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Clinical and histopathological data were obtained from medical records. Immunohistochemical expression of CD8 and CD68 was assessed quantitatively and qualitatively in stromal and intratumoral compartments. PDL1 expression was evaluated using the Combined Positive Score (CPS). HPV genotyping was performed using the Anyplex II HPV28 assay. Statistical analyses included descriptive statistics, Fisher\u2019s exact test, Chi-square test, Spearman\u2019s correlation, Student\u2019s t-test, Mann-Whitney U test, Kaplan-Meier survival analysis with log-rank test, and Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort included 15 (55.6%) males and 12 (44.4%) females, with a mean age of 59.5 years. Most patients presented without recurrence (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200917, 63.0%), lymph node metastasis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200922, 81.5%), or distant metastasis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200923, 85.2%). HPV-33 was the predominant genotype, detected in 17 cases (63.0%). PDL1 positivity was observed in 12 tumors (44.4%) and correlated with increased CD8\u2009+\u2009infiltration (\u03c1\u2009=\u20090.602,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Higher densities of CD8\u2009+\u2009T cells and CD68\u2009+\u2009macrophages were associated with reduced recurrence risk. Older age correlated with higher Ki67 index (\u03c1\u2009=\u20090.452,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), lower PDL1 expression (\u03c1=-0.436,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), and increased recurrence. Lymph node and distant metastases were associated with poorer disease-specific survival (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020 and\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The immune microenvironment, characterized by CD8\u2009+\u2009and CD68\u2009+\u2009cell density and PDL1 expression, together with patient age, appears to influence clinical outcomes in HMSC. These findings suggest that a subset of HMSC patients, particularly those with an inflamed tumor microenvironment, may be candidates for PDL1-targeted immunotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12105-026-01908-0","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T04:35:09Z","timestamp":1773894909000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Characterization of CD8\u2009+\u2009and CD68\u2009+\u2009Microenvironment and PDL1 Expression in HPV-related Multiphenotypic Sinonasal Carcinoma"],"prefix":"10.1007","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5481-953X","authenticated-orcid":false,"given":"Jo\u00e3o Epaminondas Silva","family":"de Ara\u00fajo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0079-2373","authenticated-orcid":false,"given":"Jo\u00e3o Paulo Gon\u00e7alves","family":"de Paiva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0377-0441","authenticated-orcid":false,"given":"Igor Lima","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3790-4479","authenticated-orcid":false,"given":"Lucas Faria","family":"Abrahao-Machado","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre","family":"de Oliveira Sales","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1830-8439","authenticated-orcid":false,"given":"Ma\u00edra Medeiros Pacheco","family":"de Andrade","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6861-6640","authenticated-orcid":false,"given":"Ciro Dantas","family":"Soares","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"issue":"12","key":"1908_CR1","doi-asserted-by":"publisher","first-page":"1690","DOI":"10.1097\/PAS.0000000000000944","volume":"41","author":"JA Bishop","year":"2017","unstructured":"Bishop JA, Andreasen S, Hang JF et al (2017) HPV-related Multiphenotypic Sinonasal Carcinoma: An Expanded Series of 49 Cases of the Tumor Formerly Known as HPV-related Carcinoma With Adenoid Cystic Carcinoma-like Features. 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