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de Sousa LG, Lazar Neto F, Dal Lago EA, Sikora A, Hanna E, Moreno A, Phan J, Glisson BS, Bell D, Ferrarotto R. Human papillomavirus status and prognosis of oropharyngeal high-grade neuroendocrine carcinoma. Oral Oncol 2023; 138:106311. [PMID: 36702015 DOI: 10.1016/j.oraloncology.2023.106311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/12/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND The prognostic impact of human papillomavirus (HPV) infection or smoking on oropharyngeal high-grade neuroendocrine carcinoma (HG-NEC) is not established. METHODS Retrospective study with patients with oropharyngeal HG-NEC seen at MD Anderson Cancer Center from 1997 to 2020, and previously reported patients with oropharyngeal HG-NEC and known p16 and HPV status from the literature review. Survival was estimated with the Kaplan-Meier method, and survival differences assessed with the log-rank test and Cox proportional hazards models. RESULTS Thirty patients were included; most had a heavy (≥10 pack-years) smoking history (52%), locoregional disease (stage III-IVB; 77%), and p16-positive tumor (92%). HPV was positive in 65% of tested samples (15/23). Of 24 patients treated with curative intent, the objective response rates was 90% (9/10) and 81% (17/21), respectively, for induction chemotherapy and definitive radiotherapy. During follow-up, 54% (13/24) recurred, mostly (11/13) at distant sites. Median overall survival (OS) was 46 months (95% CI, 14.3 - NA). OS was not associated with HPV status (HR 0.73, P = 0.6) or smoking (HR 1.16, P = 0.8). Among 63 patients with known HPV status after the literature review (19 HPV- and 44 HPV + ), HPV status remained unassociated with OS (P = 0.92). CONCLUSIONS This is the largest retrospective cohort of oropharyngeal HG-NEC. Distant recurrence rate after curative treatment was high, suggesting that multimodality treatment including systemic therapy may benefit patients with locally advanced disease. HPV infection did not affect survival outcomes, therefore should not lead to therapy de-intensification for this histology.
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Affiliation(s)
- Luana G de Sousa
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Felippe Lazar Neto
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo A Dal Lago
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew Sikora
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ehab Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bonnie S Glisson
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diana Bell
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renata Ferrarotto
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Niforatos S, Sandhu M, Kallem M, Serinelli S, Curtiss C, Akhtar K. Small Cell Neuroendocrine of the Head and Neck: A Rare Presentation and Review of the Literature. J Investig Med High Impact Case Rep 2022; 10:23247096221127792. [PMID: 36165297 PMCID: PMC9520175 DOI: 10.1177/23247096221127792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Head and neck tumors account for roughly 3% of malignancies in the United States and about 90% of these tumors are squamous cell cancers. Neuroendocrine neoplasms arise from neural crest cells and are commonly found in the gastrointestinal tract. Neuroendocrine neoplasms arising from the head and neck tend to be rare. In this article, we present a rare case of human papilloma virus–associated poorly differentiated small cell neuroendocrine carcinoma (NEC). Our patient was a 62-year-old African American man who presented with worsening left-sided neck pain and swelling that started 3 months prior to presentation, associated with an unintentional 20-pound weight loss over 6 months, hoarseness in his voice, in addition to dysphagia and odynophagia. Biopsy of left-sided tongue mass revealed poorly differentiated small cell NEC that was positive for HPV (E6/E7) RNA in situ hybridization. Patient was found to have metastatic disease at the time of diagnosis and given the aggressive nature of small cell NECs and the patient’s symptomatic burden, chemotherapy with cisplatin and etoposide was initiated in the hospital. The patient was subsequently discharged from the hospital and is continuing treatment outpatient with cisplatin, etoposide, and atezolizumab.
