Revisión

Patología del cáncer de cabeza y cuello en la era del virus del papiloma humano

José Carlos Plaza Hernández

Prepublicado: 2024-04-12

Publicado: 2024-04-30

VOLUMEN 38, NÚM. 1, enero-febrero (2024), PAG. 9-16

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El carcinoma epidermoide de cabeza y cuello, y especialmente el localizado en la orofaringe, es una entidad propia con unas características histológicas, epidemiológicas y pronósticas diferentes. Se trata de un tumor relacionado con la infección por el virus del papiloma humano de alto riesgo (VPH-AR), que, pese a mostrar una histología agresiva y metastatizar de forma precoz, tiene un mejor pronóstico que el carcinoma no relacionado con el VPH. Existen en el mercado multitud de técnicas para determinar la presencia del VPH en el tumor. La más utilizada actualmente es la expresión de p16, una oncoproteína relacionada con el virus, utilizada como marcador subrogado de la infección, que se considera positiva cuando más del 70 % de las células tumorales muestra expresión intensa en el núcleo y el citoplasma. No obstante, debido a su baja especificidad (y pese a su alta sensibilidad), se recomienda realizar otra técnica de detección directa (PCR, FISH para detectar ADN o ARN) asociada a esta, manteniendo el p16 como metodología de cribado de la infección. En la actualidad todas las guías clínicas internacionales recomiendan el estudio del VPH en los carcinomas epidermoides de orofaringe, independientemente del subtipo histológico.

Palabras Clave: Carcinoma epidermoide. Orofaringe. VPH. p16.

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