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Abi-Saab T, Lozar T, Chen Y, Tannenbaum AP, Geye H, Yu M, Weisman P, Harari PM, Kimple RJ, Lambert PF, Lloyd RV, Hu R. Morphologic Spectrum of HPV-associated Sinonasal Carcinomas. Head Neck Pathol 2024; 18:67. [PMID: 39101976 DOI: 10.1007/s12105-024-01670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/18/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND High-risk human papillomavirus (HR-HPV) infection has been increasingly recognized as a risk factor for sinonasal tract carcinomas. However the prevalence and prognostic significance of HPV-associated sinonasal carcinomas is not well known due to limited studies and inconsistency in HPV testing modalities in literatures. Morphologically, HPV-associated sinonasal carcinomas encompass a diverse group of tumors. HPV-associated sinonasal adenocarcinoma has not been reported. The purpose of this study was to determine the prevalence, morphologic spectrum and prognostic implication of HPV-associated sinonasal carcinomas. METHODS This cohort included 153 sinonasal carcinomas. Tissue microarrays were constructed. P16 immunohistochemistry and HR-HPV E6/7 in-situ Hybridization (ISH) were performed. Carcinomas were deemed HPV-associated based on a positive ISH testing. Clinicopathologic data was collected. RESULTS 28/153 (18%) sinonasal carcinomas were HPV-associated. HPV-associated carcinomas consisted of 26 (93%) squamous cell carcinomas and variants, 1 (3.5%) HPV-related multiphenotypic sinonasal carcinoma and 1 (3.5%) adenocarcinoma. The HPV-associated adenocarcinoma closely resembled HPV-associated endocervical adenocarcinoma morphologically. HPV-associated carcinomas occurred in 8 (29%) women and 20 (71%) men with a median age of 66 years old. HPV-associated carcinomas were predominantly located at nasal cavity. A trend toward improved overall survival and progression free survival in HPV-associated carcinomas patients was observed, yet without statistical significance. CONCLUSION Our study identifies a novel HPV-associated sinonasal adenocarcinoma subtype, highlights the broad morphologic spectrum of HPV-associated sinonasal carcinomas, and supports routine p16 testing during pathology practice regardless of tumor subtype followed by a confirmatory HR-HPV testing. This practice is critical for studying the clinical behavior of HPV-associated sinonasal carcinomas.
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Affiliation(s)
- Tarek Abi-Saab
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Taja Lozar
- McArdle Laboratory for Cancer Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Yi Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Alex P Tannenbaum
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Heather Geye
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Menggang Yu
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Paul Weisman
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
- McArdle Laboratory for Cancer Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
- McArdle Laboratory for Cancer Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Paul F Lambert
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
- McArdle Laboratory for Cancer Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Ricardo V Lloyd
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Rong Hu
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA.
- McArdle Laboratory for Cancer Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA.
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Beaumont C, Nadeau S, Champagne PO, Beauchemin M, Villemure-Poliquin N. HPV-Related Multiphenotypic Sinonasal Carcinoma: A Clinicoradiological Series of 3 Cases With Full Endoscopic Surgical Outcome. EAR, NOSE & THROAT JOURNAL 2024:1455613241247729. [PMID: 38591784 DOI: 10.1177/01455613241247729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Context: Human papillomavirus (HPV)-related multiphenotypic sinonasal carcinoma (HMSC), formerly known as HPV-related carcinoma with adenoid cystic like features, is a rare tumor subtype with unusual correlation between radiological, histopathological, and surgical findings. The shared histological characteristics with other sinonasal tumors make the diagnosis challenging. Optimal surgical and oncological treatments for this rare condition remains to be clearly defined. Methods: The objective of the study was to describe the unique characteristics and endoscopic surgical treatment of this rare tumor. In this retrospective case series, all patients with an HMSC diagnosis treated in our tertiary center were selected. Results: Three HMSC cases were identified, including 2 male and 1 female patients. All cases originated from the posterior nasal cavity. One case presented with a tumor of 8.9 cm × 6.4 cm × 8.7 cm, which is the largest tumor volume described to date. All patients received exclusively endoscopic surgical treatment, followed by adjuvant radiation therapy. No patient showed clinical or radiological sign of disease recurrence, or regional or distant metastasis, with a follow-up ranging from 9 months to 4 years. In 2 cases, initial diagnoses incorrectly suggested adenoid cystic or basaloid squamous cell carcinoma. HPV-DNA testing confirmed the presence of HPV in all cases, with identification of strains 16 and 18. Conclusion and Relevance: HMSC represents a newly identified diagnosis that constitutes a significant challenge for both clinicians and pathologists. It is crucial to acknowledge its indolent clinical course and the apparent contradiction between aggressive radiological features and the noninvasive nature of surgical findings. Skull base surgeons should be aware that, despite these complexities, endoscopic treatment is achievable in the majority of cases. This understanding is essential for the effective management of HMSC.
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Affiliation(s)
- Catherine Beaumont
- Department of Otolaryngology-Head and Neck Surgery, Université Laval, Quebec City, QC, Canada
| | - Sylvie Nadeau
- Department of Otolaryngology-Head and Neck Surgery, Université Laval, Quebec City, QC, Canada
| | - Pierre-Olivier Champagne
- Department of Neurosurgery, Centre hospitalier universitaire de Québec-Université Laval, Quebec City, QC, Canada
| | - Michel Beauchemin
- Department of Pathology, Centre hospitalier universitaire de Québec-Université Laval, Quebec City, QC, Canada
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Hirakawa H, Ikegami T, Touyama M, Ooshiro Y, Higa T, Higa T, Agena S, Kinjyo H, Kondo S, Kise N, Tanaka K, Maeda H, Tamaki T, Wada N, Suzuki M. p16 Overexpression in Sinonasal Squamous Cell Carcinoma: Association with Human Papillomavirus and Prediction of Survival Outcomes. J Clin Med 2023; 12:6861. [PMID: 37959327 PMCID: PMC10650892 DOI: 10.3390/jcm12216861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
p16 overexpression is often used as a surrogate marker for human papillomavirus (HPV) infection in oropharyngeal squamous cell carcinoma but remains an uncertain diagnostic tool for HPV-related sinonasal squamous cell carcinoma (SNSCC). Our study involved 79 consecutive SNSCC patients who were treated at a tertiary referral university hospital during 2006-2021. We retrospectively examined their clinical characteristics and conducted p16 immunohistochemistry and HPV detection. We found that 12.7% of the patients exhibited p16 overexpression, which was significantly more common in the nasal cavity and increased from 2015 onward. The HPV was a high-risk type and viral loads ranged from 4.2 to 1.6 × 106 copies/ng DNA with genome integration. Five-year overall survival (OS) and five-year relapse-free survival (RFS) rates were 74.6% and 69.9%, respectively. Our multivariate analysis showed that T category (T1-4a) and hemoglobin levels (≥13.7) were significant favorable prognostic factors for OS, while T category, performance status, and p16 overexpression were significantly associated with RFS. In patients with p16 overexpression, OS was 100% and RFS was 90%. Our findings suggest that p16 overexpression is a reliable surrogate marker for transcriptionally active HPV infection and predicts a favorable prognosis.
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Affiliation(s)
- Hitoshi Hirakawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Taro Ikegami
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Masatomo Touyama
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Yurika Ooshiro
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Tomoyo Higa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Teruyuki Higa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Shinya Agena
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Hidetoshi Kinjyo
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Shunsuke Kondo
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Norimoto Kise
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Katsunori Tanaka
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Hiroyuki Maeda
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Tomoko Tamaki
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan (N.W.)
| | - Naoki Wada
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan (N.W.)
| | - Mikio Suzuki
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
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Kakkar A, Satapathy S, Sikka K, Tanwar P, Deo S, Jain D. Evaluation of high-risk human papillomavirus in sinonasal papillomas and squamous cell carcinomas. Virchows Arch 2023; 483:381-392. [PMID: 37452847 DOI: 10.1007/s00428-023-03601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
The sinonasal tract is considered a second hotspot for human papillomavirus (HPV)-related tumors in the head and neck, with HPV being identified in up to 62% of squamous cell carcinomas (SCCs) and 38% of papillomas. There is limited data from geographical regions with low prevalence of high-risk (HR)-HPV on the association of HR-HPV in sinonasal neoplasms and on utility of p16 as a surrogate marker. p16 immunohistochemistry, HR-HPV mRNA ISH and quantitative real-time PCR (qPCR) were performed on a retrospective cohort of sinonasal papillomas and SCCs. KRAS mutation analysis was done in oncocytic papillomas. p16 positivity was present in 22/142 cases (15.5%) including eight inverted papillomas, one oncocytic papilloma (OP), and 13 SCC. Among these, mRNA ISH showed HR-HPV in the OP and two SCC, while another SCC was found to harbour HPV18 by qPCR. Two HPV-associated SCCs had foci of OP. mRNA ISH was negative in all p16 negative cases. p16 immunohistochemistry showed 68% concordance with mRNA ISH, and had sensitivity and negative predictive value of 100%; specificity was 67%, and positive predictive value was 14.3%. Association with HR-HPV in sinonasal papillomas and SCC is rare, and may be seen in cases demonstrating oncocytic morphology. p16 immunohistochemistry has low specificity and positive predictive value in low-prevalence populations; thus, reflex direct HR-HPV testing should be performed in p16 immunopositive cases. This two-step approach is viable in resource-limited settings, as the proportion of p16 positive cases is small.
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Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, 110029, New Delhi, India
| | | | - Kapil Sikka
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, 110029, New Delhi, India
| | - Pranay Tanwar
- Department of Laboratory Oncology, All India Institute of Medical Sciences, 110029, New Delhi, India
| | - Svs Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, 110029, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, 110029, New Delhi, India.
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5
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Apaydin Arikan E, Aydemir L, Ulusan M, Yilmazbayhan D, Ozluk Y. High-risk HPV Does not Appear to be an Important Risk Factor for Sinonasal Carcinomas in Turkish Population: A Tertiary Center Experience. Int J Surg Pathol 2023; 31:124-136. [PMID: 35404169 DOI: 10.1177/10668969221091590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. The sinonasal tract is the second most common site of human papillomavirus (HPV)-related carcinomas in the head and neck. Published data on the association between sinonasal tumors and HPV are quite inconsistent among different regions. Material and methods. We performed high-risk HPV DNA in situ hybridization (ISH) and p16 immunohistochemistry on sinonasal carcinomas diagnosed between 2006 and 2016. Results. Of 105 sinonasal carcinomas, we found only two (2%) HPV-positive cases; both had non-keratinizing morphology and were diffusely positive for p16. By histologic type, HPV DNA positivity rate was 14% in non-keratinizing squamous cell carcinomas, and we did not detect HPV DNA in any other type of sinonasal carcinomas. Thirteen HPV-negative tumors (7 salivary gland carcinomas, 3 sinonasal undifferentiated carcinomas, 2 keratinizing squamous cell carcinomas, and 1 non-keratinizing squamous cell carcinoma) were positive for p16. In nine carcinomas arising from an underlying sinonasal papilloma, p16 and HPV DNA ISH were evaluated in both carcinoma and papilloma areas and all were negative. Follow-up information was available for 104 patients; 46 (44%) were alive and 58 (55%) died of disease. One of the two HPV-positive patients died of the disease; the other was alive at 100 months of follow-up. Conclusions. We detected a much lower percentage of HPV positivity in sinonasal carcinomas when compared to the literature. We believe that our results support various rates of HPV-related carcinomas depending on the geographic and ethnic characteristics.