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Affiliation(s)
| | - Michael Sandhu
- State University of New York Upstate Medical University, Syracuse, USA
| | - Mansi Kallem
- State University of New York Upstate Medical University, Syracuse, USA
| | | | | | - Komal Akhtar
- State University of New York Upstate Medical University, Syracuse, USA
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3
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Schuch LF, Schmidt TR, de Oliveira Zigmundo G, Kirschnick LB, Silveira FM, Martins MAT, Carlos R, Dos Santos JN, Fonseca FP, Vargas PA, Wagner VP, Martins MD. Oral and Maxillofacial Neuroendocrine Carcinoma: A Systematic Review. Head Neck Pathol 2021; 16:525-537. [PMID: 34870796 PMCID: PMC9187797 DOI: 10.1007/s12105-021-01398-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
The aim of the present study was to integrate the available data published in the literature on oral and maxillofacial neuroendocrine carcinomas concerning the demographic, clinical and histopathological features of this condition. An electronic search with no publication date restriction was undertaken in April 2021 in four databases. Eligibility criteria included reports published in English having enough data to confirm a definite diagnosis, always showing a neuroendocrine marker. Cases originating in the oropharynx, including base of the tongue and tonsils, were excluded. Outcomes were evaluated by the Kaplan-Meier method along with Cox regression. Twenty-five articles (29 cases) from nine different countries were detected. Mean patient age was 56.3 (± 17.5) years, with a slight male predilection. Symptomatology was present in 72.2% of informed cases. Regarding clinical presentation, a non-ulcerated nodule located in the gingiva with a mean size of 3.4 (± 2.0) cm was most frequently reported. Concomitant metastasis was identified in seven individuals. Histopathologically, most neoplasms were of the small cell type, and immunohistochemistry for both epithelial and neuroendocrine differentiation was used in 65.5% cases. Radical surgery was the treatment of choice in almost all cases, with or without adjuvant therapy. Mean follow-up was 20.5 (± 21.2) months, and only four patients developed recurrences. Eleven (44.0%) individuals died due to the disease. Ulcerated lesions were a prognostic factor. This study provides knowledge that can assist surgeons, oncologists, and oral and maxillofacial pathologists with the diagnosis and management of neuroendocrine carcinomas. Our findings demonstrated that the long-term prognosis of this lesion continues to be poor.
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Affiliation(s)
- Lauren Frenzel Schuch
- grid.411087.b0000 0001 0723 2494Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, São Paulo Brazil
| | - Tuany Rafaeli Schmidt
- grid.8532.c0000 0001 2200 7498Department of Oral Pathology, Faculdade de Odontologia, School of Dentistry, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos, 2492, room 503, Porto Alegre, Rio Grande do Sul CEP: 90035-003 Brazil
| | - Gisele de Oliveira Zigmundo
- grid.8532.c0000 0001 2200 7498Department of Oral Pathology, Faculdade de Odontologia, School of Dentistry, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos, 2492, room 503, Porto Alegre, Rio Grande do Sul CEP: 90035-003 Brazil
| | - Laura Borges Kirschnick
- grid.411087.b0000 0001 0723 2494Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, São Paulo Brazil
| | - Felipe Martins Silveira
- grid.11630.350000000121657640Molecular Pathology Area, School of Dentistry, Universidad de la República (UDELAR), Montevideo, Uruguay
| | - Marco Antonio Trevizani Martins
- grid.8532.c0000 0001 2200 7498Department of Oral Pathology, Faculdade de Odontologia, School of Dentistry, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos, 2492, room 503, Porto Alegre, Rio Grande do Sul CEP: 90035-003 Brazil ,grid.8532.c0000 0001 2200 7498Department of Oral Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul Brazil
| | - Roman Carlos
- Pathology Section, Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi, Guatemala City, Guatemala
| | - Jean Nunes Dos Santos
- grid.8399.b0000 0004 0372 8259Department of Pathology, Postgraduate Program in Dentistry and Health, School of Dentistry, Universidade Federal da Bahia, Salvador, Bahia Brazil
| | - Felipe Paiva Fonseca
- grid.8430.f0000 0001 2181 4888Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - Pablo Agustin Vargas
- grid.411087.b0000 0001 0723 2494Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, São Paulo Brazil
| | - Vivian Petersen Wagner
- grid.11835.3e0000 0004 1936 9262Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Manoela Domingues Martins
- grid.8532.c0000 0001 2200 7498Department of Oral Pathology, Faculdade de Odontologia, School of Dentistry, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos, 2492, room 503, Porto Alegre, Rio Grande do Sul CEP: 90035-003 Brazil ,grid.411087.b0000 0001 0723 2494Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, São Paulo Brazil
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Maleki Z, Nadella A, Nadella M, Patel G, Patel S, Kholová I. INSM1, a Novel Biomarker for Detection of Neuroendocrine Neoplasms: Cytopathologists’ View. Diagnostics (Basel) 2021; 11:diagnostics11122172. [PMID: 34943408 PMCID: PMC8700458 DOI: 10.3390/diagnostics11122172] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Insulinoma-associated protein 1 (INSM1) has been considered as a novel immunostain for neuroendocrine tumors (NETs) and is hypothesized to be more reliable than first-generation NET biomarkers, such as CGA (chromogranin A), SYP (synaptophysin) and CD56 (neural cell adhesion molecule). In this review, we summarize existing literature on INSM1′s reliability as an immunostain for detection of various NETs, its results in comparison to first-generation NET biomarkers, and its expression in both non-NETs and benign tissues/cells on cytology specimens (cell blocks/smears).
