Shimizu Fukuko, Okami Kenji, Ebisumoto Koji, Maki Daisuke, Sakai Akihiro, Ogura Go, Nakamura Naoya, Iida Masahiro
Department of Otolaryngology-Head and Neck Surgery, Tokai University, Isehara, Japan.
Department of Pathology, Tokai University, Isehara, Japan.
Case Rep Otolaryngol. 2017;2017:9647010. doi: 10.1155/2017/9647010. Epub 2017 Oct 12.
The incidence of human papillomavirus- (HPV-) related oropharyngeal squamous cell carcinoma (OPSCC) has been rapidly increasing worldwide. HPV is reported in approximately 50% cases of OPSCC in Japan. However, there are few reports of synchronous bilateral HPV-positive tonsillar carcinoma, and, in almost all those cases, carcinoma was detected using positron emission tomography/computed tomography and/or bilateral tonsillectomy.
We report the case of a 63-year-old male with bilateral tonsillar carcinoma detected using transoral endoscopic examination with narrow-band imaging (NBI). A biopsy of the bilateral tonsils revealed squamous cell carcinoma, which was demonstrated to be HPV-related using in situ hybridization and p16 immunohistochemistry. The patient was diagnosed as synchronous bilateral tonsillar carcinoma: T1 (2) N2b M0. He was treated with induction chemotherapy, bilateral radical tonsillectomy with neck dissection, and radiotherapy.
To our knowledge, this is the first report of a synchronous bilateral tonsillar carcinoma detected using transoral NBI in the outpatient setting. Early diagnosis without the inspection under general anesthesia is beneficial for the patients with lymph node metastasis from unknown primary lesion.
人乳头瘤病毒（HPV）相关的口咽鳞状细胞癌（OPSCC）的发病率在全球范围内迅速上升。在日本，约50%的OPSCC病例中报告有HPV感染。然而，关于同步双侧HPV阳性扁桃体癌的报道很少，而且在几乎所有这些病例中，癌症是通过正电子发射断层扫描/计算机断层扫描和/或双侧扁桃体切除术检测到的。
我们报告了一例63岁男性患者，通过经口内镜窄带成像（NBI）检查发现双侧扁桃体癌。双侧扁桃体活检显示为鳞状细胞癌，通过原位杂交和p16免疫组化证实与HPV相关。该患者被诊断为同步双侧扁桃体癌：T1（2）N2b M0。他接受了诱导化疗、双侧根治性扁桃体切除加颈部清扫以及放疗。
据我们所知，这是首例在门诊环境中通过经口NBI检测到的同步双侧扁桃体癌报告。无需全身麻醉检查即可早期诊断，这对不明原发灶伴有淋巴结转移的患者有益。