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Affiliation(s)
- Evsen Apaydin Arikan
- Department of Pathology, Istanbul Faculty of Medicine, 64041Istanbul University, Istanbul, Turkey
| | - Levent Aydemir
- Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul Faculty of Medicine, 64041Istanbul University, Istanbul, Turkey
| | - Murat Ulusan
- Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul Faculty of Medicine, 64041Istanbul University, Istanbul, Turkey
| | - Dilek Yilmazbayhan
- Department of Pathology, Istanbul Faculty of Medicine, 64041Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, 64041Istanbul University, Istanbul, Turkey
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Baněčková M, Cox D. Top 10 Basaloid Neoplasms of the Sinonasal Tract. Head Neck Pathol 2023; 17:16-32. [PMID: 36928732 PMCID: PMC10063752 DOI: 10.1007/s12105-022-01508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/28/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Basaloid neoplasms of the sinonasal tract represent a significant group of tumors with histological overlap but often with different etiologies (i.e., viral, genetics), clinical management, and prognostic significance. METHODS Review. RESULTS "Basaloid" generally refers to cells with coarse chromatin in round nuclei and sparse cytoplasm, resembling cells of epithelial basal layers or imparting an "immature" appearance. Tumors with this characteristic in the sinonasal tract are represented by a spectrum of benign to high-grade malignant neoplasms, such as adenoid cystic carcinoma, NUT carcinoma, sinonasal undifferentiated carcinoma, SWI/SNF complex-deficient carcinomas, and adamantinoma-like Ewing sarcoma. CONCLUSION In some instances, histology alone may be sufficient for diagnosis. However, limited biopsy material or fine-needle aspiration specimens may be particularly challenging. Therefore, often other diagnostic procedures, including a combination of histology, immunohistochemistry (IHC), DNA and RNA testing, and molecular genetics are necessary to establish an accurate diagnosis.
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Affiliation(s)
- Martina Baněčková
- Department of Pathology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic.
- Bioptic Laboratory Ltd, Plzen, Czech Republic.
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University, E. Benese 13, 305 99, Pilsen, Czech Republic.
| | - Darren Cox
- University of Pacific Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA
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Lucidi D, Cantaffa C, Miglio M, Spina F, Alicandri Ciufelli M, Marchioni A, Marchioni D. Tumors of the Nose and Paranasal Sinuses: Promoting Factors and Molecular Mechanisms-A Systematic Review. Int J Mol Sci 2023; 24:ijms24032670. [PMID: 36768990 PMCID: PMC9916834 DOI: 10.3390/ijms24032670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/22/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023] Open
Abstract
Sinonasal neoplasms are uncommon diseases, characterized by heterogeneous biological behavior, which frequently results in challenges in differential diagnosis and treatment choice. The aim of this review was to examine the pathogenesis and molecular mechanisms underlying the regulation of tumor initiation and growth, in order to better define diagnostic and therapeutic strategies as well as the prognostic impact of these rare neoplasms. A systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis criteria was conducted between September and November 2022. The authors considered the three main histological patterns of sinonasal tumors, namely Squamous Cell Carcinoma, Intestinal-Type Adenocarcinoma, and Olfactory Neuroblastoma. In total, 246 articles were eventually included in the analysis. The genetic and epigenetic changes underlying the oncogenic process were discussed, through a qualitative synthesis of the included studies. The identification of a comprehensive model of carcinogenesis for each sinonasal cancer subtype is needed, in order to pave the way toward tailored treatment approaches and improve survival for this rare and challenging group of cancers.
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Affiliation(s)
- Daniela Lucidi
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy
| | - Carla Cantaffa
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy
- Correspondence: ; Tel.: +39-3385313850; Fax: +39-0594222402
| | - Matteo Miglio
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy
| | - Federica Spina
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy
| | - Matteo Alicandri Ciufelli
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy
| | - Alessandro Marchioni
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, 41124 Modena, Italy
| | - Daniele Marchioni
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, 41124 Modena, Italy
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8
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Kuo YJ, Lewis JS, Truong T, Yeh YC, Chernock RD, Zhai C, Chen YA, Hongo T, Lee CK, Shi Q, Velez Torres JM, Geromes AB, Chu YH, Hsieh MS, Yamamoto H, Weinreb I, Hang JF. Nuclear expression of AFF2 C-terminus is a sensitive and specific ancillary marker for DEK::AFF2 carcinoma of the sinonasal tract. Mod Pathol 2022; 35:1587-1595. [PMID: 35701667 DOI: 10.1038/s41379-022-01117-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/27/2022]
Abstract
DEK::AFF2 carcinoma of the sinonasal tract is an emerging entity. The tumor is typically characterized by papillary proliferation of non-keratinizing squamous epithelial cells with monotonous cytologic features, which may mimic other sinonasal tumors. The confirmation of this gene fusion has thus far relied solely on next-generation sequencing, fluorescence in situ hybridization (FISH), or reverse transcription polymerase chain reaction (RT-PCR). This current study aimed to validate an immunohistochemical assay for AFF2 C-terminus as an ancillary marker. We first analyzed publicly available RNA sequencing data of sinonasal tumors from the national center for biotechnology information (NCBI) sequence read archive and identified 3 DEK::AFF2 carcinomas out of 28 sinonasal tumors. The gene expression of AFF2 was significantly higher in the fusion-positive cases compared to the wild-type tumors (p < 0.001), while DEK was not. We then optimized an immunohistochemical assay with an anti-AFF2 C-terminus antibody for ancillary diagnosis. Seventeen DEK::AFF2 carcinomas, including 11 cases with predominantly low-grade morphology and one showing glandular differentiation, as well as 78 DEK FISH-negative sinonasal tumors were evaluated by AFF2 immunohistochemistry (IHC). Sixteen of the 17 DEK::AFF2 carcinomas showed nuclear AFF2 expression in ≥30% of tumor cells, including one decalcified case that failed FISH and RT-PCR confirmation. The one case that was negative for AFF2 IHC in the tumor cells also lacked expression in the internal positive control. It was thus considered a failure of the IHC rather than a truly negative case and was excluded from the statistical analysis. All DEK FISH-negative sinonasal tumors were negative for nuclear AFF2 expression. The nuclear expression of AFF2 IHC showed 100% sensitivity and specificity for DEK::AFF2 carcinoma. Accordingly, AFF2 IHC is a highly sensitive and specific ancillary marker that distinguishes DEK-AFF2 carcinoma from the other sinonasal tumors with overlapping morphological features and may be an especially useful alternative for decalcified specimens.
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Affiliation(s)
- Ying-Ju Kuo
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - James S Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tra Truong
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Rebecca D Chernock
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
| | - Changwen Zhai
- Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Yun-An Chen
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Takahiro Hongo
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Chien-Kuan Lee
- Department of Pathology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Qiuying Shi
- Department of Pathology, Emory University, Atlanta, GA, USA
| | - Jaylou M Velez Torres
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ariana B Geromes
- Anatomic and Clinical Laboratory Associates, P.C, Nashville, TN, USA
| | - Ying-Hsia Chu
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ilan Weinreb
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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9
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Lopez DC, Hoke AT, Rooper LM, London NR. Human Papillomavirus-Related Carcinomas of the Sinonasal Tract. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022; 10:291-302. [PMID: 36311560 PMCID: PMC9610077 DOI: 10.1007/s40136-022-00404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
Purpose of review The sinonasal tract is home to a uniquely heterogenous collection of malignant tumors. Human papillomavirus (HPV) has been detected in a number of these, but the virus' role as an oncogenic driver or coincidental finding remains unclear. We aim to highlight five sinonasal tumor types and synthesize the prevalence, etiologic role, and known clinicopathologic relevance of HPV in each. Recent findings The last decade has seen an expansion of investigation into HPV's oncogenic and prognostic significance within sinonasal malignancies. The sinonasal tract poses challenges to HPV detection where p16 lacks value as an accurate surrogate. A growing body of data supports a potentially favorable clinical profile for certain sinonasal HPV-positive lesions. Summary HPV represents a potential biologically and clinically relevant factor for some sinonasal malignancies. Definitive conclusions regarding HPV's role as a potential oncogenic agent require routine testing using validated methodologies, genomic interrogation, and large-scale prospective studies.
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Affiliation(s)
- Diana C. Lopez
- Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health; Bethesda, MD, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Austin T.K. Hoke
- Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health; Bethesda, MD, USA
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Lisa M. Rooper
- Department of Pathology, Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - Nyall R. London
- Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health; Bethesda, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine; Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine; Baltimore, MD, USA
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10
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Abraham ZS, Ngimba CP, Malango AE, Mrema A, Saleh MA, Vuhahula E. Human papillomavirus-related carcinoma with adenoid cystic-like features of the sinonasal tract: Case report and literature review. Int J Surg Case Rep 2022; 97:107462. [PMID: 35908454 PMCID: PMC9403303 DOI: 10.1016/j.ijscr.2022.107462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/09/2022] [Accepted: 07/24/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE HPV-related carcinoma with adenoid cystic carcinoma-like features currently known as HPV-related multiphenotypic sinonasal carcinoma (HMSC) is a rare distinct head and neck high-risk HPV-related carcinoma. The high-risk HPV subtypes implicated are particularly type 33,35 and 56. So far this is the first reported rare case of a variant of sinonasal carcinoma in Tanzania. CASE PRESENTATION We present a 59-year old female who presented with a history of right-sided nasal obstruction and intermittent epistaxis for about one year and later on had ipsilateral proptosis. A provisional diagnosis of advanced right-sided malignant sinonasal tumor was made. Trans nasal biopsy revealed HMSC. CLINICAL DISCUSSION The patient had a right sided fixed neck mass that measured about 7.5 × 8.2 cm. Magnetic resonance imaging (MRI) of the paranasal sinuses revealed a T1 weighted contrasted images that showed a huge extensive enhancing mass (estimated to measure 4.5 × 4.4) involving the nasal cavity, bilateral ethmoid sinuses, frontal and sphenoid sinuses and also the tumor exhibit intracranial extension (anterior cranial fossa) and tend to compress medial walls of both orbits though more marked on the right side. Histopathology and immunohistochemistry confirmed HPV-related multiphenotypic sinonasal carcinoma. The disease was staged to be T4bN3aM0 and the patient was referred for palliative chemoradiation. CONCLUSION Although HMSC presents at advanced stage in close to half of cases and has a high-grade histological appearance it paradoxically exhibits a relatively indolent manner with frequent local recurrences. Prompt histopathological diagnosis is important to prevent metastases and HMSC-related deaths.
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Affiliation(s)
- Zephania Saitabau Abraham
- Department of Surgery, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania,Corresponding author.
| | - Caroline Philip Ngimba
- Department of Anatomical Pathology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Alita Mrema
- Department of Clinical Oncology, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Mwajabu Athman Saleh
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Edda Vuhahula
- Department of Anatomical Pathology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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11
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Towards a Molecular Classification of Sinonasal Carcinomas: Clinical Implications and Opportunities. Cancers (Basel) 2022; 14:cancers14061463. [PMID: 35326613 PMCID: PMC8946109 DOI: 10.3390/cancers14061463] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 12/16/2022] Open
Abstract
Simple Summary In recent years, there have been several molecular and immunohistochemical additions to the pathologic diagnosis of sinonasal malignancies that could facilitate the identification of clinically relevant groups of sinonasal malignancies. Molecular profiling is progressively integrated in the histopathologic classification of sinonasal carcinomas, and it is likely to influence the management of these tumors in the near future. In this article we review the recent literature on molecular analysis and/or subtyping of sinonasal carcinomas and we discuss the possible clinical implications of a classification of sinonasal tumors based on their molecular features. Abstract Sinonasal carcinomas are a heterogeneous group of rare tumors, often with high-grade and/or undifferentiated morphology and aggressive clinical course. In recent years, with increasing molecular testing, unique sinonasal tumor subsets have been identified based on specific genetic alterations, including protein expression, chromosomal translocations, specific gene mutations, or infection by oncogenic viruses. These include, among others, the identification of a subset of sinonasal carcinomas associated with HPV infection, the identification of a subset of squamous cell carcinomas with EGFR alterations, and of rare variants with chromosomal translocations (DEK::AFF2, ETV6::NTRK and others). The group of sinonasal adenocarcinomas remains very heterogeneous at the molecular level, but some recurrent and potentially targetable genetic alterations have been identified. Finally, poorly differentiated and undifferentiated sinonasal carcinomas have undergone a significant refinement of their subtyping, with the identification of several new novel molecular subgroups, such as NUT carcinoma, IDH mutated sinonasal undifferentiated carcinoma and SWI/SNF deficient sinonasal malignancies. Thus, molecular profiling is progressively integrated in the histopathologic classification of sinonasal carcinomas, and it is likely to influence the management of these tumors in the near future. In this review, we summarize the recent developments in the molecular characterization of sinonasal carcinomas and we discuss how these findings are likely to contribute to the classification of this group of rare tumors, with a focus on the potential new opportunities for treatment.
