HPV-associated oropharyngeal ciliated carcinoma

Although human papillomavirus (HPV)-related oropharyngeal carcinomas (HPV-OPCs) are generally regarded as "poorly differentiated," they actually maintain a close resemblance to the lymphoepithelium of the tonsillar crypts from which they arise: they are basaloid, exhibit minimal keratinization, and are often permeated by lymphocytes. In rare cases, the presence of cilia in a primary HPV-OPC and their persistence in lymph node metastasis can confound the distinction between a benign and malignant process.

It has been drawn attention to this variant of HPV-related head and neck cancer that exhibits ciliated columnar cells.

This variant challenges prevailing notions that:
 (1) HPV-OPCs are uniformly poorly differentiated cancers;
 (2) cilia are an infallible feature of benignancy;
 (3) presence of cilia is a reliable criterion for establishing branchial cleft origin when dealing with cystic lesions of the lateral neck.

References

 Ciliated HPV-related Carcinoma: A Well-differentiated Form of Head and Neck Carcinoma That Can Be Mistaken for a Benign Cyst. Bishop JA, Westra WH.
Am J Surg Pathol. 2015 Nov;39(11):1591-5. doi : 10.1097/PAS.0000000000000521 PMID: 26457358