Synchronous, bilateral tonsillar carcinomas: Patient characteristics and human papillomavirus genotypes. (November 2017)

• Record Type: Journal Article
• Authors: Nami Saber, Camelia; Grønhøj, Christian; Jensen, David Hebbelstrup; Nørregaard, Cecilie; Carlander, Amanda; Garnæs, Emilie; Kiss, Katalin; Specht, Lena; von Buchwald, Christian
• Is Part Of: Oral oncology. Volume 74(2017)
• Page Start: 105
• Page End: 110
• Publication Date: 2017-11
• Subjects: BiTSCC bilateral tonsillar squamous cell carcinoma -- HPV human papillomavirus -- OPSCC oropharyngeal squamous cell carcinoma -- SPM secondary primary malignancy; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2017.09.019
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Bilateral tonsillar squamous cell carcinomas (BiTSCCs) in eastern Denmark identified. As the first study, we assessed HPV DNA, HPV-genotype and p16-overexpression in a cohort. Two patients with a different HPV genotype in each tonsil. The study showed an overweight of HPV+ BiTSCCs, and only one HPV− patient. Most contralateral TSCCs were identified through the diagnostic work-up for CUP in the neck. We found an incidence of 9% BiTSCCs in patients with TSCC after 2012 when tonsils were totally embedded. Abstract: Introduction: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing, but data on the incidence of synchronous, bilateral tonsillar squamous cell carcinomas (BiTSCCs) is sparse. In this study, we report the incidence and tumour characteristics of BiTSCCs in a population-based, consecutive cohort of OPSCCs. Methods: We identified all patients diagnosed with tonsillar squamous cell carcinoma (TSCC) in eastern Denmark during a 15-year period to detect the incidence of synchronous BiTSCCs. The tumours were assessed for p16 Ink4a expression, the presence of HPV DNA and HPV genotypes. Furthermore, we systematically reviewed the literature examining BiTSCCs. Results: Of the total of 1119 TSCCs diagnosed in eastern Denmark from 2000 to 2014, we identified 12 BiTSCCs, nine of which initially presented as a cancer of unknown primary (CUP) in the neck. Nine cases were bilaterally HPV16 positive (HPV16+), while two cases were HPV16+ in one tonsil and respectively, HPV33 and HPV35 positive in the contralateral tonsil. One case was bilaterally HPV-negative. We also identified an increase in the incidence of BiTSCCs after 2012 when histological examination of the entire tonsil tissue became routine, suggesting that BiTSCCs might be underdiagnosed. In the literature, we identified 15 studies from six countries, encompassing 25 cases in total. Conclusions: BiTSCCs were primarily HPV16+ and were most often diagnosed as part of the diagnostic work-up for CUP. We found an incidence of 9% BiTSCCs in patients with TSCC after 2012 and we therefore recommend focusing on putative BiTSCC with total embedding and histological examination of tonsils harvested by bilateral tonsillectomies.