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Ramberg IMS. Human papillomavirus-related neoplasia of the ocular adnexa. Acta Ophthalmol 2022; 100 Suppl 272:3-33. [PMID: 36203222 PMCID: PMC9827891 DOI: 10.1111/aos.15244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/21/2022] [Indexed: 01/12/2023]
Abstract
Human papillomaviruses (HPV) are involved in approximately 5% of solid cancers worldwide. The mucosotropic genotypes infect the stratified epithelium of various locations, where persistent infection may lead to invasive carcinomas. While the causative role of HPV in certain anogenital and head and neck carcinomas is well established, the role of HPV in carcinomas arising in the mucosal membranes of the ocular adnexal tissue (the lacrimal drainage system and the conjunctiva) has been a topic of great uncertainty. Therefore, we conducted a series of studies to assess the correlation between HPV and carcinomas arising in the mucosa of the ocular adnexal tissue and characterize the clinical, histopathological, and genomic features of the tumors in the context of HPV status in a Danish nationwide cohort. We collected clinical and histopathological data and tumor specimens from patients with carcinomas of the conjunctiva and the lacrimal drainage system, and their potential precursors, identified in Danish nationwide registries. The HPV status of the tumors was determined by the combined use of HPV DNA polymerase chain reaction (PCR), HPV E6/E7 mRNA in-situ hybridization, and p16 immunohistochemistry. The genomic profile was investigated by high-throughput DNA sequencing targeting 523 cancer-relevant genes. The literature to date on carcinomas of the lacrimal drainage system and the conjunctiva was summarized. In the Danish cohort, 67% of all carcinomas of the lacrimal drainage system and 21% of all conjunctival carcinomas were HPV-positive. HPV16 was the most frequently implicated genotype. A full-thickness expression of the viral oncogenes E6 and E7 was evident in almost all HPV DNA-positive cases. The HPV-positive carcinomas of the conjunctiva and the lacrimal drainage system shared histopathological and genomic features distinct from their HPV-negative counterparts. The HPV-positive carcinomas were characterized by a non-keratinizing morphology, p16 overexpression, high transcriptional activity of HPV E6/E7, and frequent pathogenic variants in the PI3K-AKT signaling cascade. In contrast, the HPV-negative carcinomas were characterized by a keratinizing morphology, lack of p16 and E6/E7 expression, and frequent somatic pathogenic variants in TP53, CDKN2A, and RB1. Among the patients with conjunctival tumors, HPV positivity was associated with a younger age at diagnosis and a higher risk of recurrence. In conclusion, the results support an etiological role of HPV in a subset of conjunctival and LDS carcinomas and their precursor lesions. Our investigations have shown that the HPV-positive carcinomas of the ocular adnexa share genomic and phenotypic characteristics with HPV-positive carcinomas of other anatomical locations. Therefore, these patients may be eligible for inclusion in future basket trials and future treatment regimens tailored to the more frequently occurring HPV-positive carcinomas of other locations. Future research will further elucidate the diagnostic, prognostic, and predictive role of HPV in these carcinomas.