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Affiliation(s)
- Zahra Maleki
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, The Johns Hopkins Medical Institution, Baltimore, MD 21218, USA
- Correspondence: ; Tel.: +1-410-955-1180
| | - Akash Nadella
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA; (A.N.); (M.N.); (G.P.); (S.P.)
| | - Mohnish Nadella
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA; (A.N.); (M.N.); (G.P.); (S.P.)
| | - Gopi Patel
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA; (A.N.); (M.N.); (G.P.); (S.P.)
| | - Shivni Patel
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA; (A.N.); (M.N.); (G.P.); (S.P.)
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Tampere, Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland;
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Neuroendocrine Carcinoma of the Larynx and Pharynx: A Clinical and Histopathological Study. Cancers (Basel) 2021; 13:cancers13194813. [PMID: 34638312 PMCID: PMC8507659 DOI: 10.3390/cancers13194813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Neuroendocrine carcinomas (NECs) of the head and neck are rare. The presented series of 20 patients with laryngeal and pharyngeal NECs is population-based and one of the largest published to date. We analyzed the treatment results according to the type of therapy and the role of various standard (synaptophysin-chromogranin-CD56, Ki-67, p16, HPV, and EBV) and some novel (INSM1 and PD-L1) neuroendocrine markers or potential prognosticators. The results indicate the following: (1) laryngeal and pharyngeal NECs accounted for 0.43% and 0.17% of the cases in the corresponding tumor groups, respectively; (2) neuroendocrine differentiation can be reliably determined by INSM1 immunohistochemistry; (3) the prognosis was determined by the nodal stage and TNM stage but not by the histological grade (which refers to moderately and poorly differentiated NECs); (4) except in well-differentiated NECs and early-stage (T1-2N0-1) moderately/poorly differentiated NECs, aggressive multimodal therapy is needed; and (5) the p16, HPV, and EBV statuses failed to show any prognostic value. Abstract Neuroendocrine carcinomas (NECs) of the head and neck are rare and the experience scanty. The Cancer Registry of Slovenia database was used to identify cases of laryngeal and pharyngeal NECs diagnosed between 1995–2020. Biopsies were analyzed for the expression of standard neuroendocrine markers (synaptophysin, chromogranin, CD56), INSM1, Ki-67, p16, and PD-L1 (using the combined positive score, CPS). In situ hybridization for human papillomavirus (HPV) and Epstein–Barr virus (EBV) was performed. Twenty patients (larynx, 12; pharynx, 8) were identified. One tumor was well differentiated (WD), five were moderately differentiated (MD), and 14 were poorly differentiated (PD). Disease control was achieved solely by surgery in 4/4 MD/PD T1-2N0-1 tumors. Eight patients died of the disease, seven of which were due to distant metastases. All three traditional markers were positive in 11/17 NECs and the INSM1 marker in all 20 tumors. Two of fourteen p16-positive tumors were HPV-positive, but all three nasopharyngeal NECs were EBV-negative. Three tumors had CPSs ≥ 1. In conclusion, INSM1 was confirmed to be a reliable marker of neuroendocrine differentiation. Except in WD and early-stage MD/PD tumors, aggressive multimodal therapy is needed; the optimal systemic therapy remains to be determined. p16, HPV, and EBV seem to bear no prognostic information.
