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Histopathologic risk factors in oral and oropharyngeal squamous cell carcinoma variants: an update with special reference to HPV-related carcinomas.

El-Mofty SK - Med Oral Patol Oral Cir Bucal (2014)

Bottom Line: These tumors are found to be more responsive to treatment with a favorable patient outcome and good prognosis.As a result, several clinical and pathologic questions have emerged.Because of that, it is prudent at this stage, not to alter management protocols as a result of identification of HPV in these variants and to await additional information.

View Article: PubMed Central - PubMed

Affiliation: Campus Box 8118, Washington University School of Medicine, Department of Pathology and Immunology, 660 South Euclid Avenue, St Louis, MO. 63110, USA, elmofty@wustl.edu.

ABSTRACT
Accurate identification of the microscopic risk factors of oral and oropharyngeal (OP) squamous cell carcinomas (SCC) and their morphologic variants is of at most importance, as these generally determine treatment modalities, prognosis and overall patient outcome. The great majority of oral and oropharyngeal squamous cell carcinomas are microscopically described as kerartinizing squamous cell carcinoma (KSCC). They bear certain resemblance to keratinizing stratified squamous epithelium. Tobacco habits and excessive consumption of alcoholic beverages have been considered to be the main etiologic agents in these carcinomas. The tumors occurred in older patients more commonly affected the oral tongue and floor of the mouth with well established morphologic risk factors including tumor grade, pattern of invasion and perineural involvement. Within the last 30 years however, the advent and expanding prevalence of high risk human papillomavirus (HPV) as an important etiologic agent for head and neck squamous cell carcinoma, particularly in the OP, has resulted in a significant change in the established morphologic criteria for risk assessment. The majority of HPV relate carcinomas of the OP are nonkeratinizing squamous cell carcinoma (NKSCC). These tumors are found to be more responsive to treatment with a favorable patient outcome and good prognosis. Consequently, alterations in treatment protocols aimed at de-escalation are currently being evaluated. More recently, other morphologic variants that are HPV positive are reported with increasing frequency in the OP and other head and neck sites. As a result, several clinical and pathologic questions have emerged. Importantly, whether the virus is biologically active in these tumors and involved in their pathogenesis, and second, what are the clinical implications with regard to patient management and outcome in the HPV-related variants. Examples of HPV-related squamous cell carcinoma variants that will be addressed here are: basaloid squamous cell carcinoma (BSCC), undifferentiated carcinoma (UCa), papillary squamous carcinoma (PSCC) and small cell carcinoma. Some studies have suggested favorable prognosis in some variants, analogous to that of the (NKSCC), while others showed poorer outcome. So far the number of studies on this subject is limited and the number of cases evaluated in each investigation is few. Because of that, it is prudent at this stage, not to alter management protocols as a result of identification of HPV in these variants and to await additional information.

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Undifferentiated (lymphoepithelial) carcinoma. Undifferentiated epithelial cells forming a syncytium and intermingled with lymphocytes and plasma cells. The tumor cells have large vesicular nuclei.
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Figure 4: Undifferentiated (lymphoepithelial) carcinoma. Undifferentiated epithelial cells forming a syncytium and intermingled with lymphocytes and plasma cells. The tumor cells have large vesicular nuclei.

Mentions: The microscopic features of oropharyngeal undifferentiated carcinoma are indistinguishable from those of the nasopharyngeal type as defined by the WHO. The tumors are composed of solid sheets, trabeculae, nests and single neoplastic epithelial cells intimately intermingled with lymphocytes and plasma cells. The epithelial tumor cells are large with indistinct cell borders forming a syncytium (Fig. 4). The nuclei are round to oval and vesicular with large central nucleoli. HPV DNA was identified in these tumors by PCR and ISH. Evidence for biologic activity of the virus was demonstrated by p16 over- expression (39,40). The 3 year OS was found to be 55%, while the DSS was 100% (39). No tumor recurrence was observed during a median follow up period of 23 months (40). The patient’s outcome in HPV positive undifferentiated carcinoma of the OP is generally favorable and comparable to that of the nonkeratinizing HPV-related squamous cell carcinoma.


