title: Spindle cell carcinomas of the head and neck rarely harbor transcriptionally-active human papillomavirus.
abstract: Spindle cell carcinoma is an uncommon variant of squamous cell carcinoma characterized by spindled or pleomorphic cells which appear to be a true sarcoma but are actually epithelial. Some head and neck squamous cell carcinoma variants can be human papillomavirus (HPV)-related and have improved outcomes. We sought to determine if spindle cell carcinomas are associated with transcriptionally-active HPV. Cases of spindle cell carcinoma were retrieved from department files. Transcriptionally-active HPV was determined by mRNA in situ hybridization for high risk HPV E6 and E7 transcripts and by a surrogate marker, p16 immunohistochemistry, with a 50% staining cutoff. RT-PCR for high risk HPV mRNA was performed on the cases that were technical failures by in situ hybridization. Medical records and follow up information were retrieved for all patients. Of 31 cases, 5 were from the oropharynx, 12 from the oral cavity, and 14 from the larynx or hypopharynx. One purely spindled oral cavity spindle cell carcinoma was HPV positive. It was also diffusely positive for p16. Another laryngeal spindle cell carcinoma was HPV positive in both the squamous and spindle cell components, but was negative for p16. None of the five oropharyngeal spindle cell carcinomas were positive for p16 or HPV RNA. The HPV positive patients both presented at high stage (IV) and died with disease within 2 years of diagnosis. The majority of spindle cell carcinomas of the head and neck, including those arising in the oropharynx, are not related to transcriptionally active HPV. Although the number of cases is too small for any definitive conclusions, for the rare HPV positive spindle cell carcinoma cases, positive viral status does not appear to confer any prognostic benefit.
authors.affiliation: Pathology and Immunology, Washington University School of Medicine, Campus Box 8118, 660 S. Euclid Ave, St. Louis, MO 63110, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Watson
authors.forename: R D
authors.initials: RD
authors.lastname: Chernock
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.forename: W
authors.initials: W
authors.lastname: Liu
authors.forename: X J
authors.initials: XJ
authors.lastname: Ma
authors.forename: Y
authors.initials: Y
authors.lastname: Luo
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.forename: S K
authors.initials: SK
authors.lastname: El-Mofty
authors.forename: J S
authors.initials: JS
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000821:virology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000821:virology*; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology*; D020133:Reverse Transcriptase Polymerase Chain Reaction
references.citation: Int J Cancer. 2007 Oct 15;121(8):1813-20
references.pmid: 17546592
references.citation: Am J Surg Pathol. 2011 Nov;35(11):1679-84
references.pmid: 21997688
references.citation: Cancer. 1981 Aug 15;48(4):994-1003
references.pmid: 7272943
references.citation: Am J Surg Pathol. 2002 Feb;26(2):153-70
references.pmid: 11812937
references.citation: N Engl J Med. 2010 Jul 1;363(1):24-35
references.pmid: 20530316
references.citation: J Natl Cancer Inst. 2008 Feb 20;100(4):261-9
references.pmid: 18270337
references.citation: Oral Surg Oral Med Oral Pathol. 1980 Dec;50(6):523-33
references.pmid: 6935609
references.citation: Mod Pathol. 2005 Nov;18(11):1471-81
references.pmid: 15976812
references.citation: Otolaryngol Head Neck Surg. 1997 Jan;116(1):47-52
references.pmid: 9018257
references.citation: Head Neck Pathol. 2011 Jun;5(2):108-16
references.pmid: 21305368
references.citation: Head Neck Pathol. 2012 Jul;6 Suppl 1:S55-62
references.pmid: 22782224
references.citation: Virchows Arch A Pathol Anat Histopathol. 1991;419(3):177-82
references.pmid: 1718079
references.citation: Am J Surg Pathol. 1986 Nov;10(11):741-53
references.pmid: 2430474
references.citation: Am J Surg Pathol. 2008 Jul;32(7):1044-50
references.pmid: 18496144
references.citation: J Natl Cancer Inst. 2009 Mar 18;101(6):412-23
references.pmid: 19276448
references.citation: Int J Cancer. 2013 Feb 15;132(4):882-90
references.pmid: 22821242
references.citation: Clin Cancer Res. 2009 Nov 15;15(22):6758-62
references.pmid: 19861444
references.citation: Ann Diagn Pathol. 2012 Apr;16(2):91-9
references.pmid: 22197546
references.citation: Am J Surg Pathol. 2009 Nov;33(11):1720-4
references.pmid: 19745700
references.citation: Am J Surg Pathol. 2010 Aug;34(8):1088-96
references.pmid: 20588174
references.citation: Head Neck. 2009 Nov;31(11):1393-422
references.pmid: 19787782
references.citation: Hum Pathol. 2010 Jul;41(7):1016-23
references.pmid: 20236687
references.citation: Head Neck Pathol. 2008 Jun;2(2):103-10
references.pmid: 20614332
references.citation: Hum Pathol. 1997 Jun;28(6):664-73
references.pmid: 9191000
references.citation: Am J Surg Pathol. 1996 Mar;20(3):277-85
references.pmid: 8772780
references.citation: Am J Surg Pathol. 2003 Sep;27(9):1216-20
references.pmid: 12960805
references.citation: Head Neck Pathol. 2012 Jul;6 Suppl 1:S75-82
references.pmid: 22782226
references.citation: Head Neck Pathol. 2010 Dec;4(4):265-75
references.pmid: 20730609
references.citation: Am J Surg Pathol. 2012 Mar;36(3):321-30
references.pmid: 22301491