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12
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Thompson LDR, Bishop JA. Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Nasal Cavity, Paranasal Sinuses and Skull Base. Head Neck Pathol 2022; 16:1-18. [PMID: 35312976 PMCID: PMC9018924 DOI: 10.1007/s12105-021-01406-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/17/2021] [Indexed: 12/31/2022]
Abstract
The World Health Organization Classification of Head and Neck Tumours recently published the 5th edition. There are new entities, emerging entities, and significant updates to the taxonomy and characterization of tumor and tumor-like lesions, specifically in this article as it relates to nasal cavity, paranasal sinuses and skull base. Importantly, the number of diagnostic entries has been reduced by creating category-specific chapters for soft tissue, hematolymphoid, melanocytic, neuroectodermal, and metastatic tumors. Bone and salivary gland tumors are also not separately reported in the sinonasal tract, but included in the jaw and salivary gland sections, respectively. Repetition of characteristic entities in each anatomic site was also reduced, instead highlighting only the unique features in each anatomic site. Two new entities (SWI/SNF complex-deficient sinonasal carcinomas and HPV-related multiphenotypic sinonasal carcinoma) will be highlighted in this review, with a discussion of several emerging entities. There is a short description of updated information for all 24 diagnostic entities included in this edition to allow the reader a snapshot of current state of knowledge, but to encourage more investigation and further broaden understanding of these diverse and rare entities.
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Affiliation(s)
- Lester D. R. Thompson
- Head and Neck Pathology Consultations, 22543 Ventura Boulevard, Ste 220 PMB1034, Woodland Hills, CA 91364 USA
| | - Justin A. Bishop
- University of Texas Southwestern Medical Center, Clements University Hospital, UH04.250, 6201 Harry Hines Blvd., Dallas, TX 75390 USA
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13
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Jun HW, Ji YB, Song CM, Myung JK, Park HJ, Tae K. Positive Rate of Human Papillomavirus and Its Trend in Head and Neck Cancer in South Korea. Front Surg 2022; 8:833048. [PMID: 35127812 PMCID: PMC8814325 DOI: 10.3389/fsurg.2021.833048] [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] [Received: 12/10/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction This study aimed to investigate the positive rate of human papillomavirus (HPV) and its trend in head and neck squamous cell carcinoma (HNSCC) in South Korea and to evaluate the clinical differences between HPV-positive and -negative tumors. Methods We studied 300 patients with HNSCC arising in the oropharynx (n = 77), oral cavity (n = 65), larynx (n = 106), hypopharynx (n = 40), and sinonasal cavity (n = 12), treated in a tertiary university hospital in South Korea from January 2008 to July 2020. HPV status was determined using p16 immunohistochemical staining of formalin-fixed paraffin-embedded tissues. Results Of the 300 patients with HNSCC, the positive rate of p16 was 30.3% (91/300). The p16 positive rate was 70.1, 13.9, 20.8, 15, and 0% in the oropharynx, oral cavity, larynx, hypopharynx, and sinonasal cavity, respectively. HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) patients were significantly younger than HPV-negative OPSCC patients. The positive rate of HPV in OPSCC has increased over time from 2008 to 2020, but has not changed significantly in the other primary sites. The disease-free survival curve of HPV-positive OPSCC was significantly better than that of HPV-negative tumors. Conclusion The positive rate of HPV in Korean patients with OPSCC is significantly high (70.1%), similar to that in North America and Europe, and has increased abruptly in the past 12 years.
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Affiliation(s)
- Hyun Woong Jun
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jae Kyung Myung
- Department of Pathology, College of Medicine, Hanyang University, Seoul, South Korea
| | - Hae Jin Park
- Department of Radiation Oncology, College of Medicine, Hanyang University, Seoul, South Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
- *Correspondence: Kyung Tae
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14
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Shen J, Zhou H, Liu J, Zhang Z, Fang W, Yang Y, Hong S, Xian W, Ma Y, Zhou T, Zhang Y, Zhao H, Huang Y, Zhang L. Incidence and risk factors of second primary cancer after the initial primary human papillomavirus related neoplasms. MedComm (Beijing) 2021; 1:400-409. [PMID: 34766131 PMCID: PMC8491207 DOI: 10.1002/mco2.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022] Open
Abstract
Comprehensive studies in second primary cancer (SPC) after the initial primary human papillomavirus (HPV)-related cancer still remain warranted. We aimed to analyze the incidence and risk factors of SPC after HPV-related cancer. We identified 86 790 patients diagnosed with initial primary HPV-related cancer between 1973 and 2010 in the SEER database. Standardized incidence ratio (SIR) and cumulative incidence were calculated to assess the risk of SPC after HPV-related cancer. The SIR of SPC after HPV-related cancer was 1.60 (95% confidence interval [CI], 1.55-1.65) for male and 1.25 (95% CI, 1.22-1.28) for female. SIR of second primary HPV-related cancer (7.39 [95% CI, 6.26-8.68] male and 4.35 [95% CI, 4.04-4.67] female) was significantly higher than that of HPV-unrelated cancer (1.54 [95% CI, 1.49-1.60] male and 1.16 [95% CI, 1.13-1.19] female). The 5-year cumulative incidence of SPC was 7.22% (95% CI, 6.89-7.55%) for male and 3.72% (95% CI, 3.58-3.88%) for female. Risk factors for SPC included being married and having initial primary cancer (IPC) diagnosed at earlier stage for both genders, and IPC diagnosed at older age as well as surgery performed for female. Patients diagnosed with HPV-related cancer are more likely to develop another primary cancer, compared with the age-specific reference population.
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Affiliation(s)
- Jiayi Shen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China.,Zhongshan School of Medicine Sun Yat-sen University Guangzhou China
| | - Huaqiang Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Jiaqing Liu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China.,Zhongshan School of Medicine Sun Yat-sen University Guangzhou China
| | - Zhonghan Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Wenfeng Fang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Yunpeng Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Shaodong Hong
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Wei Xian
- Zhongshan School of Medicine Sun Yat-sen University Guangzhou China
| | - Yuxiang Ma
- Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Ting Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Yaxiong Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Hongyun Zhao
- Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Yan Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
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15
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Sjöstedt S, von Buchwald C, Agander TK, Aanaes K. Impact of human papillomavirus in sinonasal cancer-a systematic review. Acta Oncol 2021; 60:1175-1191. [PMID: 34319844 DOI: 10.1080/0284186x.2021.1950922] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) is an established prognostic marker in oropharyngeal squamous cell carcinoma. Currently, the role of HPV in sinonasal carcinoma is being explored. OBJECTIVES This systematic review addresses the role of HPV in sinonasal cancer, establishing the occurrence of HPV-positive cancers and the influence of HPV-positivity on prognosis in sinonasal cancer as well as the utility of the putative surrogate marker of HPV (p16) in sinonasal cancer. MATERIAL AND METHODS Studies were identified with searches of Medline via PubMed and Embase via OVID (4 May 2020). Articles on original research concerning sinonasal cancer and HPV in humans written in English were included. Case reports with less than five cases were excluded. RESULTS Initially, 545 articles were identified; 190 duplicate articles were removed leaving 355 articles for title/abstract screening. Title/abstract screening excluded 243 articles, leaving 112 studies assessed for eligibility. After full-text screening, 57 studies were included. All articles investigated the significance of HPV in sinonasal carcinomas. HPV was reported in approximately 30% of sinonasal squamous cell carcinoma (SNSCC), where it was associated with a better prognosis. In sinonasal cancer, p16 is associated with diagnostic pitfalls and a putative utility of p16 in SNSCC has yet to be established. HPV was not frequently reported in other types of sinonasal carcinomas, besides the recently described subtype, HPV-dependent Multiphenotypic Sinonasal Carcinoma. In other types of sinonasal carcinoma, HPV is not frequently found. CONCLUSION Approximately 30% of SNSCC are HPV-positive. HPV-positivity in SNSCC is associated with improved survival. HPV occurs only rarely in other sinonasal cancers. There is currently not sufficient evidence for p16 as a surrogate marker of HPV in SNSCC.
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Affiliation(s)
- Sannia Sjöstedt
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Kasper Aanaes
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital, Copenhagen, Denmark
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16
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Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence. Cancers (Basel) 2021; 13:cancers13112835. [PMID: 34200193 PMCID: PMC8201377 DOI: 10.3390/cancers13112835] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Sinonasal squamous cell carcinomas are a group of diverse tumors affecting the nasal cavity and paranasal sinuses. As a direct consequence of their rarity and heterogeneity, diagnosis is challenging, and treatment does not follow universally accepted protocols. Though surgery represents the mainstay of treatment, neoadjuvant and adjuvant therapies have pivotal roles in improving outcomes of patients treated with curative intent. Indications to endoscopic surgery have been expanding over the last three decades, but a considerable number of patients affected by sinonasal squamous cell carcinoma still need open surgical procedures. Management of the neck in patients affected by sinonasal squamous cell carcinoma is controversial. Curative-intended treatment of recurrent and/or metastatic tumors, alongside palliation of uncurable cases, represent poorly explored aspects of this disease. Abstract Sinonasal squamous cell carcinoma is a rare tumor affecting the nasal cavity and paranasal sinuses. Several aspects of this disease, ranging from epidemiology to biology, pathology, diagnosis, staging, treatment, and post-treatment surveillance are controversial, and consensus on how to manage this sinonasal cancer is lacking. A narrative literature review was performed to summarize the current evidence and provide the reader with available data supporting the decision-making process in patients affected by sinonasal squamous cell carcinoma, alongside the authors’ personal opinion on the unsolved issues of this tumor. The review has highlighted several advances in molecular definition of epithelial cancers of the sinonasal tract. Surgery represents the pivot of treatment and is performed through an endoscopic transnasal approach whenever feasible. Open surgery is required for a large proportion of cases. Reconstruction of the defect follows principles of skull base and cranio-maxillo-facial reconstruction. Chemotherapy is given as neoadjuvant treatment or concomitantly to radiotherapy. Photon-based radiation therapy has a crucial role in the adjuvant setting. Particle therapy is providing promising results. Management of the neck should be planned based on the presence of clinically appreciable metastases, primary tumor extension, and need for recipient vessels. Biotherapy and immunotherapy are still underexplored therapeutical modalities.
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17
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Sommer F. Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base. Laryngorhinootologie 2021; 100:S1-S44. [PMID: 34352902 PMCID: PMC8354577 DOI: 10.1055/a-1331-2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.
