Bonomi Marcelo, Ahmed Tamjeed, Warner David, Waltonen Joshua, Sullivan Christopher, Porosnicu Mercedes, Batt Katharine, Ruiz Jimmy, Cappellari James
1Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA.
2Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA.
Cancers Head Neck. 2017 Feb 6;2:3. doi: 10.1186/s41199-017-0022-4. eCollection 2017.
Small cell carcinoma (SCC) is a rare variant of head and neck cancer characterized by a high-grade neuroendocrine cancer with similar features to small cell lung carcinoma (SCLC). Human papillomavirus (HPV) is an increasingly recognized cause of head and neck cancer but usually associated squamous cell carcinoma of the oropharynx. In this report, we present the clinical presentation, diagnosis, and management of a patient with HPV-related SCC of the oropharynx that responded favorably to chemotherapy with cisplatin plus etoposide and concomitant radiation therapy, a regimen typically used in SCLC.
We present a rare case of a 56-year-old man who presented with a three-month history of an enlarging left-sided neck mass. Imaging was consistent with a soft tissue density at the left tongue base, left level IIB nodal conglomerate, and multiple bilateral cervical lymph nodes, without evidence of distant metastasis. The patient underwent a core biopsy of the left neck level II node which read as a poorly differentiated neuroendocrine carcinoma consistent with small cell carcinoma. Polymerase chain reaction revealed that the tumor was positive for HPV16. The tumor was staged T1N2cM0 (stage IVA). He went on to receive four cycles of cisplatin and etoposide. On cycle two, he started radiotherapy to the oropharynx and involved neck nodes. He received a dose of 70 Gray (2 Gy/fraction) over a seven week-period. During the concomitant phase of chemo-radiation, the patient experienced grade IV mucositis, grade II nausea, and dehydration for which he received additional outpatient fluid and electrolyte replacement. Three months after completion of therapy, a PET/CT showed complete resolution of the tumor and metastatic lymph nodes along with no evidence of distant metastasis.
Patients with HPV-related cancer of the oropharynx require identification of the small cell variant to optimize therapy and improve outcomes.
小细胞癌（SCC）是头颈部癌症的一种罕见变体，其特征为高级别神经内分泌癌，与小细胞肺癌（SCLC）具有相似特征。人乳头瘤病毒（HPV）是头颈部癌症中越来越被认可的病因，但通常与口咽鳞状细胞癌相关。在本报告中，我们介绍了一名口咽HPV相关SCC患者的临床表现、诊断和治疗情况，该患者对顺铂加依托泊苷化疗及同步放疗反应良好，这是SCLC常用的治疗方案。
我们报告一例罕见病例，一名56岁男性，有左侧颈部肿块进行性增大3个月的病史。影像学检查显示左侧舌根软组织密度影、左侧IIB区淋巴结融合及双侧多个颈部淋巴结，无远处转移证据。患者接受了左侧颈部II区淋巴结的粗针活检，结果显示为低分化神经内分泌癌，符合小细胞癌。聚合酶链反应显示肿瘤HPV16阳性。肿瘤分期为T1N2cM0（IVA期）。他接受了四个周期的顺铂和依托泊苷治疗。在第二个周期时，他开始对口咽及受累颈部淋巴结进行放疗。在7周内共接受70格雷（2格雷/分次）的剂量。在放化疗同步阶段，患者出现IV级粘膜炎、II级恶心和脱水，为此他在门诊接受了额外的液体和电解质补充。治疗完成3个月后，PET/CT显示肿瘤及转移淋巴结完全消退，无远处转移证据。
口咽HPV相关癌症患者需要识别小细胞变体以优化治疗并改善预后。
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