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Julius P, Siyumbwa SN, Moonga P, Maate F, Kaile T, Haynatski G, Minhas V, Snow J, Peterson K, Gihozo P, Streeter S, Kaur S, Evans A, Gonzalez D, Samwel K, Kang G, West JT, Wood C, Angeletti PC. Epstein–Barr Virus, But Not Human Papillomavirus, Is Associated With Preinvasive and Invasive Ocular Surface Squamous Neoplasias in Zambian Patients. Front Oncol 2022; 12:864066. [PMID: 35494029 PMCID: PMC9047892 DOI: 10.3389/fonc.2022.864066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe etiopathogenesis of ocular surface squamous neoplasia (OSSN) is not fully understood. We assessed the frequency of oncogenic viruses in OSSN by immunohistochemistry (IHC) and polymerase chain reaction (PCR) for human papillomavirus (HPV), Epstein–Barr virus (EBV), Merkel cell polyomavirus (MCPyV), Kaposi sarcoma virus, and adenovirus. Cases from Zambia were prospectively enrolled using a cross-sectional study design between November 2017 and March 2020.MethodsDemographic and clinical data [age, sex, HIV status, antiretroviral therapy (ART) history, CD4 count, plasma viral load] and tumor biopsies were collected from 243 consenting patients. Tumor samples were bisected, and half was used for DNA isolation, while the other half was formalin fixed and paraffin embedded (FFPE) for histopathology analysis. The expressions of latent EBV nuclear antigen 1 (EBNA1), CDKN2A/p16INK4A (p16), and MCPyV large T-antigen (LT) were tested by IHC. Multiplex PCR was used to detect 16 HPV genotypes and four other DNA tumor viruses [Kaposi’s sarcoma-associated herpesvirus (KSHV), EBV, MCPyV, and adenovirus]. Relationships between HIV status, viral DNA and protein expression, and tumor grades were determined by statistical analysis.ResultsOSSN tumors from patients were 29.6% preinvasive and 70.4% invasive. Patients presented with unilateral tumors that were 70.4% late stage (T3/T4). OSSN patients were HIV positive (72.8%). IHC on 243 FFPE biopsies resulted in the detection of EBNA1 (EBV), p16 high-risk HPV (HR-HPV), and MCPyV LT expression in 89.0%, 4.9%, and 0.0%, respectively. EBNA1 was expressed in all grades of preinvasive [cornea–conjunctiva intraepithelial neoplasia (CIN)1, 100%; CIN2, 85.7%; CIN3, 95.8%; and carcinoma in situ (CIS), 83.8%] and in invasive (89.2%) OSSN. PCR on 178 samples detected EBV, HR-HPV, and MCPyV in 80.3%, 9.0%, and 13.5% of tumors, respectively. EBV was detected in all grades of preinvasive and invasive OSSN. EBV detection was associated with high HIV viral loads (p = 0.022). HR-HPV was detected in 0.0% CIN1, 0.0% CIN2, 5.6% CIN3, 13.0% CIS, and 7.0% invasive OSSN.ConclusionsOur findings of EBV DNA and EBNA1 protein in all the grades of preinvasive and especially invasive OSSN are consistent with a potential causal role for EBV in OSSN. A role of HPV in OSSN was not clearly established in this study.
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Affiliation(s)
- Peter Julius
- Department of Pathology and Microbiology, School of Medicine, Lusaka, Zambia
| | | | - Phyllis Moonga
- University Teaching Hospital, Eye Hospital, Lusaka, Zambia
| | - Fred Maate
- Department of Pathology and Microbiology, School of Medicine, Lusaka, Zambia
| | - Trevor Kaile
- Department of Pathology and Microbiology, School of Medicine, Lusaka, Zambia
| | - Gleb Haynatski
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Veenu Minhas
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jazmine Snow
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Kerstin Peterson
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Patience Gihozo
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Sam Streeter
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Salan Kaur
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Annika Evans
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Daniela Gonzalez
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | | | - Guobin Kang
- Department of Interdisciplinary Oncology, Louisiana State University Health Science Center, New Orleans, LA, United States
| | - John T. West
- Department of Interdisciplinary Oncology, Louisiana State University Health Science Center, New Orleans, LA, United States
| | - Charles Wood
- Department of Interdisciplinary Oncology, Louisiana State University Health Science Center, New Orleans, LA, United States
| | - Peter C. Angeletti
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
- *Correspondence: Peter C. Angeletti,
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Ramberg I, Heegaard S. Human Papillomavirus Related Neoplasia of the Ocular Adnexa. Viruses 2021; 13:v13081522. [PMID: 34452388 PMCID: PMC8402806 DOI: 10.3390/v13081522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 01/23/2023] Open
Abstract
Human papillomaviruses (HPV) are a large group of DNA viruses that infect the basal cells of the stratified epithelium at different anatomic locations. In the ocular adnexal region, the mucosa of the conjunctiva and the lacrimal drainage system, as well as the eyelid skin, are potential locations for HPV-related neoplasia. The role of HPV in squamous cell neoplasia of the ocular adnexa has been debated for several decades. Due to the rarity of all these tumors, large studies are not available in the scientific literature, thereby hampering the precision of the HPV prevalence estimates and the ability to conclude. Nevertheless, increasing evidence supports that defined subsets of conjunctival papillomas, intraepithelial neoplasia, and carcinomas develop in an HPV-dependent pathway. The role of HPV in squamous cell tumors arising in the lacrimal drainage system and the eyelid is still uncertain. Further, the potential of HPV status as a diagnostic, prognostic, or predictive biomarker in these diseases is a topic for future research.
