International Journal of Head and Neck Surgery

Register      Login

VOLUME 14 , ISSUE 2 ( April-June, 2023 ) > List of Articles


A Case of Human Papillomavirus-positive Nasal Vestibule Squamous Cell Carcinoma

Mervyn Owusu-Ayim, Somayyeh Shahsavari, Jaiganesh Manickavasagam

Keywords : Head and neck cancer, Human papillomavirus, Squamous cell carcinoma

Citation Information : Owusu-Ayim M, Shahsavari S, Manickavasagam J. A Case of Human Papillomavirus-positive Nasal Vestibule Squamous Cell Carcinoma. Int J Head Neck Surg 2023; 14 (2):36-39.

DOI: 10.5005/jp-journals-10001-1546

License: CC BY-NC 4.0

Published Online: 15-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


A 68-year-old man with a history of recurrent right epistaxis was diagnosed with a case of human papillomavirus (HPV)-positive nasal squamous cell carcinoma (SCC) on biopsy. A computed tomography (CT) scan revealed an infiltrative right nasal mass with surrounding bone destruction. The tumor was described to be invading the right nasal alar, medial rectus, and lacrimal punctum. Further involvement of the right maxillary nasal process was noted. Immunohistochemistry revealed a lesion with a surface epithelium exhibiting high-grade cytonuclear atypia and conferring positivity for p16 and HPV. After deliberation with the local head and neck multidisciplinary team (MDT), it was decided this case was not fit for surgical excision due to tumor involvement of the eye. The patient was offered a combination of radiotherapy with chemotherapy and responded well to treatment. HPV is prevalent in tumors of the sinonasal (SN) tract although, at present, limited information is available on the clinical profile of individuals diagnosed with this condition. We report a peculiar case of HPV-positive nasal SCC and evaluate the current understanding of the disease within the literature.

