FGFR1/2/3‐rearranged carcinoma of the head and neck: expanded histological spectrum crossing path with high‐risk HPV in the sinonasal tract

• Published in: Histopathology 2024-03, Vol.84 (4), p.589-600
• Main Authors: Chu, Ying‐Hsia, Mullaney, Kerry, DiNapoli, Sara E, Cohen, Marc A, Xu, Bin, Ghossein, Ronald, Katabi, Nora, Dogan, Snjezana
• Format: Article
• Language: English
• Subjects: Aged; Cancer; Carcinoma, Squamous Cell - pathology; Electronic medical records; FGFR1; FGFR2; FGFR3; Fibroblast growth factor receptor 1; Fibroblast growth factor receptor 2; Fibroblast growth factor receptors; Head and neck carcinoma; head and neck squamous cell carcinoma; Human papillomavirus; Humans; Immunohistochemistry; Kinesins; Male; Microtubule-Associated Proteins; Middle Aged; Papillomavirus Infections; Paranasal sinus; Paranasal Sinus Neoplasms - genetics; Paranasal Sinus Neoplasms - pathology; Paranasal Sinuses - pathology; parotid; Parotid gland; Receptor, Fibroblast Growth Factor, Type 1; Retrospective Studies; RNA sequencing; sinonasal carcinoma; Squamous cell carcinoma
• ISSN: 0309-0167; 1365-2559
• DOI: 10.1111/his.15099

Aims Oncogenic FGFR1/2/3 rearrangements are found in various cancers. Reported cases in head and neck (HN) are mainly squamous cell carcinomas (SCCs) with FGFR3::TACC3 fusions, a subset of which also harbour high‐risk human papillomavirus (HPV). However, the knowledge of the clinicopathological spectrum of FGFR‐rearranged head and neck carcinomas (FHNC) is limited. Methods and results A retrospective MSK‐fusion clinical sequencing cohort 2016–23 was searched to identify malignant tumours in the HN region harbouring FGFR1/2/3 fusion. FHNC were characterised by histological examination, immunohistochemistry and molecular analysis. Electronic medical records were reviewed. Three FHNC were identified. Two cases (cases 1 and 2) involved sinonasal tract and were high‐grade carcinomas with squamous, basaloid, glandular and/or ductal–myoepithelial features. Case 1 arose in a 79‐year‐old man and harboured FGFR2::KIF1A fusion. Case 2 arose in a 58‐year‐old man, appeared as HPV‐related multiphenotypic sinonasal carcinoma (HMSC), and was positive for FGFR2::TACC2 fusion and concurrent high‐risk HPV, non‐type 16/18. Case 3 was FGFR3::TACC3 fusion‐positive keratinising SCCs arising in the parotid of a 60‐year‐old man. All three cases presented at stage T4. Clinical follow‐up was available in two cases; case 1 remained disease‐free for 41 months post‐treatment and case 3 died of disease 2 months after the diagnosis. Conclusions FHNC include a morphological spectrum of carcinomas with squamous features and may occur in different HN locations, such as parotid gland and the sinonasal tract. Sinonasal cases can harbour FGFR2 rearrangement with or without associated high‐risk HPV. Timely recognition of FHNC could help select patients potentially amenable to targeted therapy with FGFR inhibitors. Further studies are needed (1) to determine if FGFR2 rearranged/HPV‐positive sinonasal carcinomas are biologically distinct from HMSC, and (2) to elucidate the biological and clinical significance of FGFR2 rearrangement in the context of high‐risk HPV. FGFR‐rearranged head and neck carcinomas encompass a diverse morphologic spectrum and may occur with or without associated high‐risk human papillomavirus. We characterised three FGFR2/3‐rearranged cases exhibiting squamous, basaloid, glandular and/or ductal–myoepithelial features that arose in the sinonasal tract and the parotid.