Response to R-CHOP in HPV-related squamous cell carcinoma of base of tongue: a case report

Abstract

Background: Synchronous squamous cell carcinoma of the head and neck (HNSCC) and non-Hodgkin's lymphoma is a rare clinical scenario. It is unknown whether the R-CHOP chemotherapy for lymphoma would also be active against HNSCC. Herein, we present such a case and a review of the literature.

Case presentation: A 64 year-old female presented with painless jaundice. CT demonstrated a retroperitoneal mass and pathology showed follicular lymphoma. A base-of-tongue HPV⁺ squamous cell carcinoma was found incidentally on staging CT. R-CHOP chemotherapy was initiated. After 3 cycles of R-CHOP the lymphoma had a complete metabolic response and, unexpectedly, the HNSCC also demonstrated excellent response. The patient received another 3 cycles followed by radiation to the HNSCC and to date is in remission for both cancers.

Conclusions: This case highlights the exquisite sensitivity of HPV-related HNSCC, which should be taken into consideration in treatment prioritization of a concurrent diagnosis of a second cancer.

Keywords: HPV; Non-Hodgkin’s lymphoma; R-CHOP; Squamous cell carcinoma; Synchronous.

Fig. 1

Flexible nasopharyngolaryngoscopy view of the right BOT mass before treatment (a), after 3 cycles of R-CHOP chemotherapy (b) and after the completion of 6 cycles of R-CHOP chemotherapy (c)

Fig. 2

a Baseline head and neck maximum intensity projection (MIP) image demonstrating focal FDG uptake in the patient’s BOT HNSCC (red arrow) as well as ipsilateral cervical adenopathy (red arrowhead). b Representative axial PET/CT slice from the same time point as in (a) which delineates the BOT HNSCC (red arrow) and also highlights one of the right-sided cervical lymph nodes (red arrowhead). c Head and neck MIP image following 3 cycles of R-CHOP demonstrates complete metabolic response in the patient’s BOT HNSCC and partial response in the ipsilateral cervical adenopathy (red arrowhead). d Axial PET/CT image from the same time point as (c) shows no abnormal uptake at the BOT (persistently FDG-avid cervical nodes are not shown on this slice). e Head and neck MIP image following completion of R-CHOP therapy demonstrates very subtle increased uptake in the BOT HNSCC (red arrow, barely visible) and increasing uptake in ipsilateral cervical lymph nodes (red arrowhead). Note normal physiologic activity in the vocal cords (thin red arrow). f Representative axial PET/CT image through the neck shows an FDG-avid right level III lymph node compatible with residual HNSCC. g Head and neck MIP and (h) axial PET/CT images following completion of chemoradiation therapy show no evidence of metabolically active primary or nodal HNSCC

Fig. 3

a Baseline whole-body MIP image demonstrating intense FDG uptake in a large retroperitoneal mass (red arrow) compatible with patient’s follicular lymphoma. b Representative axial PET/CT image from the same time point as in (a) showing the large, FDG-avid mass (red arrow). Note the common bile duct stent (red arrowhead) that is markedly anteriorly displaced by the lymphomatous mass and explains the patient’s presentation with obstructive jaundice. c Whole-body MIP image following three cycles of R-CHOP shows no residual metabolically active lymphoma. d Representative axial PET/CT image from the same time point as in (c) is notable for the presence of minimal residual abnormal soft tissue in the retroperitoneum (red arrow, Lugano 2), with uptake equal to blood pool, compatible with a complete metabolic response. The common bile duct stent is in near-orthotopic location now that the retroperitoneal mass has dramatically reduced in size (red arrowhead). e Whole-body MIP image at the end of therapy, again demonstrating no metabolically active tumor. f Representative axial PET/CT image from the same time point as in (e) again depicts the complete metabolic response (Lugano 1) and also the removal of the common bile duct stent