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6
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Mitchell MB, Kimura K, Chapurin N, Saab Chalhoub M, Mehrad M, Langerman A, Mannion K, Netterville J, Rohde S, Sinard R, Kim Y. Neuroendocrine carcinomas of the head and neck: A small case series. Am J Otolaryngol 2021; 42:102992. [PMID: 33640803 DOI: 10.1016/j.amjoto.2021.102992] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Neuroendocrine tumors of the head and neck are rare and arise either from epithelial or neuronal origin. Debate continues over the classification systems and appropriate management of these pathologies. OBJECTIVE By investigating a small set of cases of high grade epithelial-derived neuroendocrine tumors of the head and neck (neuroendocrine carcinomas or NEC) from one institution, we compare survival rates of NEC of the head and neck to pulmonary NEC. METHODS We identified patients from pathology records with neuroendocrine carcinomas of the head and neck and retrospectively collected clinical data as well as immunohistochemical (IHC) staining data. RESULTS We identified 14 patients with NEC, arising from the parotid (n = 5), nasal cavity (n = 4), larynx (n = 2), and other regions (n = 2). One additional patient had NEC arising in two sites simultaneously (parotid and nasal). Staining patterns using IHC were relatively consistent across specimens, showing reactivity to chromogranin and synaptophysin in 73% and 100% of specimens, respectively. Treatment courses varied across patients and included combinations of surgery, chemotherapy, and/or radiation. The overall survival rate at 1, 2, and 5 years of these patients was 56%, 56%, and 43% with a mean follow-up time of 2.12 years. CONCLUSION Compared to NEC arising in the lung, this subset of patients had better survival rates, but worse survival rates than the more common squamous cell carcinoma of the head and neck.
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Affiliation(s)
- Margaret B Mitchell
- Vanderbilt University School of Medicine, 1161 21st Ave S #D3300, Nashville, TN 37232, United States of America.
| | - Kyle Kimura
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, United States of America.
| | - Nikita Chapurin
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, United States of America.
| | - Mario Saab Chalhoub
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, 1611 21st Ave S Suite C-2314, Nashville, TN 37232, United States of America
| | - Mitra Mehrad
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, 1611 21st Ave S Suite C-2314, Nashville, TN 37232, United States of America.
| | - Alexander Langerman
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, United States of America.
| | - Kyle Mannion
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, United States of America.
| | - James Netterville
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, United States of America.
| | - Sarah Rohde
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, United States of America.
| | - Robert Sinard
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, United States of America.
| | - Young Kim
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, United States of America.
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7
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Ma W, Betts G, Dykes M, St Leger D, Sargent A, Shelton D, Holbrook M, Rana D. Human papillomavirus-associated small cell carcinoma with synchronous squamous cell carcinoma in the nasopharynx: Report of a rare case. Cytopathology 2020; 32:385-388. [PMID: 33382464 DOI: 10.1111/cyt.12952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/13/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Weihong Ma
- Manchester Cytology Centre, Manchester University NHS Foundation, Manchester, UK
| | - Guy Betts
- Department of Adult Histopathology, Manchester University NHS Foundation, Manchester, UK
| | - Michael Dykes
- Department of Radiology, Manchester University NHS Foundation, Manchester, UK
| | - Dominic St Leger
- Department of Radiology, Manchester University NHS Foundation, Manchester, UK
| | - Alexandra Sargent
- Manchester Cytology Centre, Manchester University NHS Foundation, Manchester, UK
| | - David Shelton
- Manchester Cytology Centre, Manchester University NHS Foundation, Manchester, UK
| | - Miles Holbrook
- Manchester Cytology Centre, Manchester University NHS Foundation, Manchester, UK
| | - Durgesh Rana
- Manchester Cytology Centre, Manchester University NHS Foundation, Manchester, UK
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Mashiana SS, Navale P, Khandakar B, Sobotka S, Posner MR, Miles BA, Zhang W, Gitman M, Bakst RL, Genden EM, Westra WH. Human papillomavirus genotype distribution in head and neck cancer: Informing developing strategies for cancer prevention, diagnosis, treatment and surveillance. Oral Oncol 2020; 113:105109. [PMID: 33232848 DOI: 10.1016/j.oraloncology.2020.105109] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 12/23/2022]