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Affiliation(s)
- Ingvild Ramberg
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, DK-2100 Copenhagen, Denmark;
- Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, DK-2100 Copenhagen, Denmark;
- Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, DK-2100 Copenhagen, Denmark
- Correspondence:
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Ramberg I, Møller‐Hansen M, Toft PB, Funding M, Heegaard S. Human papillomavirus infection plays a role in conjunctival squamous cell carcinoma: a systematic review and meta-analysis of observational studies. Acta Ophthalmol 2021; 99:478-488. [PMID: 33191633 DOI: 10.1111/aos.14666] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE We aimed to study the prevalence of human papillomavirus (HPV) in conjunctival intraepithelial neoplasia and carcinoma. Furthermore, we aimed to explore whether geographical differences or different detection modalities are associated with the conflicting information regarding HPV and the development of the disease. METHODS We searched the MEDLINE, EMBASE and Scopus databases for studies reporting on HPV and conjunctival intraepithelial neoplasia or carcinoma. The pooled prevalence proportions, odds ratio (OR) and corresponding 95% confidence intervals were calculated assuming a random-effects model. Subgroup analyses and meta-regression explored possible sources of heterogeneity. RESULTS A total of 39 studies were included in the systematic review. The pooled prevalence of HPV in conjunctival intraepithelial neoplasia and carcinoma was 26%, with HPV16, 18, and 33 being the most frequently reported genotypes. Human papillomavirus (HPV) infection was associated with an increased risk of conjunctival intraepithelial neoplasia and carcinoma (OR 8.4, 95% confidence interval (CI) 3.7-19.1); lower in studies from African countries (OR 1.7, 95% CI 0.9-3.5) than other countries (OR 16.1, 95% CI 5.8-44.3), p = 0.013. CONCLUSION Human papillomavirus infection increases the odds of conjunctival intraepithelial neoplasia and carcinoma by 8.4 compared to healthy conjunctival mucosa or other ocular surface diseases. There seem to be geographical differences regarding HPV in conjunctival intraepithelial neoplasia and carcinoma. HPV16 was the most prevalent genotype, followed by HPV18 and HPV33, meaning that most of the HPV-related conjunctival intraepithelial neoplasia and carcinoma may be prevented by the HPV vaccines that are currently available.
