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Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinomas typically arise from the tonsillar crypts and grow beneath the surface epithelium as expanding lobules, often with central necrosis (a). The lobules are composed of nonkeratinized basaloid cells that are surrounded and infiltrated by lymphocytes (a, inset). (b) In the reticulated crypt epithelium, p16 staining is useful in highlighting the distribution of tumor cells in the tonsils.
