Synchronous bilateral tonsillar carcinomas associated with human papillomavirus

Although the incidence of human papillomavirus (HPV)-positive oropharyngeal carcinoma is increasing, only a limited number of synchronous bilateral HPV-positive tonsillar carcinomas have been reported to date. Here, we describe an additional case of 61-year-old female. Pathological analysis proved squamous cell carcinoma in biopsy specimens from bilateral tonsillar lesions and a fine needle aspirate from an enlarged cervical node. Polymerase chain reaction (PCR) and direct sequencing showed HPV-16 DNA in all of the biopsy specimens and fine needle aspirate with completely concordant sequences. Bilateral tonsillar lesions were immunohistochemically positive for p16. Taken together with radiological findings, she was diagnosed to have bilateral tonsillar carcinomas (cT1N2bM0 on the right side and cT2N0M0 on the left side). We administered concurrent chemoradiotherapy to treat these synchronous lesions, and the restaging workup resulted in overall complete response. No recurrent and/or metastatic disease has been evident 20 months after the restaging. It seems reasonable to include bilateral tonsils as a therapeutic target in the treatment of HPV-positive unknown primary carcinoma.