[1239] Adenosquamous Carcinoma of the Head and Neck: Relationship to HPV

RP Masand, SK El-Mofty, JS Lewis, Jr. Washington University in St.Louis, St.Louis, MO

Background: Adenosquamous carcinoma (ADSC) of the head and neck is believed to be an aggressive variant of squamous cell carcinoma (SCC) with poor patient outcome. We and others have shown that some variants of SCC of the upper aerodigestive tract are HPV related and have better prognosis than those that are unrelated. While it has been demonstrated that some adenosquamous carcinomas of the uterine cervix are HPV driven, the relationship of HPV to ADSC of the head and neck has so far not been investigated. The purpose of this study is to evaluate HPV relationship in a group of ADSC of the head and neck, using in situ hybridization (ISH) for high risk HPV and immunohistochemical stains for p16 and p53.
Design: We searched Washington University Pathology Department files for the term "adenosquamous and head and neck subsites" and found cases from 1998 to 2009. The slides were reviewed by 2 of the study pathologists. The requisite histologic criteria were the presence of squamous carcinoma combined with distinct gland formation and/ or intracellular mucin. Mucin staining was not required. In-situ hybridization for high-risk HPV and immunohistochemistry for p16 and p53 were performed.
Results: Of the 18 cases identified, 8 were from the larynx and hypopharynx, 4 from the oral cavity, 3 from the oropharynx, and 3 from the nasal cavity. The average age of the patients was 59.7 years and 16 patients were male. ISH for HPV and Immunohistochemical results are shown in the table. The majority of cases 14/18 (78%) were p53 reactive. Only three cases (16%) were positive for both HPV and p16, one from the nasal cavity* and two from the oropharynx.**

Larynx/hypopharynx (N=8)262653
Oral (N=4)041331
Nasal (N=3)1*21*230

Conclusions: Adenosquamous carcinomas of the head and neck are a heterogeneous group of tumors. Only a small minority of cases are HPV related as documented by ISH and P16 immunoreactivity. HPV related ADSC are located in the oropharynx and nasal cavity, sites with known high prevalence of HPV related carcinomas. This supports the findings in the uterine cervix that HPV- related tumors may adopt the morphology of SCC variants, such as ADSC, basaloid, or papillary. The clinical significance of these findings in terms of patient outcome is the subject of further investigation.
Category: Head & Neck

Monday, March 22, 2010 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 169, Monday Morning


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