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HPV and p16 Testing in Oropharyngeal Squamous Cell Carcinoma

Methodology, Interpretation, and Significance


Slide 15

March 2012

HPV detection using HPV in situ hybridization is considered to be the gold standard by many clinicians—but certainly not all of them. We will address the advantages and disadvantages of HPV in situ hybridization shortly. Using in situ hybridization, HPV DNA can be seen as episomal, fully integrated, or both. The episomal pattern is characterized by diffuse nuclear staining, representing an accumulation of episomal sequences. This is precisely what we see in this micrograph; sheets of neoplastic cells with diffuse nuclear staining, almost smudgy in appearance. Naturally, the assay in this micrograph is directed against high-risk HPV genotypes. In our experience at Mayo Clinic, this is the most common pattern of HPV-positivity in oropharyngeal squamous cell carcinoma. One can often accurately interpret a case as positive even before placing the slide on the microscope stage, simply recognizing the diffuse blue or purple haze in areas of malignant tumor.



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