | PMID = 22046680 }}</ref>
*Lesions more radiosensitive and usually have a better prognosis.<ref name=pmid22001331/>
*Lesions more radiosensitive and usually have a better prognosis.<ref name=pmid22001331/>


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*[[Nasopharyngeal carcinoma]].
*[[Nasopharyngeal carcinoma]].


Images:
===Images===
====Case 1====
<gallery>
Image: Squamous cell carcinoma - p16 positive -- very low mag.jpg | SCC p16 positive - very low mag.
Image: Squamous cell carcinoma - p16 positive -- low mag.jpg | SCC p16 positive - low mag.
Image: Squamous cell carcinoma - p16 positive -- intermed mag.jpg | SCC p16 positive - intermed. mag.
Image: Squamous cell carcinoma - p16 positive - alt -- intermed mag.jpg | SCC p16 positive - intermed. mag.
Image: Squamous cell carcinoma - p16 positive -- high mag.jpg | SCC p16 positive - high mag.
Image: Squamous cell carcinoma - p16 positive -- very high mag.jpg | SCC p16 positive - very high mag.
</gallery>
====Case 2====
<gallery>
Image: Consistent with HPV-associated SCC in muscle -- intermed mag.jpg | c/w HPV-SCC - intermed. mag.
Image: Consistent with HPV-associated SCC in muscle -- high mag.jpg | c/w HPV-SCC - high mag.
 
Image: Consistent with HPV-associated SCC - p16 -- high mag.jpg | c/w HPV-SCC - [[p16]] - high mag.
Image: Consistent with HPV-associated SCC - p40 -- high mag.jpg | c/w HPV-SCC - [[p40]] - high mag.
 
Image: Consistent with HPV-associated SCC -- low mag.jpg | c/w HPV-SCC - low mag.
Image: Consistent with HPV-associated SCC -- intermed mag.jpg | c/w HPV-SCC - intermed. mag.
Image: Consistent with HPV-associated SCC - alt -- intermed mag.jpg | c/w HPV-SCC - intermed. mag.
Image: Consistent with HPV-associated SCC -- high mag.jpg | c/w HPV-SCC - high mag.
</gallery>
 
====www====
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811624/figure/Fig1/ HPV NK SCC (nih.gov)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811624/figure/Fig1/ HPV NK SCC (nih.gov)].


==IHC==
==IHC==
*p16 +ve.<ref name=pmid21752613>{{Cite journal  | last1 = Heath | first1 = S. | last2 = Willis | first2 = V. | last3 = Allan | first3 = K. | last4 = Purdie | first4 = K. | last5 = Harwood | first5 = C. | last6 = Shields | first6 = P. | last7 = Simcock | first7 = R. | last8 = Williams | first8 = T. | last9 = Gilbert | first9 = DC. | title = Clinically significant human papilloma virus in squamous cell carcinoma of the head and neck in UK practice. | journal = Clin Oncol (R Coll Radiol) | volume = 24 | issue = 1 | pages = e18-23 | month = Feb | year = 2012 | doi = 10.1016/j.clon.2011.05.007 | PMID = 21752613 }}</ref>
*p16 +ve<ref name=pmid21752613>{{Cite journal  | last1 = Heath | first1 = S. | last2 = Willis | first2 = V. | last3 = Allan | first3 = K. | last4 = Purdie | first4 = K. | last5 = Harwood | first5 = C. | last6 = Shields | first6 = P. | last7 = Simcock | first7 = R. | last8 = Williams | first8 = T. | last9 = Gilbert | first9 = DC. | title = Clinically significant human papilloma virus in squamous cell carcinoma of the head and neck in UK practice. | journal = Clin Oncol (R Coll Radiol) | volume = 24 | issue = 1 | pages = e18-23 | month = Feb | year = 2012 | doi = 10.1016/j.clon.2011.05.007 | PMID = 21752613 }}</ref> -  should be >70% of cells, strong, nuclear and cytoplasmic staining.
*EBER -ve.
*EBV -ve.
*CK5/6 +ve.
*p63 +ve.
 
A panel:
*p16, CK5/6, CK34betaE12, CD56, synaptophysin, LCA, Ki-67.
 
==Molecular==
*[[EBER]] -ve.
**Positive in [[nasopharyngeal carcinoma]].
 
==Sign out==
<pre>
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.
</pre>
==See also==
==See also==
*[[Head and neck pathology]].
*[[Head and neck pathology]].

Latest revision as of 16:41, 22 December 2020

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

Case 2

www

IHC

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

A panel:

  • p16, CK5/6, CK34betaE12, CD56, synaptophysin, LCA, Ki-67.

Molecular

Sign out

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/.