Department of Anatomical Pathology, ACT Pathology, The Canberra Hospital, Woden, ACT, Australia; Australian National University Medical School, College of Health and Medicine, Canberra, ACT, Australia.
Central Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
Pathology. 2020 Feb;52(2):179-191. doi: 10.1016/j.pathol.2019.10.008. Epub 2019 Dec 27.
High-risk human papillomavirus (HPV) positive squamous cell carcinoma (SCC) of the head and neck is reported most commonly in the oropharynx but can also uncommonly be found in other sites such as the anterior oral cavity and sinonasal tract. While HPV positive oropharyngeal squamous cell carcinoma (HPV-OPSCC) has been shown to have a more favourable prognosis than conventional smoking- and alcohol-related anterior oral cavity squamous cell carcinoma (OSCC), HPV positive SCC arising elsewhere in the head and neck region does not carry the same favourable prognosis. HPV-OPSCC often tends to present with large cystic metastases in the cervical lymph nodes, with a clinically and radiologically occult primary. Correct diagnosis of the initial biopsy/cytology specimen is critical for directing further investigations and management. In recognition of its distinct biological behaviour, the 8th edition of the American Joint Commission on Cancer (AJCC 8) has proposed a separate clinical and pathological staging system for HPV-OPSCC compared to that for a conventional primary OSCC or neck metastasis of similar size. The new AJCC staging does not apply to other HPV positive SCC of the head and neck. This review examines the current biology of HPV positive SCC, focusing on HPV-OPSCC. The value and pitfalls of current detection methods of HPV are discussed with an emphasis on the role of the pathologist in the diagnosis and management of HPV positive SCC of the head and neck.
高危型人乳头瘤病毒（HPV）阳性头颈部鳞状细胞癌（SCC）最常发生于口咽，但也罕见于其他部位，如口腔前部和鼻-鼻窦。HPV 阳性口咽鳞状细胞癌（HPV-OPSCC）与传统的与吸烟和饮酒相关的口腔前部鳞状细胞癌（OSCC）相比，预后更好，但发生于头颈部其他部位的 HPV 阳性 SCC 则没有相同的良好预后。HPV-OPSCC 常表现为颈部淋巴结中有大的囊性转移灶，而原发灶在临床上和影像学上隐匿。正确诊断初始活检/细胞学标本对于指导进一步的检查和治疗至关重要。为了认识到其独特的生物学行为，第 8 版美国癌症联合委员会（AJCC 8）提出了 HPV-OPSCC 的单独临床和病理分期系统，与传统的原发性 OSCC 或类似大小的颈部转移灶的分期系统不同。新的 AJCC 分期不适用于其他 HPV 阳性的头颈部 SCC。这篇综述检查了 HPV 阳性 SCC 的当前生物学，重点关注 HPV-OPSCC。讨论了当前 HPV 检测方法的价值和陷阱，并强调了病理学家在头颈部 HPV 阳性 SCC 的诊断和管理中的作用。
