Ciliated HPV-related Carcinoma: A well-differentiated form of head and neck carcinoma that can be mistaken for a benign cyst

Justin A. Bishop, William H. Westra

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Although human papillomavirus (HPV)-related oropharyngeal carcinomas (HPV-OPCs) are generally regarded as "poorly differentiated," they actually maintain a close resemblance to the lymphoepithelium of the tonsillar crypts from which they arise: They are basaloid, exhibit minimal keratinization, and are often permeated by lymphocytes. In rare cases, the presence of cilia in a primary HPV-OPC and their persistence in lymph node metastasis can confound the distinction between a benign and malignant process. Three cases of ciliated HPVOPCs were identified from the archives of The Johns Hopkins Head and Neck Pathology consultation service. HPV status was determined using p16 immunohistochemistry and high-risk HPV in situ hybridization. All 3 patients presented with a cystic lymph node metastasis without a known primary carcinoma. One metastasis was originally diagnosed as a branchial cleft cyst only to regionally recur 7 years later. In 2 cases, a primary HPVOPC was found in the tonsil. The carcinomas exhibited both nonkeratinizing squamous epithelium and cystic/microcystic spaces lined by ciliated columnar cells. Both the squamous and ciliated cells were HPV positive. This report draws attention to a novel variant of HPV-related head and neck cancer that exhibits ciliated columnar cells. This variant challenges prevailing notions that: (1) HPV-OPCs are uniformly poorly differentiated cancers; (2) cilia are an infallible feature of benignancy; and (3) presence of cilia is a reliable criterion for establishing branchial cleft origin when dealing with cystic lesions of the lateral neck.

Original languageEnglish (US)
Pages (from-to)1591-1595
Number of pages5
JournalAmerican Journal of Surgical Pathology
Volume39
Issue number11
StatePublished - Jan 1 2015

Fingerprint

Cysts
Neck
Head
Carcinoma
Cilia
Neoplasm Metastasis
Branchioma
Lymph Nodes
Palatine Tonsil
Head and Neck Neoplasms
In Situ Hybridization
Referral and Consultation
Epithelium
Epithelial Cells
Immunohistochemistry
Lymphocytes
Pathology
Neoplasms

Keywords

  • Cilia
  • HPV
  • Human papillomavirus
  • P16

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Ciliated HPV-related Carcinoma : A well-differentiated form of head and neck carcinoma that can be mistaken for a benign cyst. / Bishop, Justin A.; Westra, William H.

In: American Journal of Surgical Pathology, Vol. 39, No. 11, 01.01.2015, p. 1591-1595.

Research output: Contribution to journalArticle

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