Human Papillomavirus-Related Carcinomas of the Sinonasal Tract
Justin A Bishop, Theresa W Guo, David S Smith, Hao Wang, Sara I Pai, William H Westra. The Johns Hopkins Hospital, Baltimore, MD; Cleveland Clinic Lerner College of Medicine, Cleveland, OH
Background: High risk human papillomavirus (HPV) is an established cause of head and neck carcinomas arising in the oropharynx. The presence of HPV has also been reported in some carcinomas arising in sinonasal tract, but little is known about the overall incidence of HPV-related carcinomas of the sinonasal tract or the histologic features that characterize these tumors.
Design: We searched the surgical pathology archives of The Johns Hopkins Hospital for all carcinomas arising in the sinonasal tract from 1995 to 2011. We constructed tissue microarrays from 141 of the tissue blocks, and used whole slides for 37 additional cases. In situ hybridization for high-risk types of HPV was performed.
Results: Of 178 sinonasal carcinomas, thirty-five (20%) were positive for high risk HPV. The HPV-related carcinomas occurred in 20 men and 15 women ranging in age from 33 to 87 years (mean 55). HPV-positive carcinomas consisted of 26 squamous cell carcinomas and variants (14 non-keratinizing, 4 papillary, 4 adenosquamous, 3 basaloid, and 1 keratinizing), 1 small cell carcinoma, 1 sinonasal undifferentiated carcinoma, and 7 carcinomas that were difficult to subtype by current classification schemes. These unclassifiable carcinomas were uniformly associated with high grade features (e.g. high mitotic rate, tumor necrosis), a basaloid component, a ductal component reminiscent of salivary gland origin (e.g. tubular and cribriforming structures, stromal matrix deposition), and an immunohistochemical profile demonstrating the biphasic presence of ductal cells (c-kit and cytokeratin positive) and myoepithelial cells (S100, actin, calponin, and p63). Although these tumors were originally diagnosed as salivary gland neoplasms (e.g. solid variant of adenoid cystic carcinoma in 3 cases), the common presence of squamous dysplasia of the lining epithelium suggested surface origin.
Conclusions: The presence of high risk HPV in 20% of sinonasal carcinomas suggests that it may play an important etiologic role for some carcinomas arising in the nasal passages. While non-keratinizing squamous cell carcinoma is the most common histologic type, there is a wide morphologic spectrum of HPV-related disease that includes a previously unrecognized high grade variant that is prone to confusion with salivary gland tumors, particularly the solid variant of adenoid cystic carcinoma.
Category: Head & Neck
Monday, March 19, 2012 2:00 PM
Platform Session: Section F, Monday Afternoon