Human papillomavirus‐associated small cell carcinoma with synchronous squamous cell carcinoma in the nasopharynx: Report of a rare case

Small cell carcinoma is a high-grade neuroendocrine carcinoma with an aggressive behaviour. In the upper aerodigestive tract, it is most frequently found to arise in the larynx1 but is extremely uncommon in the pharynx with only a handful of cases reported in the English literature. Similar to head and neck squamous cell carcinomas, highrisk human papillomavirus (HPV) can be associated with small cell carcinomas arising in the oropharynx2,3 and, very rarely, in the nasopharynx.4,5 However, unlike in their squamous cell carcinoma counterpart, HPV positivity no longer confers a favourable outcome in HPV-related small cell carcinoma as the poor prognosis is largely determined by the neuroendocrine differentiation.6 We present a rare case of HPV-positive small cell carcinoma in the nasopharynx, initially diagnosed by fine needle aspiration (FNA) from an involved cervical lymph node and subsequently confirmed on a biopsy of the primary site, which also reveals a component of conventional squamous cell carcinoma.