Abstract
The histology and immunohistochemistry (IHC) of primary and metastatic diseases from a human papilloma virus- (HPV-) related anal squamous carcinoma (ASCC) would typically demonstrate the same histology as an HPV-related oropharyngeal squamous carcinoma (OPSCC). However, determining whether a site of squamous cell carcinoma represents distant metastatic ASCC versus a metastatic HPV-related metastasis from an OPSCC to a regional lymph node carries profound prognostic and therapeutic implications. A patient with a history of locally advanced ASCC treated with standard concurrent radiation therapy and chemotherapy in 2015 is described. In 2018, an enlarged supraclavicular lymph node was excised demonstrating squamous cell carcinoma and radiographic staging revealed no other areas suspicious for malignancy. Direct laryngoscopy with operating telescope and biopsies demonstrated squamous cell carcinoma at the tongue base. Described here are assays that might be considered in distinguishing between whether a focus distant from a previously identified ASCC represents metastatic disease or instead a separate primary HPV-related cancer.
Highlights
The incidence of human papilloma virus- (HPV-)related anal squamous carcinoma (ASCC) and that of HPVrelated oropharyngeal squamous carcinoma (OPSCC) are rising [1]
Both ASCC and OPSCC are commonly related to human papillomavirus mucosal infection and malignant transformation
It is possible that the patient has metastatic ASCC to a supraclavicular lymph node and tongue base
Summary
The incidence of HPV-related ASCC and that of HPVrelated OPSCC are rising [1]. By histology and IHC evaluation, HPV-related separate ASCC and OPSCC primaries would typically be similar or identical. Promising assays and currently available tests to help distinguish the likely origin of the squamous cell carcinoma in the supraclavicular lymph node and at the tongue base are reviewed as well as clinical considerations. Distinguishing between a focus of metastatic disease from a known HPV-related primary carcinoma versus metastatic disease from a different HPV-related primary carcinoma remains challenging
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