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Affiliation(s)
- Ingvild Ramberg
- Department of Pathology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet‐Glostrup Copenhagen Denmark
| | - Michael Møller‐Hansen
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet‐Glostrup Copenhagen Denmark
| | - Peter Bjerre Toft
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet‐Glostrup Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Mikkel Funding
- Department of Ophthalmology Aarhus University Hospital Aarhus Denmark
| | - Steffen Heegaard
- Department of Pathology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet‐Glostrup Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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PV16-Positive Invasive Conjunctival Squamous Cell Carcinoma in an Anophthalmic Socket. Ophthalmic Plast Reconstr Surg 2017; 33:S2-S4. [DOI: 10.1097/iop.0000000000000521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Asadi-Amoli F, Ghanadan A. Survey of 274 patients with conjunctival neoplastic lesions in Farabi Eye Hospital, Tehran 2006-2012. J Curr Ophthalmol 2015; 27:37-40. [PMID: 27239573 PMCID: PMC4877714 DOI: 10.1016/j.joco.2015.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To evaluate conjunctival epithelial neoplastic lesions in a 7-year period. Materials and methods The data of all primary cases of conjunctival neoplasia diagnosed in the Pathology Department of Farabi Eye Hospital were analyzed. Results The patient group consisted of 179 (65.3%) males and 95 (34.6%) females, with an age range of 14–90 years and a mean age of 57.9 years. The most common primary conjunctival epithelial neoplastic lesion was invasive squamous cell carcinoma (SCC) (40.8%), followed by dysplasia (17%), papilloma (16.4%), In situ SCC (16%), actinic keratosis (7.3%), basal cell carcinoma (0.7%), xeroderma pigmentosum (0.7%), and mucoepidermoid carcinoma (0.3%). Of 274 lesions, 47 (17.1%) were benign, 159 (58%) were malignant, and 68 (24.8%) were precancerous. Compared to the results of a previous study of this center (1990–2004), the incidence of precancerous lesions has slightly increased whereas the incidence of SCC has decreased (22.1% vs. 24.8% and 59% vs. 40.8%, respectively). Conclusion SCC is the most common conjunctival epithelial neoplasm in this study, and its prevalence in males is nearly two times higher than in females. The high percentage of squamous cell carcinoma can likely be attributed to elevated sun exposure and ultraviolet light in Iran.
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Affiliation(s)
- Fahimeh Asadi-Amoli
- Department of Pathology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ghanadan
- Department of Pathology, Razi Skin Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Carreira H, Coutinho F, Carrilho C, Lunet N. HIV and HPV infections and ocular surface squamous neoplasia: systematic review and meta-analysis. Br J Cancer 2013; 109:1981-8. [PMID: 24030075 PMCID: PMC3790185 DOI: 10.1038/bjc.2013.539] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/26/2013] [Accepted: 08/13/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The frequency of ocular surface squamous neoplasias (OSSNs) has been increasing in populations with a high prevalence of infection with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and infection with human papillomavirus (HPV). We aimed to quantify the association between HIV/AIDS and HPV infection and OSSN, through systematic review and meta-analysis. METHODS The articles providing data on the association between HIV/AIDS and/or HPV infection and OSSN were identified in MEDLINE, SCOPUS and EMBASE searched up to May 2013, and through backward citation tracking. The DerSimonian and Laird method was used to compute summary relative risk (RR) estimates and 95% confidence intervals (95% CI). Heterogeneity was quantified with the I(2) statistic. RESULTS HIV/AIDS was strongly associated with an increased risk of OSSN (summary RR=8.06, 95% CI: 5.29-12.30, I(2)=56.0%, 12 studies). The summary RR estimate for the infection with mucosal HPV subtypes was 3.13 (95% CI: 1.72-5.71, I(2)=45.6%, 16 studies). Four studies addressed the association between both cutaneous and mucosal HPV subtypes and OSSN; the summary RR estimates were 3.52 (95% CI: 1.23-10.08, I(2)=21.8%) and 1.08 (95% CI: 0.57-2.05, I(2)=0.0%), respectively. CONCLUSION Human immunodeficiency virus infection increases the risk of OSSN by nearly eight-fold. Regarding HPV infection, only the cutaneous subtypes seem to be a risk factor.