Abstract
Current clinical practice algorithms for HPV testing make no effort to discern the impact of genotypes for patients with head and neck squamous cell carcinoma (HNSC). Data was collected for all patients with HNSCs that had undergone HPV testing at an academic hospital as part of clinical care (2012-2019). Screening was performed using real-time PCR targeting L1 of low and high-risk HPV types, followed by genotyping of positive cases. Genotype status was correlated with age, site and histologic parameters. Of the 964 patients tested, 68% had HPV-positive cancers. Most arose from the oropharynx (OP) (89%) and sinonasal tract (5%). The most frequent genotype was 16 (84.4%) followed by 35 (5.6%), 33 (4.1%), 18 (2.7%), 45 (1.1%), 69 (0.8%) and others (1.3%). There was an association between genotype (16 vs non-16) and tumor origin (OP vs non-OP) (p < 0.0001). HPV18 was associated with transformation to an aggressive small cell phenotype, but HPV16 was not (22% vs 0%, p < 0.0001). Patients with HPV-non-16 OP carcinomas were older than patients with HPV16 OP carcinomas, but the difference was not significant. HPV genotypes are variable and unevenly distributed across anatomic sites of the head and neck. The association of HPV18 with small cell transformation suggests that variants can track with certain phenotypes in ways that may account for differences in clinical behavior. This study challenges the prevailing assumption of HPV equivalency across all high-risk genotypes in ways that may inform preventive, diagnostic, therapeutic and surveillance strategies.
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Affiliation(s)
- S S Mashiana
- Departments of Pathology, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, United States
| | - P Navale
- Departments of Pathology, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, United States
| | - B Khandakar
- Departments of Pathology, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, United States
| | - S Sobotka
- Departments of Urology, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, United States
| | - M R Posner
- Departments of Medicine (Division of Hematology and Medical Oncology), Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, United States
| | - B A Miles
- Otolaryngology/Head and Neck Surgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, United States
| | - W Zhang
- The Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - M Gitman
- Departments of Pathology, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, United States
| | - R L Bakst
- Radiation Oncology, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, United States
| | - E M Genden
- Otolaryngology/Head and Neck Surgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, United States
| | - W H Westra
- Departments of Pathology, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, United States.
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9
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Sastre-Garau X, Harlé A. Pathology of HPV-Associated Head and Neck Carcinomas: Recent Data and Perspectives for the Development of Specific Tumor Markers. Front Oncol 2020; 10:528957. [PMID: 33312940 PMCID: PMC7701329 DOI: 10.3389/fonc.2020.528957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 10/19/2020] [Indexed: 12/23/2022] Open
Abstract
A significant subset of carcinomas developed in the head and neck (H&NCs) are associated with specific human papillomaviruses (HPV) genotypes. In particular, 40–60% of oropharyngeal carcinoma cases are linked to HPV. Epidemiological studies have demonstrated that HPV oral infections are predominantly sexually transmitted and are more frequent among men (10–18%) than women (3.6–8.8%). Although there is a large diversity of HPV genotypes associated with H&NCs, HPV16 lineage represents 83% of the reported cases. The prognostic value of HPV as a biological parameter is well recognized. However, the use of HPV DNA as a diagnostic and/or predictive marker is not fully developed. Recent data reporting the physical state of the HPV genome in tumors have shown that HPV DNA integration into the tumor cell genome could lead to the alteration of cellular genes implicated in oncogenesis. Most importantly, HPV DNA corresponds to a tumor marker that can be detected in the blood of patients. Profile of the HPV DNA molecular patterns in tumor cells using New Genome Sequencing-based technologies, allows the identification of highly specific tumor markers valuable for the development of innovative diagnostic and therapeutic approaches. This review will summarize recent epidemiological data concerning HPV-associated H&NCs, the genomic characterization of these tumors, including the presence of HPV DNA in tumor cells, and will propose perspectives for developing improved care of patients with HPV-associated H&NCs, based on the use of viral sequences as personalized tumor markers and, over the longer term, as a therapeutic target.
