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A Case of HPV-Associated Oropharyngeal Squamous Cell Carcinoma with Block-Like, Partial Loss of p16 Expression

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Abstract

Background

Oropharyngeal squamous cell carcinoma is frequently associated with high-risk HPV infection, which confers a good prognosis. Immunohistochemistry for p16 is used as a surrogate for HPV status, but discrepant results are occasionally seen. Here, we report a case with a unique pattern of partial loss of p16.

Methods

A 63 year old male presented with a base of tongue nonkeratinizing squamous cell carcinoma and a large metastatic neck mass. The primary lesion and multiple regions of the metastatic mass were assessed with p16 immunohistochemistry, RNA in situ hybridization for high-risk HPV, and HPV16 genome sequencing.

Results

The primary lesion was p16 negative, and the metastatic neck mass had large, confluent regions that were either strongly p16 positive or entirely p16 negative. All of these regions were positive for high-risk HPV with identical HPV16 genomes.

Conclusion

This unusual case illustrates a potential diagnostic pitfall, and it raises important questions regarding molecular mechanisms and prognostic implications of p16 staining in oropharyngeal squamous cell carcinoma.

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Data Availability

Not applicable.

Code Availability

https://github.com/NCI-CGR/cgrHPV16.

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Funding

This study was funded by the intramural research program of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH.

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Authors and Affiliations

  1. Division of Anatomical Pathology, Queen Elizabeth II Health Science Centre, and Department of Pathology, Dalhousie University, 7th floor, MacKenzie Building, 5788 University Ave, Halifax, NS, B3H 1V8, Canada

    S. A. Rasmussen & M. J. Bullock

  2. Departments of Otolaryngology - Head and Neck Surgery, Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA

    J. S. Lewis Jr

  3. Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, National Institutes of Health, Rockville, MD, USA

    L. Mirabello, S. Bass & M. Yeager

  4. Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc, Frederick, MD, USA

    S. Bass & M. Yeager

  5. Division of Otolaryngology - Head & Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, NS, Canada

    M. J. Corsten

Authors
  1. S. A. Rasmussen
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  2. J. S. Lewis Jr
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  3. L. Mirabello
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  4. S. Bass
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  5. M. Yeager
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  6. M. J. Corsten
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  7. M. J. Bullock
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Contributions

Surgical care was provided by MJC. Pathology investigation was performed by MJB, JSL Jr., and SAR. Genome sequencing and interpretation were performed by LM, SB, and MY. The first draft of the manuscript was written by SAR. All authors contributed to subsequent revision of the manuscript.

Corresponding author

Correspondence to S. A. Rasmussen.

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The authors have no conflicts of interest to declare.

Ethical approval

Data was collected in accordance with guidelines from the institutional Research Ethics Board.

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Written informed consent was obtained from the patient for data collection and publication of this case report and accompanying images.

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Rasmussen, S.A., Lewis, J.S., Mirabello, L. et al. A Case of HPV-Associated Oropharyngeal Squamous Cell Carcinoma with Block-Like, Partial Loss of p16 Expression. Head and Neck Pathol 16, 1251–1256 (2022). https://doi.org/10.1007/s12105-022-01463-4

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  • DOI: https://doi.org/10.1007/s12105-022-01463-4

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