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Affiliation(s)
- H Carreira
- 1] Institute of Public Health of the University of Porto, Porto, Portugal [2] Department of Clinical Epidemiology, Predictive Medicine and Public Health of the University of Porto Medical School, Porto, Portugal
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Ocular Surface Squamous Neoplasia in an Anophthalmic Socket 60 Years after Enucleation. Surv Ophthalmol 2011; 56:539-43. [DOI: 10.1016/j.survophthal.2011.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/20/2011] [Accepted: 06/21/2011] [Indexed: 11/20/2022]
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Chern KC, Meisler DM. Less Common Viral Corneal Infections. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Simbiri KO, Murakami M, Feldman M, Steenhoff AP, Nkomazana O, Bisson G, Robertson ES. Multiple oncogenic viruses identified in Ocular surface squamous neoplasia in HIV-1 patients. Infect Agent Cancer 2010; 5:6. [PMID: 20346104 PMCID: PMC2859758 DOI: 10.1186/1750-9378-5-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 03/26/2010] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ocular surface squamous neoplasia (OSSN) is a rare cancer that has increased in incidence with the HIV pandemic in Africa. The underlying cause of this cancer in HIV-infected patients from Botswana is not well defined. RESULTS Tissues were obtained from 28 OSSN and 8 pterygia patients. The tissues analyzed from OSSN patients were 83% positive for EBV, 75% were HPV positive, 70% were KSHV positive, 75% were HSV-1/2 positive, and 61% were CMV positive by PCR. Tissues from pterygium patients were 88% positive for EBV, 75% were HPV positive, 50% were KSHV positive, and 60% were CMV positive. None of the patients were JC or BK positive. In situ hybridization and immunohistochemistry analyses further identified HPV, EBV, and KSHV in a subset of the tissue samples. CONCLUSION We identified the known oncogenic viruses HPV, KSHV, and EBV in OSSN and pterygia tissues. The presence of these tumor viruses in OSSN suggests that they may contribute to the development of this malignancy in the HIV population. Further studies are necessary to characterize the molecular mechanisms associated with viral antigens and their potential role in the development of OSSN.
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Affiliation(s)
- Kenneth O Simbiri
- Department of Microbiology, and Abramson Comprehensive Cancer Center, Tumor Virology Program, University of Pennsylvania, 202A Johnson Pavilion, 3610 Hamilton Walk, Philadelphia, PA 19104-6076, USA.
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Abstract
Tumors of the conjunctiva and cornea comprise a large and varied spectrum of conditions. These tumors are grouped into two major categories of congenital and acquired lesions. The acquired lesions are further subdivided based on origin of the mass into surface epithelial, mucoepidermoid, melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic, lipomatous, lymphoid, leukemic, metastatic and secondary tumors. Ocular surface tumors include a variety of neoplasms originating from squamous epithelium, melanocytic tumors and lymphocytic resident cells of the conjunctival stroma. In this review, we highlight clinical features of these lesions, important diagnostic and investigative tools and standard care of management.
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de Koning MNC, Waddell K, Magyezi J, Purdie K, Proby C, Harwood C, Lucas S, Downing R, Quint WGV, Newton R. Genital and cutaneous human papillomavirus (HPV) types in relation to conjunctival squamous cell neoplasia: a case-control study in Uganda. Infect Agent Cancer 2008; 3:12. [PMID: 18783604 PMCID: PMC2551585 DOI: 10.1186/1750-9378-3-12] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 09/10/2008] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We investigated the role of infection with genital and cutaneous human papillomavirus types (HPV) in the aetiology of ocular surface squamous neoplasia (which includes both conjunctival intraepithelial neoplasia (CIN) and carcinoma) using data and biological material collected as part of a case-control study in Uganda. RESULTS Among 81 cases, the prevalence of genital and cutaneous HPV types in tumour tissue did not differ significantly by histological grade of the lesion. The prevalence of genital HPV types did not differ significantly between cases and controls (both 38%; Odds ratio [OR] 1.0, 95% confidence interval [CI] 0.4-2.7, p = 1.0). The prevalence of cutaneous HPV types was 22% (18/81) among cases and 3% (1/29) among controls (OR 8.0, 95% CI 1.0-169, p = 0.04). CONCLUSION We find no evidence of an association between genital HPV types and ocular surface squamous neoplasia. The prevalence of cutaneous HPV was significantly higher among cases as compared to controls. Although consistent with results from two other case-control studies, the relatively low prevalence of cutaneous HPV types among cases (which does not differ by histological grade of tumour) indicates that there remains considerable uncertainty about a role for cutaneous HPV in the aetiology of this tumour.
