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Histologic identification of human papillomavirus (HPV)-related squamous cell carcinoma in cervical lymph nodes: a reliable predictor of the site of an occult head and neck primary carcinoma.
Head Neck Pathol. 2008 Sep; 2(3):163-8.HN

Abstract

OBJECTIVE

Patients with head and neck squamous cell carcinoma (SCC) often present with cervical lymph node metastasis. Occasionally the primary tumor site remains unknown even after thorough investigation. Management of such cases is problematic and may result in over-treatment and consequent increased morbidity. High risk HPV has been advocated recently as an important etiologic factor for a subset of head and neck SCC. These are believed to have a special predilection for the oropharyngeal tonsils and are characterized by nonkeratinizing basaloid morphology, and a strong reactivity to p16 immunostain. Identifying HPV-related SCC in the lymph nodes may thus provide a means for localizing the primary tumor site.

DESIGN

Ninety-three cases of SCC metastatic to the neck from known primary tumors were classified morphologically into conventional keratinizing SCC (KSCC) and non-keratinizing SCC (NKCa). In situ hybridization (ISH) for high risk HPV as well as immunostaining for p16 were performed on all metastsatic and primary tumors.

RESULTS

Of the 93 cases of metastatic carcinomas 32 were oropharyngeal, 35 oral, and 26 arose in the laryx/hypopharynx. Twenty-three cases were found to be HPV+ by ISH, of which 22/23 had oropharyngeal origin (P < 0.0001), with 95.7% sensitivity and 85.7% specificity. Twenty-one of these HPV+ oropharyngeal tumors were NKCa (P < 0.0001). The remaining case showed overlapping NKCa/KSCC hybrid morphology. All NKCa were HPV+ and stained diffusely and strongly with p16 antibodies.

CONCLUSION

We have demonstrated that HPV status of the lymph node metastasis can be assessed not only by ISH and p16 immunoreactivity but also histomorphologically. In addition, a positive microscopic identification of HPV-related carcinoma is a reliable predictor of oropharyngeal origin.

Authors+Show Affiliations

Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA. elmofty@wustl.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20614311

Citation

El-Mofty, Samir K., et al. "Histologic Identification of Human Papillomavirus (HPV)-related Squamous Cell Carcinoma in Cervical Lymph Nodes: a Reliable Predictor of the Site of an Occult Head and Neck Primary Carcinoma." Head and Neck Pathology, vol. 2, no. 3, 2008, pp. 163-8.
El-Mofty SK, Zhang MQ, Davila RM. Histologic identification of human papillomavirus (HPV)-related squamous cell carcinoma in cervical lymph nodes: a reliable predictor of the site of an occult head and neck primary carcinoma. Head Neck Pathol. 2008;2(3):163-8.
El-Mofty, S. K., Zhang, M. Q., & Davila, R. M. (2008). Histologic identification of human papillomavirus (HPV)-related squamous cell carcinoma in cervical lymph nodes: a reliable predictor of the site of an occult head and neck primary carcinoma. Head and Neck Pathology, 2(3), 163-8. https://doi.org/10.1007/s12105-008-0066-1
El-Mofty SK, Zhang MQ, Davila RM. Histologic Identification of Human Papillomavirus (HPV)-related Squamous Cell Carcinoma in Cervical Lymph Nodes: a Reliable Predictor of the Site of an Occult Head and Neck Primary Carcinoma. Head Neck Pathol. 2008;2(3):163-8. PubMed PMID: 20614311.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Histologic identification of human papillomavirus (HPV)-related squamous cell carcinoma in cervical lymph nodes: a reliable predictor of the site of an occult head and neck primary carcinoma. AU - El-Mofty,Samir K, AU - Zhang,Megan Q, AU - Davila,Rosa M, Y1 - 2008/06/24/ PY - 2008/03/24/received PY - 2008/06/03/accepted PY - 2010/7/9/entrez PY - 2008/9/1/pubmed PY - 2010/10/6/medline KW - HPV KW - ISH KW - Nonkeratinizing squamous cell carcinoma KW - Occult head and neck carcinoma KW - Oropharynx KW - p16 SP - 163 EP - 8 JF - Head and neck pathology JO - Head Neck Pathol VL - 2 IS - 3 N2 - OBJECTIVE: Patients with head and neck squamous cell carcinoma (SCC) often present with cervical lymph node metastasis. Occasionally the primary tumor site remains unknown even after thorough investigation. Management of such cases is problematic and may result in over-treatment and consequent increased morbidity. High risk HPV has been advocated recently as an important etiologic factor for a subset of head and neck SCC. These are believed to have a special predilection for the oropharyngeal tonsils and are characterized by nonkeratinizing basaloid morphology, and a strong reactivity to p16 immunostain. Identifying HPV-related SCC in the lymph nodes may thus provide a means for localizing the primary tumor site. DESIGN: Ninety-three cases of SCC metastatic to the neck from known primary tumors were classified morphologically into conventional keratinizing SCC (KSCC) and non-keratinizing SCC (NKCa). In situ hybridization (ISH) for high risk HPV as well as immunostaining for p16 were performed on all metastsatic and primary tumors. RESULTS: Of the 93 cases of metastatic carcinomas 32 were oropharyngeal, 35 oral, and 26 arose in the laryx/hypopharynx. Twenty-three cases were found to be HPV+ by ISH, of which 22/23 had oropharyngeal origin (P < 0.0001), with 95.7% sensitivity and 85.7% specificity. Twenty-one of these HPV+ oropharyngeal tumors were NKCa (P < 0.0001). The remaining case showed overlapping NKCa/KSCC hybrid morphology. All NKCa were HPV+ and stained diffusely and strongly with p16 antibodies. CONCLUSION: We have demonstrated that HPV status of the lymph node metastasis can be assessed not only by ISH and p16 immunoreactivity but also histomorphologically. In addition, a positive microscopic identification of HPV-related carcinoma is a reliable predictor of oropharyngeal origin. SN - 1936-0568 UR - https://www.unboundmedicine.com/medline/citation/20614311/Histologic_identification_of_human_papillomavirus__HPV__related_squamous_cell_carcinoma_in_cervical_lymph_nodes:_a_reliable_predictor_of_the_site_of_an_occult_head_and_neck_primary_carcinoma_ L2 - https://dx.doi.org/10.1007/s12105-008-0066-1 DB - PRIME DP - Unbound Medicine ER -