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HPV and p16 Testing in Oropharyngeal Squamous Cell Carcinoma

Methodology, Interpretation, and Significance


Slide 18

March 2012

In addition to serving as strong prognostic tools, HPV in situ hybridization and p16 immunohistochemistry can also provide tremendous utility in determining the primary source of metastatic disease. The most common scenario is a cervical lymph node or neck mass that shows morphologic and immunophenotypic features of metastatic squamous cell carcinoma. Although positive testing in either of these assays is not exclusive to squamous cell carcinoma, such results strongly suggest the possibility of an oropharyngeal primary lesion. Of note, it is important to recognize that malignant transformation of a branchial cleft cyst is exceedingly rare; in fact, some head and neck pathologists question whether such an event transpires at all.

In sum, metastatic squamous cell carcinoma to the neck that exhibits HPV and p16 positivity should be regarded as a metastasis from the tonsil or base of tongue until proven otherwise. Naturally, making the “diagnosis” of metastatic oropharyngeal squamous cell carcinoma can save precious time and resources in this cohort of patients.



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