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Affiliation(s)
- Fabian Sommer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinik Ulm
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18
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Diana G, Corica C. Human Papilloma Virus vaccine and prevention of head and neck cancer, what is the current evidence? Oral Oncol 2021; 115:105168. [PMID: 33730628 DOI: 10.1016/j.oraloncology.2020.105168] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/12/2020] [Accepted: 12/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Human Papilloma Virus is associated with the development of cancers in the head and neck region. We have witnessed, in the last decades, an increase in number of cases directly related to HPV infection, in particular in the Western Countries. Recently the FDA expanded the indications for Gardasil-9® to include the prevention of head and neck cancer. Objective of this paper is to review the evidence supporting its use. MATERIALS AND METHODS Bibliographic review enquiring Medline, Web of Science and the Cochrane Library to assess the efficacy of vaccination against oncogenic HPV in the prevention of head and neck squamous cell carcinoma. RESULTS Two prospective and 4 retrospective studies have evaluated vaccination in prevention of head and neck cancer, using persistent oral infection as surrogate of efficacy. All studies showed lower prevalence of oral infection up to 4 years following vaccination. Vaccine efficacy was estimated between 88 and 93.3%. Because of low vaccine coverage the estimated population-level effect against oral HPV16/18/6/11 infections was only 17.0%. CONCLUSIONS Antibodies concentration in the oral fluid correlate with serum level, but the threshold to ensure protection is unknown. Duration of protection has not been established. HPV vaccination can provide protection from re-infection (at different mucosal sites) in previously exposed individuals, suggesting possible use of HPV vaccine later in life. Other studies should focus on confirming causal relationship between vaccination and prevention of persistent oral infection and investigate the duration of efficacy, which is crucial in its effectiveness against HNSCC.
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Affiliation(s)
- Giovanni Diana
- Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow G51 4TF, UK.
| | - Clementina Corica
- Universidad Europea, Passeig de l'Albereda, 7, 46010 València, Spain
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19
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Human Papillomavirus in Sinonasal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2020; 13:cancers13010045. [PMID: 33561073 PMCID: PMC7796014 DOI: 10.3390/cancers13010045] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 12/18/2022] Open
Abstract
Simple Summary The causative role of human papillomavirus (HPV) in sinonasal squamous cell carcinoma (SNSCC) remains unclear and is hindered by small studies using variable HPV detection techniques. This meta-analysis aims to provide an updated overview of HPV prevalence in SNSCC stratified by detection method, anatomic subsite, and geographic region. From 60 eligible studies, an overall HPV prevalence was estimated at 26%. When stratified by detection method, HPV prevalence was lower when using multiple substrate testing compared to single substrate testing. Anatomic subsite HPV prevalence was higher in subsites with high exposure to secretion flow compared to low exposure subsites. HPV prevalence in SNSCC followed the global distribution of HPV+ oropharyngeal squamous cell carcinoma. Taken together, this meta-analysis further supports a role for HPV in a subset of SNSCCs. Abstract Human papillomavirus (HPV) drives tumorigenesis in a subset of oropharyngeal squamous cell carcinomas (OPSCC) and is increasing in prevalence across the world. Mounting evidence suggests HPV is also involved in a subset of sinonasal squamous cell carcinomas (SNSCC), yet small sample sizes and variability of HPV detection techniques in existing literature hinder definitive conclusions. A systematic review was performed by searching literature through March 29th 2020 using PubMed, Embase, and Web of Science Core Collection databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed by two authors independently. A meta-analysis was performed using the random-effects model. Sixty studies (n = 1449) were eligible for statistical analysis estimating an overall HPV prevalence of 25.5% (95% CI 20.7–31.0). When stratified by HPV detection method, prevalence with multiple substrate testing (20.5%, 95% CI 14.5–28.2) was lower than with single substrate testing (31.7%, 95% CI 23.6–41.1), highest in high-exposure anatomic subsites (nasal cavity and ethmoids) (37.6%, 95% CI 26.5–50.2) vs. low-exposure (15.1%, 95% CI 7.3–28.6) and highest in high HPV+ OPSCC prevalence geographic regions (North America) (30.9%, 95% CI 21.9–41.5) vs. low (Africa) (13.1, 95% CI 6.5–24.5)). While small sample sizes and variability in data cloud firm conclusions, here, we provide a new reference point prevalence for HPV in SNSCC along with orthogonal data supporting a causative role for virally driven tumorigenesis, including that HPV is more commonly found in sinonasal subsites with increased exposure to refluxed oropharyngeal secretions and in geographic regions where HPV+ OPSCC is more prevalent.
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20
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Ayyanar P, Mishra P, Preetam C, Adhya AK. SMARCB1/INI1 Deficient Sino-Nasal Carcinoma: Extending the Histomorphological Features. Head Neck Pathol 2020; 15:555-565. [PMID: 33141418 PMCID: PMC8134582 DOI: 10.1007/s12105-020-01246-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/07/2020] [Accepted: 10/23/2020] [Indexed: 12/20/2022]
Abstract
SMARCB1/INI1 deficient sinonasal carcinoma is a variant of sinonasal undifferentiated carcinoma (SNUC). There is a paucity of literature describing the histomorphological features of this relatively new entity. Herein we describe the histomorphological features of three such cases and review the literature. We retrospectively reviewed the cases of SNUC diagnosed in our institute in the last 6 years. Immunohistochemistry for INI1, NUT & p16 were performed on these cases. Three cases showed loss of INI1. The histomorphology and clinicopathological features of these cases were studied and compared with non INI1 deficient SNUC. A total of 9 cases of SNUC were identified. Three of these cases showed loss of INI1. These three cases had presented with large sinonasal mass and with intracranial extension. Histopathology of these cases showed a diffuse infiltrative pattern, nest, and islands of predominantly basaloid cells with focal rhabdoid morphology. Additional features like small cell carcinoma like pattern, pseudoalveolar and pseudoglandular patterns, clear vacuoles and pseudopapillary appearance were also noted. We conclude that in presence of a mixed pattern of cells with a predominance of basaloid morphology, the possibility of SMARCB1/INI1 deficient sinonasal carcinoma must be strongly suspected and immunohistochemistry for INI1 must be performed.
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Affiliation(s)
- Pavithra Ayyanar
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Pritinanda Mishra
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Chappity Preetam
- Department of ENT, All India Institute of Medical Sciences, Bhubaneswar, Odisha India
| | - Amit Kumar Adhya
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
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Chatzipantelis P, Koukourakis M, Kouroupi M, Giatromanolaki A. P16 detection in benign, precursor epithelial lesions and carcinomas of head and neck. Pathol Res Pract 2020; 216:153035. [PMID: 32703498 DOI: 10.1016/j.prp.2020.153035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) had recently been implicated in the pathogenesis of Head and Neck SCCs. The biological role of HPV in benign and pre-cancerous lesions is far less studied. p16 is a widely accepted marker to detect immonohistochemically the presence of HPV. METHODS We evaluated, immunohistochemically, expression of p16 in 212 specimens: glottis, supraglottis, oropharynx, nasal/paranasal, with various diagnoses: hyperplasia, polyp/nodule, keratosis, papilloma, inverted papilloma, dysplasia, cancer (SCC). Analysis was completed according to location and disease. RESULTS Hyperplasias/polyps were all negative for p16. A small percentage of papillomas was p16+ regardless of their location (12.5 %), the majority of inverted papillomas were p16+ (78.6 %) and statistically significant (p < 0.04). In carcinomas, 18/59 were p16+ (30.5 %): nasal/paranasal SCCs had a significantly higher percentage of p16+ cancer cells compared to glottis (p = 0.009), while tumours of the supraglottis/oropharynx had an intermediate score for p16+ cells (p = 0.07). Dysplasias were p16+ in 9/64 (14 %) regardless of grading (p = 0.03 compared to carcinomas). CONCLUSION p16 was highly detected in inverted papillomas and in certain anatomic sites; however, it failed to be traced in benign lesions and only rarely encountered in dysplasias.
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Affiliation(s)
- Paschalis Chatzipantelis
- Department of Pathology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Michail Koukourakis
- Department of Radiotherapy-Oncology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Kouroupi
- Department of Pathology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
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Baraban E, Tong CCL, Adappa ND, Cooper K. A subset of sinonasal undifferentiated carcinoma is associated with transcriptionally active high-risk human papillomavirus by in situ hybridization: a clinical and pathologic analysis. Hum Pathol 2020; 101:64-69. [PMID: 32416210 DOI: 10.1016/j.humpath.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
Sinonasal undifferentiated carcinoma (SNUC) is an aggressive malignancy with a poor prognosis, and pathologically, it is a diagnosis of exclusion. Rendering this diagnosis can be challenging in practice because of the large number of diverse entities in the differential diagnosis. We encountered an index case of a sinonasal carcinoma otherwise diagnosable as SNUC which, on further investigation, demonstrated strong and diffuse P16 expression, as well as diffuse expression of high-risk human papillomavirus (hrHPV) RNA by in situ hybridization (ISH). We therefore hypothesized that a subset of cases previously diagnosed as SNUC may in fact harbor transcriptionally active hrHPV. We further investigated a cohort of 25 SNUC cases in our pathology archives and performed ISH for hrHPV RNA on cases that demonstrated >70% nuclear and cytoplasmic P16 expression, criteria which, in other anatomic sites, correlates strongly with the presence of hrHPV. Twelve of 25 SNUC cases were P16 positive, and of these, 5 were positive for hrHPV by ISH. Thus, 20% of all SNUC cases in this cohort harbored transcriptionally active hrHPV. Herein, we report a clinical and pathologic analysis of these cases, including differential diagnostic considerations and comparison of their clinical behavior with SNUC cases that are negative for hrHPV by ISH.
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Affiliation(s)
- Ezra Baraban
- Department of Pathology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA.
| | - Charles C L Tong
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Kumarasen Cooper
- Department of Pathology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
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23
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Sinonasal Undifferentiated Carcinoma (SNUC): From an Entity to Morphologic Pattern and Back Again-A Historical Perspective. Adv Anat Pathol 2020; 27:51-60. [PMID: 31876536 DOI: 10.1097/pap.0000000000000258] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since the first description of sinonasal undifferentiated carcinoma (SNUC) as a distinctive highly aggressive sinonasal neoplasm with probable origin from the sinonasal mucosa (Schneiderian epithelium), SNUC has been the subject of ongoing study and controversy. In particular, the SNUC category gradually became a "wastebasket" for any undifferentiated or unclassifiable sinonasal malignancy of definite or probable epithelial origin. However, with the availability of more specific and sensitive immunohistochemical antibodies and increasing implementation of novel genetic tools, the historical SNUC category became the subject of progressive subdivision leading to recognition of specific genetically defined, reproducible subtypes. These recently recognized entities are characterized by distinctive genetic aberrations including NUTM1-rearranged carcinoma (NUT carcinoma) and carcinomas associated with inactivation of different members of the SWI/SNF chromatin-remodeling gene complex such as SMARCB1-deficient and less frequently SMARCA4-deficient carcinoma. The ring became almost closed, with recent studies highlighting frequent oncogenic IDH2 mutations in the vast majority of histologically defined SNUCs, with a frequency of 82%. A review of these cases suggests the possibility that "true SNUC" probably represents a distinctive neoplastic disease entity, morphologically, phenotypically, and genetically. This review addresses this topic from a historical perspective, with a focus on recently recognized genetically defined subsets within the SNUC spectrum.