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Affiliation(s)
| | | | | | - Karin Purdie
- Centre for Cutaneous Research, Institute of Cell and Molecular Science, St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary, University of London, London E1 2AT, UK
| | - Charlotte Proby
- Division of Surgery and Oncology, College of Medicine, Dentistry and Nursing, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK
| | - Catherine Harwood
- Centre for Cutaneous Research, Institute of Cell and Molecular Science, St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary, University of London, London E1 2AT, UK
| | - Sebastian Lucas
- Dept. Histopathology, KCL School of Medicine, St. Thomas' Hospital, London, UK
| | - Robert Downing
- Centers for Disease Control and Prevention, Programme on AIDS, Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda
| | - Wim GV Quint
- DDL Diagnostic Laboratory, Voorburg, The Netherlands
| | - Robert Newton
- Epidemiology and Genetics Unit, Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
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Verma V, Shen D, Sieving PC, Chan CC. The role of infectious agents in the etiology of ocular adnexal neoplasia. Surv Ophthalmol 2008; 53:312-31. [PMID: 18572051 DOI: 10.1016/j.survophthal.2008.04.008] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Given the fact that infectious agents contribute to around 18% of human cancers worldwide, it would seem prudent to explore their role in neoplasms of the ocular adnexa: primary malignancies of the conjunctiva, lacrimal glands, eyelids, and orbit. By elucidating the mechanisms by which infectious agents contribute to oncogenesis, the management, treatment, and prevention of these neoplasms may one day parallel what is already in place for cancers such as cervical cancer, hepatocellular carcinoma, gastric mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma. Antibiotic treatment and vaccines against infectious agents may herald a future with a curtailed role for traditional therapies of surgery, radiation, and chemotherapy. Unlike other malignancies for which large epidemiological studies are available, analyzing ocular adnexal neoplasms is challenging as they are relatively rare. Additionally, putative infectious agents seemingly display an immense geographic variation that has led to much debate regarding the relative importance of one organism versus another. This review discusses the pathogenetic role of several microorganisms in different ocular adnexal malignancies, including human papilloma virus in conjunctival papilloma and squamous cell carcinoma, human immunodeficiency virus in conjunctival squamous carcinoma, Kaposi sarcoma-associated herpes virus or human herpes simplex virus-8 (KSHV/HHV-8) in conjunctival Kaposi sarcoma, Helicobacter pylori (H. pylori,), Chlamydia, and hepatitis C virus in ocular adnexal mucosa-associated lymphoid tissue lymphomas. Unlike cervical cancer where a single infectious agent, human papilloma virus, is found in greater than 99% of lesions, multiple organisms may play a role in the etiology of certain ocular adnexal neoplasms by acting through similar mechanisms of oncogenesis, including chronic antigenic stimulation and the action of infectious oncogenes. However, similar to other human malignancies, ultimately the role of infectious agents in ocular adnexal neoplasms is most likely as a cofactor to genetic and environmental risk factors.
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MESH Headings
- Alphapapillomavirus/isolation & purification
- Alphapapillomavirus/physiology
- Carcinoma, Squamous Cell/virology
- Chlamydophila psittaci/isolation & purification
- Chlamydophila psittaci/physiology
- Conjunctival Neoplasms/microbiology
- Conjunctival Neoplasms/virology
- Eye Infections, Bacterial/microbiology
- Eye Infections, Bacterial/pathology
- Eye Infections, Viral/pathology
- Eye Infections, Viral/virology
- Eye Neoplasms/microbiology
- Eye Neoplasms/virology
- Eyelid Neoplasms/microbiology
- Eyelid Neoplasms/virology
- HIV-1/isolation & purification
- HIV-1/physiology
- Helicobacter pylori/isolation & purification
- Helicobacter pylori/physiology
- Hepacivirus/isolation & purification
- Hepacivirus/physiology
- Herpesvirus 8, Human/isolation & purification
