Adenosquamous Carcinoma of the Head and Neck: Relationship to Human Papillomavirus and Review of the Literature

Abstract

Adenosquamous carcinoma (ADSC) of the head and neck is an aggressive variant of squamous cell carcinoma (SCC). Certain variants of head and neck SCC are human papillomavirus (HPV)-related and have better prognosis. The relationship of HPV to head and neck ADSC has not been investigated. We searched our files for the term ''adenosquamous'' and head and neck subsites and found cases from 1998 to 2009. The requisite histologic criteria were the presence of SCC combined with distinct gland formation and/or intracellular mucin. DNA in situ hybridization for high-risk HPV, RNA in situ hybridization for high risk HPV E6 and E7 transcripts, and immunohistochemistry for p16 and p53 were performed. The existing literature on ADSC was also reviewed. Of the 18 cases, eight were from the larynx and hypopharynx, four from the oral cavity, three from the oropharynx, and three from the nasal cavity. Three cases (16%) showed both high risk HPV E6 and E7 and p16 expression, one from the nasal cavity and two from the oropharynx. Both oropharyngeal carcinoma patients were alive and disease free at 34 and 103 months, respectively. ADSCs of the head and neck are a heterogeneous group of tumors. A small minority of cases harbor HPV and most of these, particularly those occurring at sites with known high prevalence of HPV, show active viral transcription with detectable E6 and E7 and overexpression of p16. The HPV-related oropharyngeal cases, though rare, appear to do very well clinically, while the remaining cohort of ADSC patients do quite poorly. Head and neck ADSC appears to be a mixed variant that can be further classified according to its HPV status.

Sinonasal Squamous Cell Carcinoma: A Review with Emphasis on Emerging Histologic Subtypes and the Role of Human Papillomavirus

“…The relative fraction of KSCC versus NKSCC in the literature has varied somewhat, probably depending on subtle variations in definitions of the two. Summarizing results of the three largest studies to define them (Table 1), there were 99 KSCC (60 %) and 66 NKSCC (40 %) [6][7][8][9][10]. KSCC is morphologically identical to such tumors arising elsewhere ( Fig.…”

“…It was the least common SCC variant in the large SEER-based study, constituting only 0.7 % of sinonasal SCC [12]. It is defined as an invasive carcinoma with obvious squamous differentiation, but associated with punched out, ''gland-like'' spaces, frequently with intracellular and intraluminal mucin (the latter not requisite) of any amount, even if very focal [9]. The final type is verrucous carcinoma which is distinctly uncommon in the sinonasal tract [16] with only *20 to 25 cases reported in the literature [16].…”

Ciliated Adenosquamous Carcinoma: Expanding the Phenotypic Diversity of Human Papillomavirus-Associated Tumors

“…Adenosquamous carcinoma (AsqCA) of the upper aerodigestive tract is generally considered a rare, aggressive variant of squamous cell carcinoma (SCC) with divergent glandular differentiation of any amount, as defined by the World Health Organization [1,2]. The term originated in the literature in 1968, and was described as a distinct entity by Gerughty et al [3].…”

Human Papillomavirus-16 Associated Adenocarcinoma NOS of Base of Tongue

“…The recent reports describing the presence of HPV in oropharyngeal neuroendocrine carcinomas [15,16], adenosquamous carcinomas [14], and undifferentiated carcinomas [17,18], and now adenocarcinoma-raise the possibility that HPV is involved in the carcinogenesis of, not only squamous cell carcinoma, but other uncommon carcinomas of the region. This situation resembles the role played by HPV in the carcinogenesis of uterine cervix where HPV is found not only in squamous cell carcinoma [30], but also in adenocarcinomas [31], and neuroendocrine carcinomas [32,33].…”

“…Pathologically, most HPV-positive OSCCs exhibit non-keratinizing or basaloid morphology [10][11][12][13]. Recently, HPV has also been found in adenosquamous carcinomas [14], neuroendocrine carcinomas [15,16] and undifferentiated ''lymphoepithelioma-like'' carcinomas of the oropharynx [17,18]. Although the number of cases described is still small, HPV-associated neuroendocrine carcinomas of the oropharynx are aggressive malignancies [15,16].…”