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Mody MD, Saba NF. Multimodal Therapy for Sinonasal Malignancies: Updates and Review of Current Treatment. Curr Treat Options Oncol 2020; 21:4. [PMID: 31950286 DOI: 10.1007/s11864-019-0696-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OPINION STATEMENT Sinonasal malignancies pose a significant challenge in management due to their low incidence, biologic diversity, and significant symptom burden. Even though surgery remains the primary therapeutic modality, a multi-modality approach has been shown to benefit a significant proportion of patients and its success depends largely on stage and histologic type. Non-surgical approaches such as novel radiation approaches as well as intensification with systemic therapy hold promise in altering the organ preservation rate as well as overall survival for patients. Practice changing randomized trials to test these novel modalities are overdue and desperately needed.
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Affiliation(s)
- Mayur D Mody
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA. .,Winship Cancer Institute of Emory University, Atlanta, GA, USA.
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25
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26
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HPV-negative tumors of the uterine cervix. Mod Pathol 2019; 32:1189-1196. [PMID: 30911077 DOI: 10.1038/s41379-019-0249-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 02/05/2023]
Abstract
Human papillomaviruses (HPV) are the causative agents of virtually all cervical carcinomas. Nevertheless, a small proportion of cervical cancer are negative for HPV, although the significance of this finding remains unclear. We aimed to provide insight into the differential clinico-pathological characteristics of this unusual subset of HPV-negative cervical cancer. We performed HPV-DNA detection using a highly sensitive PCR test (SPF10) and p16 immunostaining in 214 cervical carcinomas specimens from women treated at the Gynecological Oncology Unit of the Hospital Clinic (Barcelona, Spain) from 2012 to 2015. The clinical and pathological characteristics, including disease-free survival and overall survival, of HPV-negative and -positive cervical carcinomas were compared. Twenty-one out of 214 tumors (10%) were negative for HPV DNA. HPV-negative tumors were more frequently of the non-squamous type (9/21, 43% vs. 37/193, 19%; p < 0.01) and showed negative p16 staining (9/21; 43% vs. 7/193; 4%; p < 0.01). HPV-negative tumors were more frequently diagnosed at advanced FIGO stage (19/21, 91% vs. 110/193, 57%; p < 0.01) and more frequently had lymph node metastases (14/21, 67% vs. 69/193, 36%; p < 0.01). Patients with HPV-negative cervical cancer had a significantly worse disease-free survival (59.8 months, 95% confidence interval 32.0-87.6 vs. 132.2 months, 95% confidence interval 118.6-145.8; p < 0.01) and overall survival (77.0 months, 95% confidence interval 47.2-106.8 vs. 153.8 months, 95% confidence interval 142.0-165.6; p = 0.01) than women with HPV-positive tumors. However, only advanced FIGO stage and lymph node metastases remained associated with a poor disease-free survival and overall survival on multivariate analysis. In conclusion, our results suggest that a low percentage of cervical cancer arise via an HPV-independent pathway. These HPV-negative tumors are diagnosed at advanced stages, show higher prevalence of lymph nodes metastases and have an impaired prognosis.
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Syrjänen S, Syrjänen K. HPV in Head and Neck Carcinomas: Different HPV Profiles in Oropharyngeal Carcinomas - Why? Acta Cytol 2019; 63:124-142. [PMID: 30861518 DOI: 10.1159/000495727] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The association of human papillomavirus (HPV) with head and neck squamous cell carcinoma (HNSCC) was first described in 1982-1983 by the authors of this review. Prompted by this discovery 35 years ago, an entirely new field of HPV research has emerged, resulting in a paradigm shift from smoking and alcohol as the only etiological factors to confirmation of HNSCC as an important group of HPV-related human malignancies. SUMMARY In this review, the authors first describe the scope (i.e., HNSCC) by the anatomic sites of the tumors. Their important site-specific differences in epidemiology are emphasized, and the misconceptions caused by the adopted practice of pooling all tumors from these divergent anatomic sites as a single entity (HNSCC) are pinpointed. The convincing evidence of the established risk factors (smoking and alcohol) is briefly addressed, before entering in the discussion on the causal role of HPV in HNSCC pathogenesis. The global HPV prevalence in different subsets of HNSCC is summarized using the data extracted from all meta-analyses published since 2010. Of all HNSCC subsets, oropharyngeal SCC has an HPV profile distinct form all the other subsets, and the possible mechanisms explaining this intimate association with HPV are discussed. Key Messages: Recent global trends show a constant increase in HNSCC rates particularly among younger age groups. The evidence on cigarette smoking and alcohol consumption as the prime risk factors of HNSCC is overwhelming. During the past 35 years, however, increasing evidence has accumulated implicating an important causal role of HPV in HNSCC. These data have important clinical implications, HPV detection and tailored treatment strategies for HPV-positive HNSCCs currently being an integral part of the oncological management practices of HNSCC.
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Affiliation(s)
- Stina Syrjänen
- Department of Oral Pathology, Institute of Dentistry, Faculty of Medicine, University of Turku, Turku, Finland,
- Department of Pathology, Turku University Hospital, Turku, Finland,
| | - Kari Syrjänen
- Department of Clinical Research, Biohit Oyj, Helsinki, Finland
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
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Human papillomavirus-related multiphenotypic sinonasal carcinoma: An emerging tumor type with a unique microscopic appearance and a paradoxical clinical behaviour. Oral Oncol 2018; 87:17-20. [DOI: 10.1016/j.oraloncology.2018.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/20/2018] [Accepted: 10/10/2018] [Indexed: 11/21/2022]
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29
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Franchi A, Bishop JA, Coleman H, Flucke U, Licitra LF, Pendás JLL, Stelow EB, Toner M, Weinreb I, Wenig BM, Thompson LDR. Data Set for the Reporting of Carcinomas of the Nasal Cavity and Paranasal Sinuses: Explanations and Recommendations of the Guidelines From the International Collaboration on Cancer Reporting. Arch Pathol Lab Med 2018; 143:424-431. [PMID: 30500298 DOI: 10.5858/arpa.2018-0404-sa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The International Collaboration on Cancer Reporting was established to internationally unify and standardize the pathologic reporting of cancers based on collected evidence, as well as to allow systematic multi-institutional intercountry data collection to guide cancer care in the future. This data set has been developed by the collaborative efforts of an international multidisciplinary panel of experts involved in the care of patients with carcinomas of the nasal cavity and paranasal sinuses (sinonasal tract). The nasal cavity and paranasal sinuses (including frontal, sphenoid, ethmoid, and maxillary sinuses) comprise a very complex anatomic area of the head and neck, affected by a sometimes bewildering array of neoplasms. Management of malignancies in this anatomic region involves complex surgery because of the anatomic confines and close proximity to many vital structures. Given a multidisciplinary approach, the standardized reporting of the carcinomas that develop in this anatomic region include both required (core) and recommended (noncore) elements in pathology reporting in order to be able to identify critical prognostic factors, often requiring clinical and radiologic correlation. A summary of the International Collaboration on Cancer Reporting guidelines and clinically relevant elements, along with additional explanatory notes, are provided, based on evidentiary support from the literature, set in the context of practical application.
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Affiliation(s)
- Alessandro Franchi
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Justin A Bishop
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Hedley Coleman
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Uta Flucke
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Lisa F Licitra
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - José Luis Llorente Pendás
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Edward B Stelow
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Mary Toner
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Ilan Weinreb
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Bruce M Wenig
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Lester D R Thompson
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
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Smith J, Kulkarni A, Birkeland AC, McHugh JB, Brenner JC. Whole-Exome Sequencing of Sinonasal Small Cell Carcinoma Arising within a Papillary Schneiderian Carcinoma In Situ. Otolaryngol Head Neck Surg 2018; 159:859-865. [PMID: 29734873 PMCID: PMC6212311 DOI: 10.1177/0194599818774004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/10/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The pathogenetic underpinnings of extrapulmonary small cell carcinomas (EPSCCs) of the head and neck are poorly understood. We sought to describe the clinical case and whole-exome DNA sequencing data of a patient with sinonasal Schneiderian carcinoma in situ whose tumor progressed to small cell carcinoma (SCC). STUDY DESIGN Case report and whole-exome sequencing of tumor DNA. SETTING Academic medical center. SUBJECTS AND METHODS A 52-year-old man with sinonasal Schneiderian carcinoma in situ whose tumor progressed to small cell carcinoma. We performed whole-exome genetic sequencing and copy-number variation (CNV) analysis of tumor and normal DNA extracted from flash-frozen, paraffin-embedded (FFPE) samples. RESULTS A total of 93 high-confidence, nonsynonymous somatic mutation events were identified in sinonasal SCC, including loss-of-function mutations in TP53, MAML3, a transcriptional coactivator of the Notch pathway, and GAS6, an activating ligand of the TAM family of tyrosine kinase receptors. Focal amplifications of chromosomal regions 6p25-11.1, containing SOX4 and VEGFA, and 14q32.1-32.3, containing AKT1 and the Notch inhibitory ligand DLK1, were also seen. Further CNV analysis revealed deletions in the critical cell cycle regulators CDKN2A, RB1, RBL1, and RBL2 and the chromatin modifier EP300. CONCLUSIONS Small cell carcinoma may rarely arise from sinonasal Schneiderian carcinoma in situ and exhibits similar genomic aberrations (eg, SOX amplification, Notch pathway inactivation) to pulmonary small cell carcinoma.
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Affiliation(s)
- Joshua Smith
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI
| | - Aditi Kulkarni
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI
| | - Andrew C Birkeland
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI
| | - Jonathan B. McHugh
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI
| | - J. Chad Brenner
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI
- Program in Cellular and Molecular Biology, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, MI. University of Michigan Medical School, Ann Arbor, MI
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31
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Ilardi G, Russo D, Varricchio S, Salzano G, Dell'Aversana Orabona G, Napolitano V, Di Crescenzo RM, Borzillo A, Martino F, Merolla F, Mascolo M, Staibano S. HPV Virus Transcriptional Status Assessment in a Case of Sinonasal Carcinoma. Int J Mol Sci 2018; 19:E883. [PMID: 29547549 PMCID: PMC5877744 DOI: 10.3390/ijms19030883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/12/2018] [Accepted: 03/15/2018] [Indexed: 12/13/2022] Open
Abstract
Human Papilloma Virus (HPV) can play a causative role in the development of sinonasal tract malignancies. In fact, HPV may be the most significant causative agent implicated in sinonasal tumorigenesis and is implicated in as many as 21% of sinonasal carcinomas. To date, there are no definitive, reliable and cost-effective, diagnostic tests approved by the FDA for the unequivocal determination of HPV status in head and neck cancers. We followed an exhaustive algorithm to correctly test HPV infection, including a sequential approach with p16INK4a IHC, viral DNA genotyping and in situ hybridization for E6/E7 mRNA. Here, we report a case of sinonasal carcinoma with discordant results using HPV test assays. The tumor we describe showed an irregular immunoreactivity for p16INK4a, and it tested positive for HPV DNA; nevertheless, it was negative for HR-HPV mRNA. We discuss the possible meaning of this discrepancy. It would be advisable to test HPV transcriptional status of sinonasal carcinoma on a diagnostic routine basis, not only by p16INK4a IHC assay, but also by HPV DNA genotyping and HR-HPV mRNA assessment.
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Affiliation(s)
- Gennaro Ilardi
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", 80131 Naples, Italy.
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", 80131 Naples, Italy.
| | - Silvia Varricchio
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", 80131 Naples, Italy.
| | - Giovanni Salzano
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Operative Unit of Maxillo-Facial Surgery, University of Naples "Federico II", 80131 Naples, Italy.
| | - Giovanni Dell'Aversana Orabona
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Operative Unit of Maxillo-Facial Surgery, University of Naples "Federico II", 80131 Naples, Italy.
| | - Virginia Napolitano
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", 80131 Naples, Italy.
| | - Rosa Maria Di Crescenzo
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", 80131 Naples, Italy.
| | - Alessandra Borzillo
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", 80131 Naples, Italy.
| | - Francesco Martino
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", 80131 Naples, Italy.
| | - Francesco Merolla
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy.
