Laryngeal squamous cell carcinoma in a 13 year-old child associated with human papillomaviruses 16 and 18: a case report and review of the literature.
Bottom Line: Immunohistochemical staining with p16 and HPV 16/18 revealed diffusely positive staining in the tumor cells.Coinfection by HPV DNA types 16 and 18 has not been previously reported, but our case suggests that HPV is a risk factor in developing laryngeal SCC in children and adolescents.Future studies evaluating HPV in the pathogenesis of these lesions is recommended to determine its prognostic significance.
Affiliation: University of Louisville, Louisville, USA.
Squamous cell carcinoma (SCC) of the larynx is extremely rare in adolescents and typically has an aggressive nature. The mechanism of laryngeal oncogenesis is complex and little is known about the role that human papillomavirus (HPV) plays in SCC in adolescents. We report a case of invasive laryngeal SCC that co-expressed HPV DNA subtypes 16 and 18 in a 13 year-old boy. Detection of HPV DNA types 6, 11, 16, 18, 31, 33, and 51 was performed by in situ hybridization, with confirmation by polymerase chain reaction. Immunohistochemical staining with p16 and HPV 16/18 revealed diffusely positive staining in the tumor cells. Coinfection by HPV DNA types 16 and 18 has not been previously reported, but our case suggests that HPV is a risk factor in developing laryngeal SCC in children and adolescents. Future studies evaluating HPV in the pathogenesis of these lesions is recommended to determine its prognostic significance.
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Mentions: The right true vocal cord biopsy demonstrated in situ and invasive moderately differentiated squamous cell carcinoma (Fig. 1). It was concluded that the patient had a T2N0Mx, stage II squamous cell carcinoma of the larynx. Immunohistochemical staining for p16 showed strong and diffuse nuclear and cytoplasmic staining in the tumor (Fig. 2). Immunohistochemical staining for HPV 16/18 showed strong nuclear staining in numerous cells (Fig. 3). ISH demonstrated co-expression of HPV DNA subtypes 16 and 18, which was confirmed by PCR. Dual-colored FISH assays failed to reveal translocation (15;19). After a multidisciplinary evaluation of the case, including radiation oncology, medical oncology, and otolaryngology, the decision was made to pursue radiation therapy to the true vocal cords only, without chemotherapy or surgical resection. The patient received hyperfractionated therapy for 49 days with a total dose of 8160 cGy delivered.Fig. 1