Anaplasia and multinucleation in metastases of oropharyngeal squamous cell carcinoma is associated with poorer outcomes

• Published in: Journal of the American Society of Cytopathology JASC 2022-07, Vol.11 (4), p.201-209
• Main Authors: Jager, Lucy, Felicelli, Christopher, Alexiev, Borislav, Samant, Sandeep, Johnson, Daniel N.
• Format: Article
• Language: English
• Subjects: Anaplasia; HPV; Multinucleation; Oropharyngeal squamous cell carcinoma; Prognosis
• ISSN: 2213-2945; 2213-2945
• DOI: 10.1016/j.jasc.2022.03.004

The presence of tumor cell anaplasia and multinucleation (A/M) in oropharyngeal squamous cell carcinoma (OPSCC) has recently been found to be associated with increased disease recurrence and poorer disease-specific survival, regardless of human papillomavirus status. We studied the detection of A/M in cytology specimens. We performed a comprehensive data search for all patients with OPSCC diagnosed and treated at Northwestern Memorial Hospital between January 2013 and April 2020. All cytology and histopathologic slides were reviewed for the presence of A/M in patients with both surgical resection or biopsy specimens and fine needle aspiration cytology of a metastatic site. A total of 87 patients were identified with both surgical and cytology specimens available for review. A/M was identified in 21 cytology specimens and 14 surgical specimens. Cytologic A/M was seen in 11 of the 14 patients (78.5%) with corresponding histologic A/M and in 10 of the 73 patients (13.7%) without histologic A/M. Disease-specific survival was significantly worse for the patients with cytologic A/M regardless of the presence of histologic A/M (P = 0.0064) and for the patients with cytologic A/M only (P = 0.0271). In patients with p16-positive/human papillomavirus-associated carcinoma, disease-specific survival was significantly worse for the patients with both histologic and cytologic A/M (P = 0.0305). A/M can be reliably identified in cytology specimens among all the various stains and preparations, irrespective of the primary tumor histologic type. Identification of A/M on cytology specimens could indicate more aggressive clinical behavior and help guide patient management. •The presence of tumor cell anaplasia and/or multinucleation in oropharyngeal squamous cell carcinoma has recently been found to be associated with increased disease recurrence and poorer disease-specific survival, regardless of HPV status.•Nuclear anaplasia was defined as the presence of any ×400 magnification field (area = 0.2 mm2) with ≥3 nuclei with diameter equal to or wider than 5 lymphocyte nuclei (approximately 25 μm).•Tumor cell multinucleation was defined as the presence of any ×400 magnification field with ≥3 tumor cells clearly having multiple nuclei.•Anaplasia and/or multinucleation can be identified in corresponding cytology cases of metastatic sites.•The presence of one or both of these morphologic features is associated with poorer disease-specific survival, potentially serving as an importa