  1. Weber AL, Stanton AC. Malignant tumors of the paranasal sinuses: radiologic, clinical, and histopathologic evaluation of 200 cases. Head Neck Surg 1984;6(3):761–776. DOI: 10.1002/hed.2890060310
  2. Lewis JS, Castro EB. Cancer of the nasal cavity and paranasal sinuses. J Laryngol Otol 1972;86(3):255–262. DOI: 10.1017/s0022215100075216
  3. d’Errico A, Pasian S, Baratti A, et al. A case-control study on occupational risk factors for sino-nasal cancer. Occup Environ Med 2009;66(7):448–455. DOI: 10.1136/oem.2008.041277
  4. Hayes RB, Kardaun JW, de Bruyn A. Tobacco use and sinonasal cancer: a case-control study. Br J Cancer 1987;56(6):843–846. DOI: 10.1038/bjc.1987.303
  5. Kilic S, Shukla PA, Marchiano EJ, et al. Malignant primary neoplasms of the nasal cavity and paranasal sinus. Curr Otorhinolaryngol Rep 2016;4(4):249–258. DOI: 10.1007/s40136-016-0134-0
  6. Turner JH, Reh DD. Incidence and survival in patients with sinonasal cancer: a historical analysis of population-based data. Head Neck 2012;34(6):877–885. DOI: 10.1002/hed.21830
  7. Jay N, Moscicki AB. Human papillomavirus infections in women with HIV disease: prevalence, risk, and management. AIDS Read 2000;10(11):659–668.
  8. Stanley M. HPV - immune response to infection and vaccination. Infect Agent Cancer 2010;5(1):19. DOI: 10.1186/1750-9378-5-19
  9. Hartwig S, Syrjänen S, Dominiak-Felden G, et al. Estimation of the epidemiological burden of human papillomavirus-related cancers and non-malignant diseases in men in Europe: a review. BMC Cancer 2012;12(1):30. DOI: 10.1186/1471-2407-12-30
  10. Lewis A, Kang R, Levine A, et al. The new face of head and neck cancer: the HPV epidemic. Oncology (Williston Park) 2015;29(9):616–626.
  11. But-Hadzic J, Jenko K, Poljak M, et al. Sinonasal inverted papilloma associated with squamous cell carcinoma. Radiol Oncol 2011;45(4):267–272. DOI: 10.2478/v10019-011-0033-4
  12. Kılıç S, Kılıç SS, Kim ES, et al. Significance of human papillomavirus positivity in sinonasal squamous cell carcinoma. Int Forum Allergy Rhinol 2017;7(10):980–989. DOI: 10.1002/alr.21996
  13. Chowdhury N, Alvi S, Kimura K, et al. Outcomes of HPV-related nasal squamous cell carcinoma. Laryngoscope 2017;127(7):1600–1603. DOI: 10.1002/lary.26477
  14. Bishop JA, Guo TW, Smith DF, et al. Human papillomavirus-related carcinomas of the sinonasal tract. Am J Surg Pathol 2013;37(2):185–192. DOI: 10.1097/PAS.0b013e3182698673
  15. Alos L, Moyano S, Nadal A, et al. Human papillomaviruses are identified in a subgroup of sinonasal squamous cell carcinomas with favorable outcome. Cancer 2009;115(12):2701–2709. DOI: 10.1002/cncr.24309
  16. Syrjänen KJ. HPV infections in benign and malignant sinonasal lesions. J Clin Pathol 2003;56(3):174–181. DOI: 10.1136/jcp.56.3.174
  17. Sakata K, Aoki Y, Karasawa K, et al. Analysis of the results of combined therapy for maxillary carcinoma. Cancer 1993;71(9):2715–2722. DOI: 10.1002/1097-0142(19930501)71:9<2715::aid-cncr2820710905>;2-0
  18. Alabi BS, Afolabi OA, Omokanye HK, et al. Clinical presentation and outcome of sinonasal tumors in a Nigerian tertiary hospital - 6-year review. Niger Med J 2017;58(3):92–95. DOI: 10.4103/nmj.NMJ_265_14
  19. Sanghvi S, Khan MN, Patel NR, et al. Epidemiology of sinonasal squamous cell carcinoma: a comprehensive analysis of 4994 patients. Laryngoscope 2014;124(1):76–83. DOI: 10.1002/lary.24264
  20. Mirabelli MC, Hoppin JA, Tolbert PE, et al. Occupational exposure to chlorophenol and the risk of nasal and nasopharyngeal cancers among U.S. men aged 30 to 60. Am J Ind Med 2000;37(5):532–541. DOI: 10.1002/(SICI)1097-0274(200005)37:5<532::AID-AJIM9>3.0.CO;2-A
  21. Mastrangelo G, Fedeli U, Fadda E, et al. Epidemiologic evidence of cancer risk in textile industry workers: a review and update. Toxicol Ind Health 2002;18(4):171–181. DOI: 10.1191/0748233702th139rr
  22. Baradaranfar MH, Dabirmoghaddam P. Endoscopic endonasal surgery for resection of benign sinonasal tumors: experience with 105 patients. Arch Iran Med 2006;9(3):244–249.
  23. Edge SB, Byrd DR, Carducci MA, et al. AJCC cancer staging manual. vol 649. Springer New York; 2010.
  24. Robbins KT, Ferlito A, Silver CE, et al. Contemporary management of sinonasal cancer. Head Neck 2011;33(9):1352–1365. DOI: 10.1002/hed.21515
  25. Bossi P, Saba NF, Vermorken JB, et al. The role of systemic therapy in the management of sinonasal cancer: a critical review. Cancer Treat Rev 2015;41(10):836–843. DOI: 10.1016/j.ctrv.2015.07.004
  26. Papadimitrakopoulou VA, Ginsberg LE, Garden AS, et al. Intraarterial cisplatin with intravenous paclitaxel and ifosfamide as an organ-preservation approach in patients with paranasal sinus carcinoma. Cancer 2003;98(10):2214–2223. DOI: 10.1002/cncr.11771
  27. Dirix P, Vanstraelen B, Jorissen M, et al. Intensity-modulated radiotherapy for sinonasal cancer: improved outcome compared to conventional radiotherapy. Int J Radiat Oncol Biol Phys 2010;78(4):998–1004. DOI: 10.1016/j.ijrobp.2009.09.067
  28. Dirix P, Nuyts S, Vanstraelen B, et al. Post-operative intensity-modulated radiotherapy for malignancies of the nasal cavity and paranasal sinuses. Radiother Oncol 2007;85(3):385–391. DOI: 10.1016/j.radonc.2007.10.001
  29. Claus F, Boterberg T, Ost P, et al. Short term toxicity profile for 32 sinonasal cancer patients treated with IMRT. Can we avoid dry eye syndrome? Radiother Oncol 2002;64(2):205–208. DOI: 10.1016/s0167-8140(02)00172-x
  30. Gillison ML, Koch WM, Capone RB, et al. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst 2000;92(9):709–720. DOI: 10.1093/jnci/92.9.709
  31. Syrjänen K, Syrjänen S. Detection of human papillomavirus in sinonasal carcinoma: systematic review and meta-analysis. Hum Pathol 2013;44(6):983–991. DOI: 10.1016/j.humpath.2012.08.017
  32. El-Mofty SK, Lu DW. Prevalence of high-risk human papillomavirus DNA in nonkeratinizing (cylindrical cell) carcinoma of the sinonasal tract: a distinct clinicopathologic and molecular disease entity. Am J Surg Pathol 2005;29(10):1367–1372. DOI: 10.1097/01.pas.0000173240.63073.fe
  33. Lawson W, Schlecht NF, Brandwein-Gensler M. The role of the human papillomavirus in the pathogenesis of Schneiderian inverted papillomas: an analytic overview of the evidence. Head Neck Pathol 2008;2(2):49–59. DOI: 10.1007/s12105-008-0048-3
  34. Larque AB, Hakim S, Ordi J, et al. High-risk human papillomavirus is transcriptionally active in a subset of sinonasal squamous cell carcinomas. Mod Pathol 2014;27(3):343–351. DOI: 10.1038/modpathol.2013.155
  35. Paver EC, Currie AM, Gupta R, et al. Human papilloma virus related squamous cell carcinomas of the head and neck: diagnosis, clinical implications and detection of HPV. Pathol 2020;52(2):179–191. DOI: 10.1016/j.pathol.2019.10.008
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.