HPV-related nasopharyngeal and cervical cancer in a married couple in North America Daniel B. Vanderbilt, MD, PhD, Quoc-Anh Ho, MD, Uma Goyal, MD, Robert.

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Presentation transcript:

HPV-related nasopharyngeal and cervical cancer in a married couple in North America Daniel B. Vanderbilt, MD, PhD, Quoc-Anh Ho, MD, Uma Goyal, MD, Robert C. Bell, MD, Robert R. Klein, MD, Sun K. Yi, MD Practical Radiation Oncology Volume 8, Issue 1, Pages e1-e5 (January 2018) DOI: 10.1016/j.prro.2017.09.003 Copyright © 2017 American Society for Radiation Oncology Terms and Conditions

Figure 1 Histopathologic specimens of the man’s nasopharyngeal carcinoma and his wife’s cervical cancer. (A) High-power magnification (20×) of hematoxylin and eosin–stained nasopharyngeal carcinoma revealing moderate to poor differentiation and focal keratinization (red arrow). (B) Low-power magnification (2×) of strong and diffuse (>70%) staining of p16 by immunohistochemistry in the man’s nasopharyngeal carcinoma. (C) Low-power magnification of (2×) showing no staining of Epstein-Barr–encoded RNA by in situ hybridization in the man’s nasopharyngeal carcinoma. (D) High-power magnification (20×) of the wife’s hematoxylin and eosin–stained poorly differentiated cervical cancer. (E) Low-power magnification (2×) of strong and diffuse (>70%) staining of p16 by immunohistochemistry in the wife’s cervical cancer. Practical Radiation Oncology 2018 8, e1-e5DOI: (10.1016/j.prro.2017.09.003) Copyright © 2017 American Society for Radiation Oncology Terms and Conditions

Figure 2 Pretreatment imaging of the man’s primary nasopharyngeal carcinoma in the left fossa of Rosenmüller (red arrows). (A) Axial T1 postgadolinium contrast weighted magnetic resonance imaging scans showing an enhancing nasopharyngeal primary mass in the left fossa of Rosenmüller. (B) Diffusion weighted imaging and (C) apparent diffusion coefficient imaging showing restricted diffusion in the left fossa of Rosenmüller mass. (D) Positron emission tomography/computed tomography imaging showing increased metabolic activity in the left fossa of Rosenmüller mass. Practical Radiation Oncology 2018 8, e1-e5DOI: (10.1016/j.prro.2017.09.003) Copyright © 2017 American Society for Radiation Oncology Terms and Conditions

Figure 3 Pretreatment flexible digital endoscopy images of the man’s nasopharyngeal carcinoma. (A) The right posterior nasopharynx shows postoperative changes and abundant telangiectasias. (B) The left nasopharynx reveals an approximately 2-cm exophytic mass (red arrow) with effacement of the ipsilateral fossa of Rosenmüller and Eustachian tube. Practical Radiation Oncology 2018 8, e1-e5DOI: (10.1016/j.prro.2017.09.003) Copyright © 2017 American Society for Radiation Oncology Terms and Conditions

Figure 4 Intensity modulated radiation therapy (IMRT) plan showing integrated dosing in which the red colorwash is receiving 70 Gy, green is receiving 59.5 Gy, and yellow is receiving 52.5 Gy. (A) Axial isodose colorwashes showing IMRT dose distribution at the level of the left fossa of Rosenmüller. (B) Coronal isodose colorwashes showing IMRT dose distribution. (C) Sagittal isodose colorwashes showing IMRT dose distribution. A, anterior; L, left; P, posterior; R, right. Practical Radiation Oncology 2018 8, e1-e5DOI: (10.1016/j.prro.2017.09.003) Copyright © 2017 American Society for Radiation Oncology Terms and Conditions

Figure 5 One month posttreatment flexible digital endoscopy images of the man’s nasopharyngeal carcinoma, showing complete clinical response. (A) The right posterior nasopharynx shows inspissated mucus. (B) The left nasopharynx reveals complete resolution of the previously seen exophytic mass (red arrow) with restoration of the ipsilateral fossa of Rosenmüller and Eustachian tube. Practical Radiation Oncology 2018 8, e1-e5DOI: (10.1016/j.prro.2017.09.003) Copyright © 2017 American Society for Radiation Oncology Terms and Conditions

Figure 6 Positron emission tomography/computed tomography imaging taken 15 weeks postchemoradiation of the man’s primary nasopharyngeal carcinoma at the level of the previously seen left fossa of Rosenmüller mass showing complete radiographic response (red arrow). Practical Radiation Oncology 2018 8, e1-e5DOI: (10.1016/j.prro.2017.09.003) Copyright © 2017 American Society for Radiation Oncology Terms and Conditions