Cho Yong Kyun, Lee Seung Ju, Woo Jeong Joo, Lee Hyekyung, Lee Hojung
Division of Infectious Diseases, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
Diagn Cytopathol. 2018 Apr;46(4):331-335. doi: 10.1002/dc.23841. Epub 2017 Oct 19.
The majority of cystic squamous cell carcinomas (SCCs) of the neck have been shown to be metastatic tumors from tonsillar SCCs associated with high-risk human papillomavirus (HR HPV). Recent studies have demonstrated cytokeratin (CK)7 involvement in the development of HPV positive SCC, but no report has been issued on its simultaneous expression in primary tonsillar and metastatic tumor with cystic change. We present a case of HPV positive tonsillar SCC of a 42-year-old male that initially manifested as a cystic neck mass expressing CK7, CK19, and p16 in primary and metastatic tumors. Immunohistochemical examination revealed diffuse CK19 and p16 expression, and patchy CK7 expression in the solid components of primary and metastatic tumors. However, in cystic components of metastatic tumors the expression of CK7 and CK19 was preserved but p16 expression was absent, which was consistent with immunocytochemical findings of fine-needle aspirates from cystic neck mass. In immunocytochemistry performed on aspirates of a branchial cleft cyst for the comparison of cystic SCC and benign cyst, CK19 staining was positive but CK7 and p16 staining was negative. These results suggest that CK7 immunocytochemistry on aspirated material from cystic neck mass may be a useful adjunct for distinguishing cystic metastasis of tonsillar SCC from branchial cleft cyst, although a larger scale study would be required.
多数颈部囊性鳞状细胞癌（SCC）已被证明是源自与高危人乳头瘤病毒（HR HPV）相关的扁桃体SCC的转移性肿瘤。最近的研究表明细胞角蛋白（CK）7参与HPV阳性SCC的发生发展，但尚无关于其在原发性扁桃体和伴有囊性变的转移性肿瘤中同时表达的报道。我们报告一例42岁男性的HPV阳性扁桃体SCC病例，最初表现为颈部囊性肿块，原发性和转移性肿瘤均表达CK7、CK19和p16。免疫组化检查显示原发性和转移性肿瘤的实性成分中CK19和p16弥漫性表达，CK7呈斑片状表达。然而，在转移性肿瘤的囊性成分中，CK7和CK19的表达得以保留，但p16表达缺失，这与颈部囊性肿块细针穿刺抽吸物的免疫细胞化学结果一致。在对鳃裂囊肿抽吸物进行免疫细胞化学检测以比较囊性SCC和良性囊肿时，CK19染色呈阳性，但CK7和p16染色呈阴性。这些结果表明，对颈部囊性肿块抽吸物进行CK7免疫细胞化学检测可能有助于区分扁桃体SCC的囊性转移和鳃裂囊肿，尽管还需要更大规模的研究。
