Cytopathologic characteristics of HPV‐related small cell carcinoma of the oropharynx

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.

High‐risk HPV and neuroendocrine carcinomas of the head and neck

“…Two original articles by Jo et al and Allison et al published in this issue of Cancer Cytopathology describe the clinical and cytologic features of HPV‐positive neuroendocrine carcinomas of the head and neck. Together, these 2 studies report 16 FNA cases of poorly differentiated neuroendocrine carcinomas from 10 patients.…”

“…6,7 One can conclude that HPV-positive neuroendocrine cancers are biologically equivalent to their HPV-negative counterparts of small cell and large cell neuroendocrine carcinoma.The 2 studies published herein of HPV-positive neuroendocrine carcinomas raise some important issues related to high-risk HPV and head and neck cancer. 6,7 Recently, the College of American Pathologists (CAP) published guidelines for the HPV testing of head and neck carcinomas. 10 To date, only HPV-positive…”

“…Eight of the 10 patients described by Jo et al and Allison et al died of disease. 6,7 One can conclude that HPV-positive neuroendocrine cancers are biologically equivalent to their HPV-negative counterparts of small cell and large cell neuroendocrine carcinoma.…”

“…The 2 studies published herein of HPV-positive neuroendocrine carcinomas raise some important issues related to high-risk HPV and head and neck cancer. 6,7 Recently, the College of American Pathologists (CAP) published guidelines for the HPV testing of head and neck carcinomas. 10 To date, only HPV-positive OPSCC and its SCC subtypes have been strongly linked by evidence-based data to improved patient outcomes.…”

“…The 2 studies published herein of HPV‐positive neuroendocrine carcinomas raise some important issues related to high‐risk HPV and head and neck cancer . Recently, the College of American Pathologists (CAP) published guidelines for the HPV testing of head and neck carcinomas .…”