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Cancer Cytopathol. 2019 Feb;127(1):35-43. doi: 10.1002/cncy.22078. Epub 2018 Nov 23.

Cytopathologic characteristics of HPV-related small cell carcinoma of the oropharynx.

Author information

1
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
2
Department of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
3
Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio.
4
Department of Pathology and Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Abstract

BACKGROUND:

Human papillomavirus (HPV)-related squamous cell carcinoma (SqCC) of the oropharynx is an epidemiologically and clinically distinct form of SqCC that is associated with an improved prognosis. However, HPV-related small cell carcinoma of the oropharynx is a rare and newly described variant that is associated with aggressive clinical behavior and poor outcomes. To date, fewer than 2 dozen reports of this entity exist in the literature, and there is no discussion of cytopathologic features. This article reports 6 cases and discusses the salient cytomorphologic findings, ancillary studies, and challenges when this entity is encountered.

METHODS:

Anatomic pathology archives were searched to identify patients with a diagnosis of HPV-related small cell carcinoma of the oropharynx. Medical records were reviewed to document the following: age, sex, smoking status, other relevant clinical history, primary location, treatment, and clinical outcome. Both p16 and high-risk HPV in situ hybridization (ISH) studies were positive in at least 1 specimen from each patient. The pathologic diagnoses, cytomorphologic characteristics, immunocytochemical stains, and HPV ISH studies were reviewed and recorded for all available cases.

RESULTS:

Six patients with 11 cytopathology specimens of HPV-related small cell carcinoma of the oropharynx were identified. The mean age was 61.3 years, and all patients died with widely metastatic disease (mean, 23 months; range, 12-48 months). Mixed small cell carcinoma and SqCC components were present in half of the cases.

CONCLUSIONS:

The identification of a small cell component can be reliably performed with cytology preparations and is crucial because this (and not the HPV status) determines the prognosis.

KEYWORDS:

cytopathology; head and neck cancer; human papillomavirus; small cell carcinoma; squamous cell carcinoma

PMID:
30468701
DOI:
10.1002/cncy.22078

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