Probes for P16

Our understanding of adenoid basal tumors of the cervix has evolved over time. Most of the proliferations referred to as adenoid basal carcinoma have a clinically benign course-leading some to suggest the term "adenoid basal epithelioma." However, rarely, these may be associated with invasive carcinomas. These tumors have been etiologically linked with high-risk human papillomavirus (HR-HPV) infection. Here, we investigate the use of p16 immunohistochemistry and HR-HPV RNA in situ hybridization (ISH) in the classification of adenoid basal tumors of the cervix. Seventeen cases of adenoid basal tumors of the cervix were included. The patients' age ranged from 19 to 79 yr (average, 59 yr). p16 immunostain was performed on all cases and RNA ISH was performed in 4 cases with available formalin-fixed paraffin-embedded tissue. There were 11 low-grade tumors, 5 frankly invasive carcinomas, and 1 with histologic features that were intermediate between the former 2 categories. p16 immunostain was negative or showed patchy cytoplasmic staining in the low-grade tumors and was strongly and diffusely positive in the invasive carcinomas. HR-HPV RNA ISH was negative in the 3 low-grade tumors and was positive in 1 case of invasive carcinoma including the adenoid basal component. Distinct p16 immunostaining and HR-HPV RNA ISH patterns exist between low-grade adenoid basal tumors and invasive adenoid basal carcinomas. Our study indicates that p16 immunostaining and HR-HPV RNA ISH can be employed as useful ancillary tools in differentiating between noninvasive and invasive adenoid basal tumors along with careful histopathologic evaluation.

We have previously demonstrated that transcriptionally active high-risk HPV (hr-HPV) is strongly incriminated in Barrett's dysplasia (BD) and oesophageal adenocarcinoma (OAC) using mainly fresh frozen tissue. This study aimed to identify biomarkers of active HPV infection in Barrett's metaplasia, (BM)/BD/OAC by immunohistochemical staining (IHC) of formalin-fixed paraffin embedded (FFPE) tissue for aberrations of p53 and the retinoblastoma (pRb) pathway which are targets for the viral oncoproteins, E6/E7 respectively. Prospectively, BM(n=81)/BD(n=72)/OAC(n=65) FFPE specimens were subjected to IHC staining for pRb, p16INK4A , cyclin D1 , p53 and RNA in-situ hybridization (ISH) for E6/E7 transcripts. HPV DNA was determined via PCR in fresh frozen specimens. Viral load measurement (real-time PCR) and Next Generation Sequencing of TP53 was also performed. Of 218 patients, 56 were HPV DNA positive [HPV16 (n=42), 18 (n=13), 6 (n=1)]. Viral load was low. Transcriptionally active HPV (DNA+ /RNA+ ) was only found in the dysplastic and adenocarcinoma group (n=21). The majority of HPV DNA+ /RNA+ BD/OAC were characterized by p16INK4Ahigh (14/21, 66.7%), pRblow (15/21, 71.4%) and p53low (20/21, 95%) and was significantly different to controls [combination of HPV DNA- /RNA- (n=94) and HPV DNA+ /RNA- cohorts (n=22)]. p53low had the strongest association with DNA+ /RNA+ oesophageal lesions (OR=23.5, 95% CI=2.94-187.8, p=0.0029). Seventeen HPV DNA+ /RNA+BD/OAC identified as p53low, were sequenced and all but one exhibited wild-type status. pRblow /p53low provided the best balance of strength of association (OR=8.0, 95% CI=2.6-25.0, p=0.0003) and sensitivity (71.4%)/specificity (71.6%) for DNA+ /RNA+ BD/OAC. Active HPV involvement in BD/OAC is characterized by wild-type p53 and aberrations of the retinoblastoma protein pathway.

OBJECTIVE:

To study the clinicopathologic features, immunophenotype, differential diagnosis and prognosis of non-keratinizing carcinoma of nasal cavity and paranasal sinus.

METHODS:

Four hundred and forty-one cases of squamous cell carcinoma of the nasal cavity and sinuses diagnosed in Beijing Tongren Hospital from January 2008 to August 2015 were included. Twenty-six cases of non-keratinizing carcinomas were selected. The histopathologic features and the clinicopathologic data of these twenty-six cases were retrospectively analyzed. Immunohistochemistry (two-step EnVision method) was done to evaluate the expression of CK, vimentin, CK5/6, CK7, CK8/18, p16, p53, Ki-67 etc. In situ hybridization was used to detect Epstein-Barr virus mRNA(EBER), and flow-through hybridization was used to evaluate the presence of human papilloma virus (HPV). One of the cases which HPV is positive was detected by HPV in situ hybridization and RNAscope technology.

RESULTS:

The mean age for the twenty-six patients (16 males, 10 females) was 51.2 years (range 22 to 79 years). Three patients had a history of inverted papilloma.Microscopically the tumors showed invasive papillary and inverted growth, and formed solid cell nests with different sizes. It was similar to papillary carcinoma of the urinary tract: the nuclei of the tumor were rounded and the nucleolus are clear. Three cases displayed transition between normal epithelium to neoplastic cells; in two cases (2/26), some tumor cells were spindle shaped. Twenty cases (20/20) were strongly positive for CK, p63; 17 cases (17/20) were strongly positive for CK5/6 and three cases (3/20) were focally positive. Sixteen cases were strongly positive for CK8/18 and three cases (3/20) were focally positive and one case was negative. Seven cases (7/20) were strongly positive for CK7 and 13 cases (13/20) were negative. Two cases (2/20) were focally positive for vimentin and eighteen (18/20) cases were negative. One case (1/20) was strongly positive for p16 and nineteen cases (19/20) were negative. Nineteen cases (19/20) were positive for p53 and one case (1/20) was negative. Ki-67 index was >50% in 11 cases. Twenty cases (20/20) were negative for AFP, NUT, S-100 protein, HMB45 and Melan A. One case was positive for HPV (6, 11, 16, 18), as detected by in situ hybridization. The HPV18 mRNA was detected by RNAscope technique. In situ hybridization were negative in all twenty cases. The mean follow-up time of the patients in this group was less than 5 years, and the prognosis needs further observation.

CONCLUSIONS:

Non-keratinizing squamous cell carcinoma is a rare neoplasm with distinct morphological characteristics. Its diagnosis is primarily based on the site of lesions and the histological features.Immunohistochemistry staining can aid the diagnosis and differential diagnoses. The tumor may originate from the epithelium of nasal cavity and sinus. This disease has no relation with HPV and EBV infection, and the treatment is primarily surgical excision combined with postoperative radiotherapy.