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", 80131 Naples, Italy.
| | - Stefania Staibano
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", 80131 Naples, Italy.
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32
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Bishop JA, Andreasen S, Hang JF, Bullock MJ, Chen TY, Franchi A, Garcia JJ, Gnepp DR, Gomez-Fernandez CR, Ihrler S, Kuo YJ, Lewis JS, Magliocca KR, Pambuccian S, Sandison A, Uro-Coste E, Stelow E, Kiss K, Westra WH. HPV-related Multiphenotypic Sinonasal Carcinoma: An Expanded Series of 49 Cases of the Tumor Formerly Known as HPV-related Carcinoma With Adenoid Cystic Carcinoma-like Features. Am J Surg Pathol 2017; 41:1690-1701. [PMID: 28877065 PMCID: PMC5680105 DOI: 10.1097/pas.0000000000000944] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Human papillomavirus (HPV)-related multiphenotypic sinonasal carcinoma (HMSC), originally known as HPV-related carcinoma with adenoid cystic carcinoma-like features, is a peculiar neoplasm that is restricted to the sinonasal tract, exhibits features of both a surface-derived and salivary gland carcinoma (particularly adenoid cystic carcinoma), and is associated with high-risk HPV. Given the limited number of published cases, the full clinicopathologic spectrum of this neoplasm is unclear. Here, we present an updated experience of 49 cases. All cases of HMSC were obtained from the authors' files. Immunohistochemistry for p16, c-kit, and myoepithelial cell markers (S100, actin, calponin, p63, and/or p40) was performed along with RNA in situ hybridization for HPV (type 33-specific as well as a high-risk cocktail). Fluorescence in situ hybridization studies for fusions of MYB, NFIB, and MYBL1 was performed on a subset of cases. Clinical follow-up was obtained from medical records. A total of 49 cases of HMSC were collected. Twenty-eight (57%) were from women and 18 (43%) from men, ranging in age from 28 to 90 years (mean, 54 y). Of 40 cases with detailed staging information, 43% of HMSCs presented with a high T-stage (T3 or T4). Histologically, most grew predominantly as solid nests of basaloid cells exhibiting high mitotic rates and frequent necrosis, with histologic and immunohistochemical evidence of myoepithelial differentiation. Most cases also demonstrated foci of cribriform and/or tubular growth, along with an inconspicuous population of ducts. Thirty-four (69%) cases demonstrated an unusual pattern of surface involvement where markedly atypical squamous cells colonized tracts of the sinonasal mucosa. Less consistent histologic features included squamous differentiation within the invasive tumor (n=6), sarcomatoid transformation (n=5) including overt chondroid differentiation (n=3), and prominent epithelial-myoepithelial carcinoma-like growth (n=3). All cases were positive for p16 by immunostaining and HPV by RNA in situ hybridization. Thirty-three (67%) were positive for HPV 33. No cases tested for MYB, MYBL1, or NFIB gene fusions were positive. In the 38 cases with follow-up data, (mean follow-up, 42 mo) 14 recurred locally and 2 metastasized (lung, finger). There were no regional lymph node metastases, and no tumor-related deaths. HMSC is a distinct sinonasal neoplasm characterized by myoepithelial differentiation, frequent surface epithelial involvement, and the presence of high-risk HPV (especially type 33). Although it classically exhibits a cribriforming pattern that closely resembles adenoid cystic carcinoma, our expanded series highlights a histologic spectrum that is much broader than previously recognized, warranting a change in terminology. HMSC usually presents as a large and destructive sinonasal mass with high-grade histologic features, but it paradoxically behaves in a relatively indolent manner, underscoring the importance of distinguishing HMSC from true adenoid cystic carcinoma, squamous cell carcinoma, and other histologic mimickers.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Carcinoma, Adenoid Cystic/chemistry
- Carcinoma, Adenoid Cystic/genetics
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Adenoid Cystic/virology
- Carcinoma, Squamous Cell/chemistry
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/virology
- Cell Proliferation
- Female
- Head and Neck Neoplasms/chemistry
- Head and Neck Neoplasms/genetics
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/virology
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Male
- Middle Aged
- Mitotic Index
- Necrosis
- Neoplasm Grading
- Neoplasm Staging
- Papillomaviridae/genetics
- Papillomaviridae/isolation & purification
- Papillomaviridae/pathogenicity
- Papillomavirus Infections/pathology
- Papillomavirus Infections/virology
- Paranasal Sinus Neoplasms/chemistry
- Paranasal Sinus Neoplasms/genetics
- Paranasal Sinus Neoplasms/pathology
- Paranasal Sinus Neoplasms/virology
- Phenotype
- Polymerase Chain Reaction
- RNA, Viral/genetics
- Squamous Cell Carcinoma of Head and Neck
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Affiliation(s)
- Justin A. Bishop
- Departments of Pathology, Oncology, and Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, MD; U.S.A
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A
| | - Simon Andreasen
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Copenhagen University Hospital, Denmark
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Denmark
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Martin J Bullock
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tiffany Y Chen
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, U.S.A
| | - Alessandro Franchi
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Italy
| | - Joaquin J. Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, U.S.A
| | - Douglas R. Gnepp
- Department of Pathology, Warren Alpert School of Medicine at Brown University (retired), Providence, RI, U.S.A
| | | | - Stephan Ihrler
- Laboratory for Dermatohistology and Oral Pathology, Munich, Germany
| | - Ying-Ju Kuo
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - James S Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, U.S.A
| | - Kelly R. Magliocca
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta GA, U.S.A
| | - Stefan Pambuccian
- Department of Pathology, Loyola University Medical Center, Chicago, IL, U.S.A
| | - Ann Sandison
- Department of Pathology, Imperial College, London, United Kingdom
| | | | - Edward Stelow
- Department of Pathology, University of Virginia, Charlottesville, VA, U.S.A
| | - Katalin Kiss
- Department of Pathology, Copenhagen University Hospital, Denmark
| | - William H. Westra
- Departments of Pathology, Oncology, and Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, MD; U.S.A
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33
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Kılıç S, Kılıç SS, Kim ES, Baredes S, Mahmoud O, Gray ST, Eloy JA. Significance of human papillomavirus positivity in sinonasal squamous cell carcinoma. Int Forum Allergy Rhinol 2017; 7:980-989. [PMID: 28859244 DOI: 10.1002/alr.21996] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 06/29/2017] [Accepted: 07/07/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The role of human papillomavirus (HPV) in sinonasal squamous cell carcinoma (SNSCC) is not well understood. METHODS The National Cancer Database was queried for cases of SNSCC with known HPV status. Demographics, socioeconomic variables, TNM stage, histology, grade, treatment modalities, and overall survival (OS) through 5 years were compared between HPV-positive and HPV-negative tumors. Cox proportional hazard regression analyses were performed. RESULTS Seven hundred seventy (770) cases were identified; 526 were HPV-negative (68.3%) and 244 (31.7%) were HPV-positive. Patients with HPV-positive tumors were younger (58.0 vs 63.7 years, p < 0.0001). Nasal cavity (49.4%) tumors were more likely to be HPV-positive (p < 0.05) than maxillary (18.8%), ethmoid (18.8%), and frontal (18.2%) sinus tumors. Large cell nonkeratinizing (42.4%), papillary (42.1%), and basaloid (56.5%) tumors were more likely than keratinizing (25.2%) tumors to be HPV-positive (p < 0.05). Well-differentiated (grade I) tumors (9.0%) were less likely than higher grade tumors to be HPV-positive (p < 0.05). Gender, race, facility type, insurance type, median income, education level, Charlson-Deyo comorbidity score, overall stage, T stage, N stage, M stage, tumor size, treatment modality, surgical approach, and surgical margins did not vary by HPV status (p ≥ 0.05). HPV-positive tumors had higher OS than HPV-negative tumors (p < 0.0001). At 5 years, OS was 68.1% and 51.5% for HPV-positive and HPV-negative tumors, respectively. On multivariate analyses, HPV positivity remained a favorable prognostic factor (hazard ratio, 0.49; 95% confidence interval, 0.34-0.70). CONCLUSION HPV positivity is more common in nasal cavity SCC and nonkeratinizing SNSCC. It is also a favorable prognostic factor in SNSCC. Future studies on SNSCC should take HPV positivity into consideration.
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Affiliation(s)
- Suat Kılıç
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Sarah S Kılıç
- Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ
| | - Emilie S Kim
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ
| | - Omar Mahmoud
- Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ
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34
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New tumor entities in the 4th edition of the World Health Organization classification of head and neck tumors: Nasal cavity, paranasal sinuses and skull base. Virchows Arch 2017; 472:315-330. [DOI: 10.1007/s00428-017-2116-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
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35
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Wang X, Lv W, Qi F, Gao Z, Yang H, Wang W, Gao Y. Clinical effects of p53 overexpression in squamous cell carcinoma of the sinonasal tract: A systematic meta-analysis with PRISMA guidelines. Medicine (Baltimore) 2017; 96:e6424. [PMID: 28328848 PMCID: PMC5371485 DOI: 10.1097/md.0000000000006424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The level of p53 protein expression in sinonasal squamous cell carcinoma (SNSCC) has been estimated, but the results remain inconsistent and the point of consensus has not been reached. This study was first determined to evaluate the clinical effects of p53 expression in SCC of the sinonasal tract. METHODS According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement criteria, the potential literature was searched from diverse databases. The pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated to assess the strength of association between p53 expression and SNSCC. RESULTS Final 17 eligible studies were included in a total of 258 cases and 748 controls. The result of p53 expression was shown to be notably higher in SNSCC than in benign sinonasal papillomas and normal sinonasal mucosa (OR = 26.93, P < 0.001; OR = 39.79, P < 0.001; respectively). Subgroup analyses of ethnicity revealed that p53 expression had significant association with SNSCC in Asian and Caucasian populations in cancer versus benign sinonasal papillomas or normal sinonasal mucosa. The expression of p53 was notably higher in moderately or poorly differentiated SNSCC than in well-differentiated SNSCC (OR = 3.51, P = 0.021), while p53 expression was not associated with histological type. CONCLUSION The results suggested that p53 overexpression may be correlated with the carcinogenesis and progression of SNSCC. The p53 gene may become a novel drug target of SNSCC. Additional studies on the correlation of p53 expression with clinicopathological features are needed.
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36
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Stelow EB, Bishop JA. Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumors of the Nasal Cavity, Paranasal Sinuses and Skull Base. Head Neck Pathol 2017; 11:3-15. [PMID: 28247233 PMCID: PMC5340732 DOI: 10.1007/s12105-017-0791-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/02/2017] [Indexed: 12/29/2022]
Abstract
The sinonasal tract remains an epicenter of a diverse array of neoplasia. This paper discusses changes to the WHO classification system of tumors involving this area. In particular, seromucinous hamartoma, NUT carcinoma, biphenotypic sinonasal sarcoma, HPV-related carcinoma with adenoid cystic features, SMARCB1-deficient carcinoma, and renal cell-like adenocarcinoma are discussed.