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Affiliation(s)
- Xavier Sastre-Garau
- Service de Pathologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Alexandre Harlé
- Université de Lorraine, CNRS UMR7039 CRAN, service de Biopathologie, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
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10
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Bahr K, Zimmer S, Springer E, Fottner C, Becker S, Ernst BP, Matthias C, Künzel J. High-Grade Neuroendocrine Carcinoma of the Head and Neck: Human Papillomavirus Status and PD-L1 Expression. ORL J Otorhinolaryngol Relat Spec 2019; 81:309-316. [PMID: 31550725 DOI: 10.1159/000502325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 07/10/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Human papillomavirus (HPV)-related head and neck squamous cell carcinoma represents an important subgroup of head and neck cancer, but HPV occurs also in the less common neuroendocrine carcinomas (NEC). The PD-1/PD-L1 pathway appears to be activated in pulmonary NEC and correlates with a higher mutation burden, but the potential of NEC to respond to checkpoint inhibitors is unknown to a large extent. OBJECTIVES To determine the HPV status of NEC of the head and neck region and to investigate the expression of PD-1 and its ligands PD-L1 and PD-L2. METHODS Surgical tumor samples from 2006 to 2017 were analyzed. HPV status was determined by p16 immunohistochemistry (IHC) and multiplex PCR. IHC using the Cologne Score was performed for PD-1, PD-L1, and PD-L2. RESULTS Seven NEC tumor samples were analyzed, three of them showed HPV type 18. Expression of PD-1 and PD-L1 differed widely and showed no correlation to HPV status. IHC showed an overexpression of PD-L2 in most of the patients. CONCLUSIONS AND SIGNIFICANCE A multicentric analysis of NEC is needed to further evaluate the role of HPV as well as immunocheckpoints with regard to inflammatory immune response in genesis and clinical course of this rare tumor entity. Biomarkers for selection of novel treatment regimens, including immunotherapeutic approaches, are warranted.
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Affiliation(s)
- Katharina Bahr
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mainz, Mainz, Germany
| | - Stefanie Zimmer
- Institute of Pathology and Tissue Biobank, University Medical Center Mainz, Mainz, Germany
| | - Erik Springer
- Institute of Molecular Pathology, University Medical Center Mainz, Mainz, Germany
| | - Christian Fottner
- Department of Endocrine and Neuroendocrine Tumors, University Medical Center Mainz, Mainz, Germany
| | - Sven Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mainz, Mainz, Germany
| | - Benjamin P Ernst
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mainz, Mainz, Germany
| | - Christoph Matthias
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mainz, Mainz, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mainz, Mainz, Germany, .,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, Regensburg, Germany,
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11
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Benzerdjeb N, Traverse-Glehen A, Philouze P, Bishop J, Devouassoux-Shisheboran M. Poorly differentiated neuroendocrine carcinoma of the head and neck: human papillomavirus tumour status/p16 status and impact on overall survival. Histopathology 2019; 76:581-591. [PMID: 31463946 DOI: 10.1111/his.13982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/06/2019] [Accepted: 08/22/2019] [Indexed: 01/06/2023]
Abstract
AIMS Poorly differentiated neuroendocrine carcinoma (PDNEC) of the head and neck is a rare high-grade neuroendocrine neoplasm. Human papillomavirus (HPV) status and p16 status are as yet unclear among PDNECs, owing to a lack of statistical analysis. The objective of the present study was therefore to evaluate their potential clinicopathological associations, and their prognostic impact on overall survival in PDNECs of the head and neck, regardless to HPV genotype. METHODS AND RESULTS All cases of PDNEC of the head and neck between 1998 and 2019 were identified from the database of the Lyon university hospital pathology department (n = 21); for these cases, p16 immunohistochemistry and HPV in-situ hybridisation were performed. Published cases of PDNEC of the head and neck with assessment of HPV status and p16 status were identified in PubMed (n = 57). Local and published cases were pooled for analysis. HPV positive (HPV+) tumour status was found to be significantly associated with oropharyngeal localisation (P < 0.001) and overexpression of p16 (P < 0.001). Multivariate analysis, adjusted on tumour site, histological subtype, p16 status, HPV status, and source of the case, showed that oropharyngeal localisation [hazard ratio (HR) 3.031, 95% confidence interval (CI) 1.257-7.310] and being a small-cell variant (HR 2.859, 95% CI 1.150-7.109) were significant predictors of worse overall survival; HPV+ tumour status was associated with better overall survival (HR 0.388, 95% CI 0.146-0.995). CONCLUSIONS HPV+ tumour status was associated with oropharyngeal PDNECs and with a better prognosis.