- Herpesvirus 8, Human/physiology
- Humans
- Lacrimal Apparatus Diseases/microbiology
- Lacrimal Apparatus Diseases/virology
- Lymphoma, B-Cell, Marginal Zone/virology
- Orbital Neoplasms/microbiology
- Orbital Neoplasms/virology
- Sarcoma, Kaposi/virology
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Affiliation(s)
- Varun Verma
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, Bethesda, Maryland 20892-1857, USA
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Sen S, Sharma A, Panda A. Immunohistochemical localization of human papilloma virus in conjunctival neoplasias: a retrospective study. Indian J Ophthalmol 2007; 55:361-3. [PMID: 17699945 PMCID: PMC2636007 DOI: 10.4103/0301-4738.33822] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The extent of association of human papilloma virus (HPV) in human conjunctival neoplasias has been debated in studies originating from different parts of the world, but no substantial evidence has been generated on Indian subjects. This prompted us to carry out a retrospective study on conjunctival neoplasias diagnosed over the past 12 years. MATERIALS AND METHODS Histopathological and immunohistochemical analysis of 65 specimens of ocular neoplasias and 30 normal controls diagnosed between 1991 and 2002 at a tertiary eye care hospital, was undertaken. Formalin-fixed, paraffin-embedded tissues were reviewed for confirming histopathological diagnosis, presence of koilocytosis and changes related to actinic keratosis. Immunohistochemical analysis was done using HPV-specific monoclonal antibodies. Clinicopathological correlation and the association of HPV antigen with the histopathological features were performed. RESULTS Out of the 65 cases analyzed, 35 were papillomas and 30 were ocular surface squamous neoplasias (OSSN). The mean age was 48 years with a male preponderance. Histologically, koilocytosis was observed in 17.1% of papillomas and 36.6% of OSSN. Actinic keratosis was present in 33% of OSSN. Immunohistochemically 17.1% conjunctival papillomas stained positive for HPV antigen, all cases of OSSN were negative for HPV. There was no correlation between koilocytosis or actinic keratosis and the detection of HPV antigen. CONCLUSIONS The association between HPV and conjunctival neoplasias is variable in different geographical areas and also depends on the methods of detection used. This study warrants the need for applying more advanced techniques at a molecular level to determine the possible etiology of HPV in conjunctival neoplasias among Asian-Indians.
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Affiliation(s)
- Seema Sen
- Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.
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Tulvatana W, Bhattarakosol P, Sansopha L, Sipiyarak W, Kowitdamrong E, Paisuntornsug T, Karnsawai S. Risk factors for conjunctival squamous cell neoplasia: a matched case-control study. Br J Ophthalmol 2003; 87:396-8. [PMID: 12642297 PMCID: PMC1771610 DOI: 10.1136/bjo.87.4.396] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To identify roles of human papillomavirus (HPV) infection and solar elastosis as the risk factors for conjunctival squamous cell neoplasia (CSCN). METHODS 30 consecutive pathological specimens, ranging from conjunctival intraepithelial neoplasia, carcinoma in situ, to invasive squamous cell carcinoma were retrieved from tissue archives. 30 controls were disease free conjunctiva from age and sex matched patients undergoing extracapsular cataract extraction. Two masked pathologists studied haematoxylin and eosin stains on paraffin embedded conjunctival tissues. Elastic stain for solar elastosis was blindly interpreted in comparison with negative and positive controls. HPV infection was studied by polymerase chain reaction and dot hybridisation. RESULTS The mean age of CSCN patients was 54.9 years. The male to female ratio was 1:1. Solar elastosis was seen in 53.3% of CSCN and in 3.3% of controls with an odds ratio of 16.0 (95% CI, 2.49 to 670.96; p value = 0.0003). HPV DNA were not detected in any of the specimens. CONCLUSION Solar elastosis is much more frequently found in CSCN cases than in their matched controls and is a risk factor for CSCN. These data are insufficient to conclude that HPV infection is a risk factor for CSCN.
