Consistent LEF-1 and MYB Immunohistochemical Expression in Human Papillomavirus-Related Multiphenotypic Sinonasal Carcinoma: A Potential Diagnostic Pitfall

  • Akeesha A. ShahEmail author
  • Bahram Robert Oliai
  • Justin A. Bishop
Original Paper


Human papillomavirus (HPV)-related multiphenotypic sinonasal carcinoma (HMSC) is a distinct, newly-described sinonasal tract neoplasm characterized by a salivary gland tumor-like appearance with myoepithelial and ductal cells, frequent surface squamous dysplasia, and relatively indolent behavior. When considering a diagnosis of HMSC, aggressive high-grade salivary gland carcinomas, particularly those with a basaloid morphology such as basal cell adenocarcinoma and adenoid cystic carcinoma, enter the differential diagnosis. The full morphologic and immunophenotypic profile of HMSC continues to be unraveled. In this series of ten cases, we demonstrate that this tumor has consistent, strong immunohistochemical expression of LEF-1 yet lacks nuclear expression of β-catenin, and also has consistent yet variable expression of MYB protein. While LEF-1 expression may be a useful diagnostic adjunct, it can also be a pitfall, as other salivary tumors such as basal cell adenocarcinoma have been previously shown to express LEF-1. Additionally, MYB protein expression is not a discriminatory marker when trying to separate HMSC from adenoid cystic carcinoma.


Human papillomavirus Multiphenotypic sinonasal carcinoma Adenoid cystic carcinoma Carcinoma with adenoid cystic-like features LEF-1 MYB 



No funding was obtained for this research.

Compliance with Ethical Standards

Conflict of interest

Authors have no conflicts of interest or disclosures as it pertains to this manuscript.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Akeesha A. Shah
    • 1
    Email author
  • Bahram Robert Oliai
    • 2
  • Justin A. Bishop
    • 3
  1. 1.Department of Pathology, Cleveland Clinic FoundationRobert J. Tomsich Pathology and Laboratory Medicine InstituteClevelandUSA
  2. 2.ProPath LaboratoriesDallasUSA
  3. 3.Department of PathologyUniversity of Texas Southwestern Medical CenterDallasUSA

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