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Affiliation(s)
- Edward B. Stelow
- Department of Pathology, Anatomic Pathology, University of Virginia Health System, Jefferson Park Ave., Box 800214, Charlottesville, VA 22908 USA
| | - Justin A. Bishop
- Department of Pathology, Johns Hopkins University, Baltimore, MD USA
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37
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Andreasen S, Bishop JA, Hansen TVO, Westra WH, Bilde A, von Buchwald C, Kiss K. Human papillomavirus-related carcinoma with adenoid cystic-like features of the sinonasal tract: clinical and morphological characterization of six new cases. Histopathology 2017; 70:880-888. [DOI: 10.1111/his.13162] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/09/2016] [Accepted: 12/28/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Simon Andreasen
- Department of Otorhinolaryngology; Head and Neck Surgery and Audiology; Copenhagen University Hospital; Copenhagen Denmark
- Department of Otorhinolaryngology and Maxillofacial Surgery; Zealand University Hospital; Køge Denmark
| | - Justin A Bishop
- Departments of Pathology, Otolaryngology and Oncology; Johns Hopkins Medical Institutions; Baltimore MD USA
| | | | - William H Westra
- Departments of Pathology, Otolaryngology and Oncology; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Anders Bilde
- Department of Otorhinolaryngology; Head and Neck Surgery and Audiology; Copenhagen University Hospital; Copenhagen Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology; Head and Neck Surgery and Audiology; Copenhagen University Hospital; Copenhagen Denmark
| | - Katalin Kiss
- Department of Pathology; Copenhagen University Hospital; Copenhagen Denmark
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38
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Rooper LM, Bishop JA, Westra WH. Transcriptionally Active High-Risk Human Papillomavirus is Not a Common Etiologic Agent in the Malignant Transformation of Inverted Schneiderian Papillomas. Head Neck Pathol 2017; 11:346-353. [PMID: 28181187 PMCID: PMC5550397 DOI: 10.1007/s12105-017-0779-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/23/2017] [Indexed: 12/16/2022]
Abstract
The role of human papillomavirus (HPV) as an etiologic and transformational agent in inverted Schneiderian papilloma (ISP) is unclear. Indeed, reported detection rates of HPV in ISPs range from 0 to 100%. The true incidence has been confounded by a tendency to conflate high- and low-risk HPV types and by the inability to discern biologically relevant from irrelevant HPV infections. The recent development of RNA in situ hybridization for high-risk HPV E6/E7 mRNA now allows the direct visualization of transcriptionally active high-risk HPV in ISP, providing an opportunity to more definitively assess its role in the development and progression of ISPs. We performed p16 immunohistochemistry and high-risk HPV RNA in situ hybridization on 30 benign ISPs, 7 ISPs with dysplasia, 16 ISPs with carcinomatous transformation, and 7 non-keratinizing squamous cell carcinomas (SCCs) with inverted growth that were unassociated with ISP. Transcriptionally active HPV was not detected in any of the 52 ISPs including those that had undergone carcinomatous transformation, but it was detected in two of seven (29%) non-keratinizing SCCs that showed inverted growth. There was a strong correlation between high-risk HPV RNA in situ hybridization and p16 immunohistochemistry (97%; p < 0.01). These results indicate that transcriptionally active high-risk HPV does not play a common role in either the development of ISP or in its transformation into carcinoma.
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Affiliation(s)
- Lisa M. Rooper
- 0000 0001 2171 9311grid.21107.35Department of Pathology, The Johns Hopkins Medical Institutions, 401 N. Broadway, Weinberg 2242, Baltimore, MD 21231-2410 USA
| | - Justin A. Bishop
- 0000 0001 2171 9311grid.21107.35Department of Pathology, The Johns Hopkins Medical Institutions, 401 N. Broadway, Weinberg 2242, Baltimore, MD 21231-2410 USA ,0000 0001 2171 9311grid.21107.35Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD USA
| | - William H. Westra
- 0000 0001 2171 9311grid.21107.35Department of Pathology, The Johns Hopkins Medical Institutions, 401 N. Broadway, Weinberg 2242, Baltimore, MD 21231-2410 USA ,0000 0001 2171 9311grid.21107.35Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD USA ,0000 0001 2171 9311grid.21107.35Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD USA
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Laco J, Chmelařová M, Vošmiková H, Sieglová K, Bubancová I, Dundr P, Němejcová K, Michálek J, Čelakovský P, Mottl R, Sirák I, Vošmik M, Ryška A. SMARCB1/INI1-deficient sinonasal carcinoma shows methylation of RASSF1 gene: A clinicopathological, immunohistochemical and molecular genetic study of a recently described entity. Pathol Res Pract 2017; 213:133-142. [PMID: 28069272 DOI: 10.1016/j.prp.2016.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/02/2016] [Accepted: 10/21/2016] [Indexed: 02/06/2023]
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Chakravarthy A, Henderson S, Thirdborough SM, Ottensmeier CH, Su X, Lechner M, Feber A, Thomas GJ, Fenton TR. Human Papillomavirus Drives Tumor Development Throughout the Head and Neck: Improved Prognosis Is Associated With an Immune Response Largely Restricted to the Oropharynx. J Clin Oncol 2016; 34:4132-4141. [PMID: 27863190 PMCID: PMC5477823 DOI: 10.1200/jco.2016.68.2955] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose In squamous cell carcinomas of the head and neck (HNSCC), the increasing incidence of oropharyngeal squamous cell carcinomas (OPSCCs) is attributable to human papillomavirus (HPV) infection. Despite commonly presenting at late stage, HPV-driven OPSCCs are associated with improved prognosis compared with HPV-negative disease. HPV DNA is also detectable in nonoropharyngeal (non-OPSCC), but its pathogenic role and clinical significance are unclear. The objectives of this study were to determine whether HPV plays a causal role in non-OPSCC and to investigate whether HPV confers a survival benefit in these tumors. Methods Meta-analysis was used to build a cross-tissue gene-expression signature for HPV-driven cancer. Classifiers trained by machine-learning approaches were used to predict the HPV status of 520 HNSCCs profiled by The Cancer Genome Atlas project. DNA methylation data were similarly used to classify 464 HNSCCs and these analyses were integrated with genomic, histopathology, and survival data to permit a comprehensive comparison of HPV transcript-positive OPSCC and non-OPSCC. Results HPV-driven tumors accounted for 4.1% of non-OPSCCs. Regardless of anatomic site, HPV+ HNSCCs shared highly similar gene expression and DNA methylation profiles; nonkeratinizing, basaloid histopathological features; and lack of TP53 or CDKN2A alterations. Improved overall survival, however, was largely restricted to HPV-driven OPSCCs, which were associated with increased levels of tumor-infiltrating lymphocytes compared with HPV-driven non-OPSCCs. Conclusion Our analysis identified a causal role for HPV in transcript-positive non-OPSCCs throughout the head and neck. Notably, however, HPV-driven non-OPSCCs display a distinct immune microenvironment and clinical behavior compared with HPV-driven OPSCCs.
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Affiliation(s)
- Ankur Chakravarthy
- Ankur Chakravarthy, Stephen Henderson, Matt Lechner, Andrew Feber, and Tim R. Fenton, UCL Cancer Institute, University College London, London; Stephen M. Thirdborough, Christian H. Ottensmeier, and Gareth J. Thomas, University of Southampton, Southampton, United Kingdom; Xiaoping Su, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen Henderson
- Ankur Chakravarthy, Stephen Henderson, Matt Lechner, Andrew Feber, and Tim R. Fenton, UCL Cancer Institute, University College London, London; Stephen M. Thirdborough, Christian H. Ottensmeier, and Gareth J. Thomas, University of Southampton, Southampton, United Kingdom; Xiaoping Su, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen M. Thirdborough
- Ankur Chakravarthy, Stephen Henderson, Matt Lechner, Andrew Feber, and Tim R. Fenton, UCL Cancer Institute, University College London, London; Stephen M. Thirdborough, Christian H. Ottensmeier, and Gareth J. Thomas, University of Southampton, Southampton, United Kingdom; Xiaoping Su, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christian H. Ottensmeier
- Ankur Chakravarthy, Stephen Henderson, Matt Lechner, Andrew Feber, and Tim R. Fenton, UCL Cancer Institute, University College London, London; Stephen M. Thirdborough, Christian H. Ottensmeier, and Gareth J. Thomas, University of Southampton, Southampton, United Kingdom; Xiaoping Su, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiaoping Su
- Ankur Chakravarthy, Stephen Henderson, Matt Lechner, Andrew Feber, and Tim R. Fenton, UCL Cancer Institute, University College London, London; Stephen M. Thirdborough, Christian H. Ottensmeier, and Gareth J. Thomas, University of Southampton, Southampton, United Kingdom; Xiaoping Su, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matt Lechner
- Ankur Chakravarthy, Stephen Henderson, Matt Lechner, Andrew Feber, and Tim R. Fenton, UCL Cancer Institute, University College London, London; Stephen M. Thirdborough, Christian H. Ottensmeier, and Gareth J. Thomas, University of Southampton, Southampton, United Kingdom; Xiaoping Su, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andrew Feber
- Ankur Chakravarthy, Stephen Henderson, Matt Lechner, Andrew Feber, and Tim R. Fenton, UCL Cancer Institute, University College London, London; Stephen M. Thirdborough, Christian H. Ottensmeier, and Gareth J. Thomas, University of Southampton, Southampton, United Kingdom; Xiaoping Su, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gareth J. Thomas
- Ankur Chakravarthy, Stephen Henderson, Matt Lechner, Andrew Feber, and Tim R. Fenton, UCL Cancer Institute, University College London, London; Stephen M. Thirdborough, Christian H. Ottensmeier, and Gareth J. Thomas, University of Southampton, Southampton, United Kingdom; Xiaoping Su, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tim R. Fenton
- Ankur Chakravarthy, Stephen Henderson, Matt Lechner, Andrew Feber, and Tim R. Fenton, UCL Cancer Institute, University College London, London; Stephen M. Thirdborough, Christian H. Ottensmeier, and Gareth J. Thomas, University of Southampton, Southampton, United Kingdom; Xiaoping Su, The University of Texas MD Anderson Cancer Center, Houston, TX
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Evaluation for High-risk HPV in Squamous Cell Carcinomas and Precursor Lesions Arising in the Conjunctiva and Lacrimal Sac. Am J Surg Pathol 2016; 40:519-28. [PMID: 26735858 DOI: 10.1097/pas.0000000000000581] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
High-risk human papilloma virus (HR-HPV) is a well-established causative agent of oropharyngeal squamous cell carcinoma (SCC). In addition, HR-HPV has occasionally been reported to be present in dysplastic and malignant lesions of the conjunctiva and lacrimal sac, although its overall incidence and etiological role in periocular SCC are controversial. Sequential surgical samples of 52 combined cases of invasive SCC (I-SCC) and SCC in situ (SCCIS) from 2 periocular sites (conjunctiva and lacrimal sac) diagnosed over a 14-year period (2000 to 2014) were selected for evaluation, and relevant patient characteristics were documented. p16 immunohistochemistry was performed as a screening test. All p16-positive cases were further evaluated for HR-HPV using DNA in situ hybridization (DNA ISH), and a subset was also analyzed by polymerase chain reaction (PCR). Of 43 ocular surface squamous neoplasias (OSSNs), 30% (n=13; 8 SCCIS and 5 I-SCC cases) were positive for HR-HPV. HPV-positive OSSNs occurred in 8 men and 5 women with a mean age of 60 years (range, 39 to 94 y). HPV type-16 was detected in all conjunctival cases evaluated by PCR. All 5 conjunctival I-SCCs were nonkeratinizing (n=4) or partially keratinizing (n=1) and managed by simple excision. In contrast, HPV-negative conjunctival I-SCCs were predominantly keratinizing (11 keratinizing and 2 nonkeratinizing). Of 9 lacrimal sac I-SCCs (LSSCCs), 66.7% (n=6) were positive for HR-HPV by p16 and DNA ISH; HPV subtypes were HPV-16 (n=5) and HPV-58 (n=1). In addition, 2 p16-positive cases with negative DNA ISH results were HR-HPV positive (HPV-16 and HPV-33) when evaluated by PCR, suggesting that the rate of HR-HPV positivity among the LSSCCs may be as high as 89% (n=8). The combined group of HR-HPV-positive LSSCCs was seen in 4 men and 4 women with a mean age of 60 years (range, 34 to 71 y). Seven of the 8 HPV-positive LSSCCs (87.5%) had a nonkeratinizing or partially keratinizing histomorphology, whereas 1 case (12.5%) was predominantly keratinizing. The presence of HR-HPV in 30% of OSSNs and at least 66.7% of LSSCCs suggests the possibility of an etiologic role for HR-HPV at these sites.