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Affiliation(s)
- Nazim Benzerdjeb
- Department of Pathology, Institut de Pathologie Multisite, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Université Lyon 1, Villeurbanne, France
| | - Alexandra Traverse-Glehen
- Department of Pathology, Institut de Pathologie Multisite, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Université Lyon 1, Villeurbanne, France
| | - Pierre Philouze
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital La Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Justin Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Institut de Pathologie Multisite, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Université Lyon 1, Villeurbanne, France
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12
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Virus-associated carcinomas of the head & neck: Update from the 2017 WHO classification. Ann Diagn Pathol 2019; 38:29-42. [DOI: 10.1016/j.anndiagpath.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 10/18/2018] [Indexed: 12/12/2022]
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13
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Jo VY, Krane JF, Pantanowitz L, Monaco SE. HPV‐associated neuroendocrine carcinomas of the head and neck in FNA biopsies: Clinicopathologic features of a rare entity. Cancer Cytopathol 2018; 127:26-34. [DOI: 10.1002/cncy.22075] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Vickie Y. Jo
- Department of Pathology Brigham and Women’s Hospital and Harvard Medical School Boston Massachusetts
| | - Jeffrey F. Krane
- Department of Pathology Brigham and Women’s Hospital and Harvard Medical School Boston Massachusetts
| | - Liron Pantanowitz
- Department of Pathology University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Sara E. Monaco
- Department of Pathology University of Pittsburgh Medical Center Pittsburgh Pennsylvania
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14
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Allison DB, Rooper LM, Mustafa S, Maleki Z, Wakely PE, Ali SZ. Cytopathologic characteristics of HPV-related small cell carcinoma of the oropharynx. Cancer Cytopathol 2018; 127:35-43. [PMID: 30468701 DOI: 10.1002/cncy.22078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/19/2018] [Accepted: 10/04/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Human papillomavirus (HPV)-related squamous cell carcinoma (SqCC) of the oropharynx is an epidemiologically and clinically distinct form of SqCC that is associated with an improved prognosis. However, HPV-related small cell carcinoma of the oropharynx is a rare and newly described variant that is associated with aggressive clinical behavior and poor outcomes. To date, fewer than 2 dozen reports of this entity exist in the literature, and there is no discussion of cytopathologic features. This article reports 6 cases and discusses the salient cytomorphologic findings, ancillary studies, and challenges when this entity is encountered. METHODS Anatomic pathology archives were searched to identify patients with a diagnosis of HPV-related small cell carcinoma of the oropharynx. Medical records were reviewed to document the following: age, sex, smoking status, other relevant clinical history, primary location, treatment, and clinical outcome. Both p16 and high-risk HPV in situ hybridization (ISH) studies were positive in at least 1 specimen from each patient. The pathologic diagnoses, cytomorphologic characteristics, immunocytochemical stains, and HPV ISH studies were reviewed and recorded for all available cases. RESULTS Six patients with 11 cytopathology specimens of HPV-related small cell carcinoma of the oropharynx were identified. The mean age was 61.3 years, and all patients died with widely metastatic disease (mean, 23 months; range, 12-48 months). Mixed small cell carcinoma and SqCC components were present in half of the cases. CONCLUSIONS The identification of a small cell component can be reliably performed with cytology preparations and is crucial because this (and not the HPV status) determines the prognosis.
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Affiliation(s)
- Derek B Allison
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa M Rooper
- Department of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara Mustafa
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zahra Maleki
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul E Wakely
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Syed Z Ali
- Department of Pathology and Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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