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Bull Cancer. 2019 Apr;106(4):395-403. doi: 10.1016/j.bulcan.2019.01.015. Epub 2019 Mar 13.

[Diagnostic and treatment pitfalls and guidelines for variants of squamous cell carcinomas of the head and neck: on behalf of the REFCOR].

[Article in French]

Author information

Centre François-Baclesse/Archade, département de radiothérapie-oncologie, 3, avenue General-Harris, 14000 Caen, France; Laboratoire de physique corpusculaire IN2P3/ENSICAEN - UMR6534, 14000 Caen, France; Unicaen - Normandie université, 14000 Caen, France. Electronic address:
Hôpital Bichat, département d'anatamo-pathologie, 46, rue Henri-Huchard, 75018 Paris, France.
AP-HP, université Paris Diderot, hôpital Lariboisière, département d'anatamo-pathologie, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
Réseau de Cancérologie d'Aquitaine, CHU de Bordeaux, département d'oncologie médicale, 33076 Bordeaux, France.
Centre Georges-François-Leclerc Center, département de radiothérapie, Dijon, France.
HEGP, department of pathology, 20 rue Leblanc, 75015 Paris, France.
CHU Tenon, department of head and neck surgery, 4 rue de la Chine, 75020 Paris, France.
Institute Gustave-Roussy, département de cancérologie cervico-faciale-cancer ORL, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
Hôpital Begin, département d'oncologie médicale, 69, avenue de Paris, 94160 Saint-Mandé, France.
Hôpital Bichat, département d'oto-rhino-laryngologie (ORL) et chirurgie cervico-faciale, 46 rue Henri-Huchard, 75018 Paris, France.


Among the 20,000 new cases of head and neck neoplasms in France each year, squamous cell carcinomas (HNSCC) represent about 90 % of the cases. Among these, variants of conventional squamous cell carcinomas represent between 5% and 10% of cases. Patient history and risk factors are often similar from those of conventional HSNCC. Variants may, however, be misdiagnosed, which can lead to therapeutic mismanagement due to confusion with sarcomas, glandular tumors or even benign tumors. Diagnostic workup needs to be more cautionary or to include additional exams not to omit their most aggressive component in the case of composite tumors or to under stage the tumor. Immunohistochemistry and specific molecular analyses may be required for proper diagnosis. Central pathological review may also be essential for some of these variants. In addition, some variants are radioresistant and, conversely, others are radiosensitive. An update of the REFCOR 2008 standards was carried out in the light of the international literature and the 2017 WHO/IARC classification for the seven main variants of HNSCC, verrucous, acantholytic (to be named adenoid carcinomas), basaloid, papillary, spindle cell (incorrectly named sarcomatoid), adenosquamous and lymphoepithelial carcinomas.


Acantholytic; Acantholytique/adénoïde; Adenoid carcinoma; Adenosquamous; Adénosquameux; Basaloid; Basaloïde; Cancer/carcinome; HNSCC; Head and neck cancer; Lymphoepithelial; Lymphoépithélial; Papillaire; Papillary; Sarcomatoid; Spindle cell; Squamous cell carcinoma; Variant; Verrucous; Verruqueux; Voies aérodigestives supérieures; À cellules fusiformes/sarcomatoïde; Épidermoïde

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