PMC4727039_01
Tumor histopathology of the initial tumor biopsy. (A and B) Hematoxylin and eosin staining showing atypical cells consistent with carcinoma (magnification, x600). (C) Diff-Quik-stained smear showing squamous cells with dense cytoplasm and necrotic squamous cells (magnification, x400). (D) Papanicolaou-stained smear showing neoplastic squamous cells with orangeophilic cytoplasm, consistent with keratinization (magnification, x600). (E) p16 stain with an inset (left lower corner) showing a cell positive for high risk HPV by in situ hybridization (magnification, x600).
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Pathology revealed classic keratinizing SCC with necrosis and p16 positivity (Fig. 1). Hematoxylin and eosin staining revealed atypical cells consistent with carcinoma (Fig. 1A and B). Diff-Quick-stained smears showed squamous cells with dense cytoplasm and necrotic squamous cells (Fig 1C). Furthermore, Papanicolaou-stained smears showed neoplastic squamous cells with orangeophilic cytoplasm, consistent with keratinization (Fig. 1D). In addition, in situ hybridization staining for high risk HPV was positive (Fig. 1E).
Pre-and post-treatment positron emission tomography-computed tomography images: (A) Pre-treatment axial section; (B) pre-treatment coronal section; (C) post-treatment axial section; (D) post-treatment coronal section.
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This revealed a 6.7x5.6x10.8 cm right neck mass with maximal standardized uptake value (SUV) of 8.1, an inferior 3.7x2.9 cm nodule with an SUV of 31.2, and a right tonsillar mass measuring 3.9x3.0 cm with an SUV of 23.4 (Fig. 2). A repeat PET-CT scan revealed a further decrease in the size of the right neck mass to 2.8x2.8x4.8 cm, with a maximal SUV of 7.9 (Fig. 2).