Histopathologic risk factors in oral and oropharyngeal squamous cell carcinoma variants: an update with special reference to HPV-related carcinomas.

El-Mofty SK - Med Oral Patol Oral Cir Bucal (2014)

Undifferentiated (lymphoepithelial) carcinoma. Undifferentiated epithelial cells forming a syncytium and intermingled with lymphocytes and plasma cells. The tumor cells have large vesicular nuclei.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4119314&req=5

Figure 4: Undifferentiated (lymphoepithelial) carcinoma. Undifferentiated epithelial cells forming a syncytium and intermingled with lymphocytes and plasma cells. The tumor cells have large vesicular nuclei.
Mentions: The microscopic features of oropharyngeal undifferentiated carcinoma are indistinguishable from those of the nasopharyngeal type as defined by the WHO. The tumors are composed of solid sheets, trabeculae, nests and single neoplastic epithelial cells intimately intermingled with lymphocytes and plasma cells. The epithelial tumor cells are large with indistinct cell borders forming a syncytium (Fig. 4). The nuclei are round to oval and vesicular with large central nucleoli. HPV DNA was identified in these tumors by PCR and ISH. Evidence for biologic activity of the virus was demonstrated by p16 over- expression (39,40). The 3 year OS was found to be 55%, while the DSS was 100% (39). No tumor recurrence was observed during a median follow up period of 23 months (40). The patient’s outcome in HPV positive undifferentiated carcinoma of the OP is generally favorable and comparable to that of the nonkeratinizing HPV-related squamous cell carcinoma.

Bottom Line: These tumors are found to be more responsive to treatment with a favorable patient outcome and good prognosis.As a result, several clinical and pathologic questions have emerged.Because of that, it is prudent at this stage, not to alter management protocols as a result of identification of HPV in these variants and to await additional information.

View Article: PubMed Central - PubMed

Affiliation: Campus Box 8118, Washington University School of Medicine, Department of Pathology and Immunology, 660 South Euclid Avenue, St Louis, MO. 63110, USA, elmofty@wustl.edu.

ABSTRACT
Accurate identification of the microscopic risk factors of oral and oropharyngeal (OP) squamous cell carcinomas (SCC) and their morphologic variants is of at most importance, as these generally determine treatment modalities, prognosis and overall patient outcome. The great majority of oral and oropharyngeal squamous cell carcinomas are microscopically described as kerartinizing squamous cell carcinoma (KSCC). They bear certain resemblance to keratinizing stratified squamous epithelium. Tobacco habits and excessive consumption of alcoholic beverages have been considered to be the main etiologic agents in these carcinomas. The tumors occurred in older patients more commonly affected the oral tongue and floor of the mouth with well established morphologic risk factors including tumor grade, pattern of invasion and perineural involvement. Within the last 30 years however, the advent and expanding prevalence of high risk human papillomavirus (HPV) as an important etiologic agent for head and neck squamous cell carcinoma, particularly in the OP, has resulted in a significant change in the established morphologic criteria for risk assessment. The majority of HPV relate carcinomas of the OP are nonkeratinizing squamous cell carcinoma (NKSCC). These tumors are found to be more responsive to treatment with a favorable patient outcome and good prognosis. Consequently, alterations in treatment protocols aimed at de-escalation are currently being evaluated. More recently, other morphologic variants that are HPV positive are reported with increasing frequency in the OP and other head and neck sites. As a result, several clinical and pathologic questions have emerged. Importantly, whether the virus is biologically active in these tumors and involved in their pathogenesis, and second, what are the clinical implications with regard to patient management and outcome in the HPV-related variants. Examples of HPV-related squamous cell carcinoma variants that will be addressed here are: basaloid squamous cell carcinoma (BSCC), undifferentiated carcinoma (UCa), papillary squamous carcinoma (PSCC) and small cell carcinoma. Some studies have suggested favorable prognosis in some variants, analogous to that of the (NKSCC), while others showed poorer outcome. So far the number of studies on this subject is limited and the number of cases evaluated in each investigation is few. Because of that, it is prudent at this stage, not to alter management protocols as a result of identification of HPV in these variants and to await additional information.

Show MeSH
Related in: MedlinePlus