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Abstract
The sinonasal cavities host a wide variety of undifferentiated malignancies with round cell morphology, including neoplasms of epithelial, mesenchymal, neuroectodermal, and hematolymphoid lineage. The differential diagnosis may be difficult, especially in small biopsy material, due to overlapping morphology, but their correct classification is clinically relevant. The aim of this review is to provide practical guidelines for the differential diagnosis of these malignancies, with emphasis on recently described entities and special reference to the role of ancillary techniques.
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Lewis JS. Sinonasal Squamous Cell Carcinoma: A Review with Emphasis on Emerging Histologic Subtypes and the Role of Human Papillomavirus. Head Neck Pathol 2016; 10:60-67. [PMID: 26830402 PMCID: PMC4746138 DOI: 10.1007/s12105-016-0692-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/03/2015] [Indexed: 02/03/2023]
Abstract
The sinonasal tract is one of the least frequent sites for squamous cell carcinoma in the head and neck. However, it is still a complex tumor type for pathologists because there are numerous histologic variants with unusual morphologic features, several non-squamous carcinomas in the differential diagnosis that can have similar morphology and even squamous differentiation, and because of the increasing recognition of human papillomavirus (HPV) in a subset of the tumors. In addition, the unique and complex anatomy of the sinonasal tract can make proper staging and management of patients' tumors quite challenging. This article reviews sinonasal tract squamous cell carcinoma in depth and provides the latest data on Schneiderian papillomas and HPV in their pathogenesis.
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Affiliation(s)
- James S. Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Room 3020D – Surgical Pathology, Nashville, TN 37232 USA ,Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN USA
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Banet N, Rooper LM, Maleki Z. Metastatic HPV-related head and neck squamous cell carcinoma to the lung and mediastinal lymph nodes in aspirated cytology material: A diagnostic pitfall. Diagn Cytopathol 2016; 44:206-14. [PMID: 26764038 DOI: 10.1002/dc.23425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 12/10/2015] [Accepted: 12/16/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although HPV-related head and neck squamous cell carcinoma (HNSCC) has good prognosis, a small proportion of patients develop distant metastases and have worse outcomes. Such metastases can be particularly difficult to diagnose in the lung and mediastinum, where they show extensive morphologic overlap with primary pulmonary neoplasms. This case series discusses metastatic HPV-related HNSCC in lung and mediastinal fine needle aspiration (FNA) cytology. METHODS The cytopathology archives were searched for lung and mediastinal FNA specimens of patients with HNSCC. Specimens were included if either the index FNA or the patient's original HNSCC was positive for HPV by DNA in-situ hybridization (ISH). Ten such cases were identified. Patient demographics and primary tumor details were tabulated from the electronic medical record. All FNA slides and stains were reviewed. RESULTS The ten patients (mean age of 58.2 years) included 4 smokers. Smears from all cases were hypercellular and hyperchromatic, with focal keratinization in 6/10 (60%). Core biopsies and cell blocks showed basaloid morphology with variable amounts of necrosis. All ten FNAs were diffusely positive for p16 (100%) and 7/9 cases stained (77.8%) were positive for HPV DNA ISH. CONCLUSIONS Metastatic HPV-related HNSCC to the lung and mediastinal lymph nodes share the characteristic basaloid, minimally keratinizing morphology seen in Primary HNSCC cytology. Poorly differentiated pulmonary squamous cell carcinoma and neuroendocrine carcinomas are the primary differentials. Although primary lung neoplasms are not HPV-related, p16 positivity can be seen in both squamous cell and small cell lung carcinomas. HPV ISH allows definitive diagnosis of metastatic HPV-related HNSCC.
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Affiliation(s)
- Natalie Banet
- Department of Pathology, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa M Rooper
- Department of Pathology, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zahra Maleki
- Department of Pathology, the Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
The nasal cavity and paranasal sinuses occupy the top of the upper respiratory tract and form pneumatic spaces connected with the atmosphere. They are located immediately beneath the base of the cranium, where crucial vital structures are harbored. From this region, very much exposed to airborne agents, arise some of the more complex and rare benign and malignant lesions seen in humans, whose difficulties in interpretation make this remarkable territory one of the most challenging in the practice of surgical pathology. Contents of this chapter cover inflammations and infections, polyps and pseudotumors, fungal and midfacial destructive granulomatous lesions, as well as benign, borderline, and malignant neoplasms. Among the neoplasms, emphasis is made on those entities characteristic or even unique for the sinonasal region, such as Schneiderian papillomas, glomangiopericytoma, intestinal- and non-intestinal-type adenocarcinomas, olfactory neuroblastoma, nasal-type NK-/T-cell lymphoma, and teratocarcinosarcoma. Moreover, recently recognized entities involving this territory, i.e., HPV-related non-keratinizing carcinoma, NUT carcinoma, and SMARCB1-deficient basaloid carcinoma, are also discussed in the light of their specific molecular findings. Furthermore, the text is accompanied by numerous classical and recent references, several tables, and 100 illustrations.
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Affiliation(s)
- Antonio Cardesa
- University of Barcelona, Anatomic Pathology Hospital Clínic University of Barcelona, Barcelona, Spain
| | - Pieter J. Slootweg
- Radboud Univ Nijmegen Medical Center, Pathology Radboud Univ Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Nina Gale
- University of Ljubljana,, Institute of Pathology, Faculty of Medic University of Ljubljana,, Ljublijana, Slovenia
| | - Alessandro Franchi
- University of Florence, Dept of Surg & Translational Medicine University of Florence, Florence, Italy
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46
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Abstract
It is now well established that human papillomavirus (HPV) is an important causative factor in a subgroup of head and neck cancer. In the head and neck, while HPV is strongly associated with squamous cell carcinoma arising in the oropharynx, there is a growing interest in HPV-associated neoplasms of non-oropharyngeal origin including those which arise within sinonasal and nasopharyngeal mucosa. This article reviews current literature on the association of HPV with Scheiderian papillomas, sinonasal squamous cell carcinoma, sinonasal undifferentiated carcinoma, carcinoma with adenoid cystic-like features, and nasopharyngeal carcinoma. Several clinical implications of HPV detection in sinonasal and nasopharyngeal carcinomas are briefly discussed.
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Affiliation(s)
- Selvam Thavaraj
- Head and Neck Pathology, Guy׳s and St Thomas׳ NHS Foundation Trust, 4th Floor Tower Wing, Guy׳s Hospital, Great Maze Pond, London SE1 9RT, UK; Oral and Maxillofacial Pathology, King׳s College London, London, UK.
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47
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Bishop JA, Lewis JS, Rocco JW, Faquin WC. HPV-related squamous cell carcinoma of the head and neck: An update on testing in routine pathology practice. Semin Diagn Pathol 2015; 32:344-51. [DOI: 10.1053/j.semdp.2015.02.013] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bossi P, Saba NF, Vermorken JB, Strojan P, Pala L, de Bree R, Rodrigo JP, Lopez F, Hanna EY, Haigentz M, Takes RP, Slootweg PJ, Silver CE, Rinaldo A, Ferlito A. The role of systemic therapy in the management of sinonasal cancer: A critical review. Cancer Treat Rev 2015; 41:836-43. [PMID: 26255226 DOI: 10.1016/j.ctrv.2015.07.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/23/2015] [Accepted: 07/26/2015] [Indexed: 02/03/2023]
Abstract
PURPOSE Due to the rarity and the variety of histological types of sinonasal cancers, there is a paucity of data regarding strategy for their optimal treatment. Generally, outcomes of advanced and higher grade tumors remain unsatisfactory, despite the employment of sophisticated surgical approaches, technical advances in radiation techniques and the use of heavy ion particles. In this context, we critically evaluated the role of systemic therapy as part of a multidisciplinary approach to locally advanced disease. RESULTS Induction chemotherapy has shown encouraging activity and could have a role in the multimodal treatment of patients with advanced sinonasal tumors. For epithelial tumors, the most frequently employed chemotherapy is cisplatin, in combination with either 5-fluorouracil, taxane, ifosfamide, or vincristine. Only limited experiences with concurrent chemoradiation exist with sinonasal cancer. The role of systemic treatment for each histological type (intestinal-type adenocarcinoma, sinonasal undifferentiated carcinoma, sinonasal neuroendocrine carcinoma, olfactory neuroblastoma, sinonasal primary mucosal melanoma, sarcoma) is discussed. CONCLUSIONS The treatment of SNC requires a multimodal approach. Employment of systemic therapy for locally advanced disease could result in better outcomes, and optimize the therapeutic armamentarium. Further studies are needed to precisely define the role of systemic therapy and identify the optimal sequencing for its administration in relation to local therapies.
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Affiliation(s)
- Paolo Bossi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Nabil F Saba
- The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | | | - Laura Pala
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Fernando Lopez
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ehab Y Hanna
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Missak Haigentz
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Robert P Takes
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Piet J Slootweg
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carl E Silver
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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The presence of high-risk human papillomavirus (HPV) E6/E7 mRNA transcripts in a subset of sinonasal carcinomas is evidence of involvement of HPV in its etiopathogenesis. Virchows Arch 2015; 467:405-15. [PMID: 26229021 DOI: 10.1007/s00428-015-1812-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 06/08/2015] [Accepted: 07/13/2015] [Indexed: 02/03/2023]
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50
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Low-grade papillary schneiderian carcinoma, a unique and deceptively bland malignant neoplasm: report of a case. Am J Surg Pathol 2015; 39:714-21. [PMID: 25634744 DOI: 10.1097/pas.0000000000000390] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The sinonasal tract harbors several different types of papillomas, some of which can progress to carcinoma. The most frequent among these are inverted and oncocytic Schneiderian papillomas. The rates of progression are somewhat controversial but are approximately 5% to 10% and are almost invariably described in the literature as in situ or invasive squamous cell carcinoma. Other carcinoma types, such as mucoepidermoid and sinonasal undifferentiated carcinoma, have also been described. Almost all of the described patterns of malignancy involve frank carcinoma with overtly dysplastic nuclear features, lack of cell maturation, and increased mitotic activity. Some squamous cell carcinomas, particularly nonkeratinizing, can grow in a papillary pattern, appearing to only line the surface epithelium, but they are cytologically overtly malignant throughout. In this case report, however, we describe a novel, human papillomavirus-negative, papillary carcinoma, which presented as a left nasal and maxillary sinus exophytic and inverted-appearing, papillomatous mass with very bland cytomorphology. The initial features were not typical for any defined Schneiderian papilloma but were also not clearly diagnostic of papillary carcinoma. The tumor recurred >10 times over 18 years despite extensive surgical resection including orbital exenteration. The tumor retained a bland appearance throughout the patient's entire clinical course, but did develop a pushing pattern of stromal invasion, increased mitotic activity, vesicular nuclei with prominent nucleoli, lymph node metastases, and eventually overwhelming local recurrence and nodal metastases, resulting in death. This tumor seems best characterized as a low-grade papillary Schneiderian carcinoma and appears to represent a novel type of sinonasal carcinoma.
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