Maeda Hiroyuki, Deng Zeyi, Ikegami Taro, Matayoshi Sen, Agena Shinya, Kiyuna Asanori, Yamashita Yukashi, Uehara Takayuki, Ganaha Akira, Suzuki Mikio
Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan.
Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan; Department of Otorhinolaryngology, Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China.
Oncol Lett. 2016 Sep;12(3):2087-2091. doi: 10.3892/ol.2016.4907. Epub 2016 Jul 22.
Branchiogenic carcinoma (BC) usually appears as a mass lesion with a predominant cystic component. Since lymph node metastasis from oropharyngeal carcinoma (OPC) has a cystic appearance, it is occasionally difficult to distinguish between BC and nodal metastases from clinically silent OPC. Factors associated with the malignant transformation process in BC remain obscure. The present study reports the case of a 56-year-old man with a right cystic cervical mass that was diagnosed as squamous cell carcinoma based on examination by fine-needle aspiration biopsy. The primary tumor could not be detected despite several imaging examinations, a pan-endoscopy of the head and neck, esophagus and stomach, biopsies of the head and neck regions, and bilateral tonsillectomies. The pathological findings of the surgical specimens from a radical neck dissection were consistent with the histological characteristics of BC, with evidence of transition from dysplasia through intraepithelial carcinoma to invasive carcinoma. Normal squamous epithelium and dysplastic and cancerous portions in the BC showed strong p16 immunoreactivity. The expression of p16 was also observed in all 9 nodal metastases in the neck dissection specimens. The cystic formation observed in the BC was not observed in the nodal metastases. As the presence of human papillomavirus-16 in the tumor was confirmed by polymerase chain reaction, quantitative polymerase chain reaction was employed for the measurement of human papillomavirus-16 viral load and integration. The results showed that the viral load of human papillomavirus-16 was 3.01×10/50 ng genomic DNA, and the E2/E6 ratio was 0.13, so the integration state was judged to be the mixed type. To the best of our knowledge, this is the first report of BC associated with high-risk-type human papillomavirus infection. The study indicates that a human papillomavirus-positive neck mass may not necessarily be OPC, but that it could be BC with a poor prognosis. This report lends support to the existence of BC and proposes that the etiology is human papillomavirus infection.
鳃源性癌（BC）通常表现为以囊性成分为主的肿块性病变。由于口咽癌（OPC）的淋巴结转移具有囊性外观，因此有时难以在临床上区分BC与隐匿性OPC的淋巴结转移。BC中与恶性转化过程相关的因素仍不清楚。本研究报告了一例56岁男性，其右侧颈部囊性肿块经细针穿刺活检检查诊断为鳞状细胞癌。尽管进行了多次影像学检查、头颈部、食管和胃的全内镜检查、头颈部区域活检以及双侧扁桃体切除术，但仍未检测到原发肿瘤。根治性颈清扫术手术标本的病理结果与BC的组织学特征一致，有从发育异常经上皮内癌到浸润癌的转变证据。BC中的正常鳞状上皮以及发育异常和癌性部分均显示出强烈的p16免疫反应性。在颈清扫标本的所有9个淋巴结转移灶中也观察到了p16的表达。在BC中观察到的囊性形成在淋巴结转移灶中未观察到。由于通过聚合酶链反应证实肿瘤中存在人乳头瘤病毒16型（HPV-16），因此采用定量聚合酶链反应测量HPV-16病毒载量和整合情况。结果显示，HPV-16的病毒载量为3.01×10/50 ng基因组DNA，E2/E6比值为0.13，因此整合状态被判定为混合型。据我们所知，这是首例与高危型人乳头瘤病毒感染相关的BC报告。该研究表明，HPV阳性的颈部肿块不一定是OPC，也可能是预后不良的BC。本报告支持BC的存在，并提出其病因是人乳头瘤病毒感染。