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Affiliation(s)
- W Tulvatana
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Porges Y, Groisman GM. Prevalence of HIV with conjunctival squamous cell neoplasia in an African provincial hospital. Cornea 2003; 22:1-4. [PMID: 12502938 DOI: 10.1097/00003226-200301000-00001] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the prevalence of HIV seropositivity among patients with malignant conjunctival squamous cell carcinoma (SCC) and carcinoma in situ (CIS) and to reassess the potential linkage, albeit well documented, between ocular surface epithelial dysplasia (OSED) and HIV infection. PATIENTS AND METHODS A case-control design study was conducted in an African provincial hospital. Twenty-three African black patients underwent excisional biopsy of conjunctival malignant lesions. In 18 of these patients, ELISA for HIV antibodies was performed prior to the excisional biopsy. RESULTS Pathological evaluation revealed SCC in 12 (52%) patients, CIS in six (26%) patients, and Kaposi sarcoma (KS) in five (22%) patients. Eighteen patients (78.3%) agreed to take a serological HIV test, and among these, seropositivity for HIV was significantly (p < 0.01) higher (92.3%, 12 of 13) in the SCC/CIS subgroup than in a control group with benign conjunctival lesions (28.5%, two of seven). The most common (91.7%) clinical finding in the SCC/CIS/HIV group (12 patients) was corneal overriding. Conjunctival malignancy was the first presenting sign for AIDS in 50% of our patients. CONCLUSIONS A significantly high rate of HIV seropositivity was found in a group of African black patients with conjunctival SCC/CIS compared with a control group with benign conjunctival lesions. The direct correlation between HIV infection and SCC/CIS was reconfirmed in a case-control study. Therefore, an HIV test should probably be performed in cases of conjunctival SCC/CIS or dysplasia, especially among patients in high-risk populations.
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Affiliation(s)
- Yair Porges
- Division of Ophthalmology, Sanz Medical Center, Laniado Hospital, Netanya, Israel
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Sherman MD, Feldman KA, Farahmand SM, Margolis TP. Treatment of conjunctival squamous cell carcinoma with topical cidofovir. Am J Ophthalmol 2002; 134:432-3. [PMID: 12208255 DOI: 10.1016/s0002-9394(02)01569-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe a case of conjunctival squamous cell carcinoma in situ that was successfully treated with adjunctive topical cidofovir. DESIGN Interventional case report. METHODS A 52-year-old woman presented with a diagnosis of diffuse conjunctival papillomatosis in the right eye. She underwent conjunctival biopsy followed by a 6-week course of cidofovir eyedrops (2.5 mg/ml). RESULTS The biopsy specimen demonstrated squamous cell carcinoma in situ. After this biopsy and treatment with cidofovir, the mass regressed into a small vascular tuft, which was excised and treated with cryotherapy. Six months after cidofovir treatment, the patient developed cicatricial changes of the inferior punctum. No recurrence of the squamous cell carcinoma has occurred in 24 months of follow-up. CONCLUSION Cidofovir has shown effectiveness in the treatment of neoplastic lesions involving various mucus membrane sites. This antiviral drug may be a valuable addition to our treatment armamentarium for patients with squamous cell carcinoma in situ of the conjunctiva. The possible relationship between topical cidofovir and cicatricial changes of the lacrimal system cannot be determined from this isolated report, but further investigation is indicated.
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Affiliation(s)
- Mark D Sherman
- Department of Ophthalmology, Southern California Permanente Medical Group, University of California, San Francisco, USA.
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19
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Eng HL, Lin TM, Chen SY, Wu SM, Chen WJ. Failure to detect human papillomavirus DNA in malignant epithelial neoplasms of conjunctiva by polymerase chain reaction. Am J Clin Pathol 2002; 117:429-36. [PMID: 11888082 DOI: 10.1309/rvup-qmu3-5x6w-3cq1] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
To elucidate the putative role of human papillomavirus (HPV) infection in the etiology of conjunctival tumors, 44 formalin-fixed, paraffin-embedded specimens of conjunctival tumors (24 patients with papillomas and 20 patients with dysplastic and/or malignant tumors) were screened for HPV infection using 4 different polymerase chain reactions (PCRs). Of the 24 samples of papilloma, 14 (58%) displayed positive results by applying nested PCR using primer sets of HPV consensus L1 region. HPV type 6 or 11 was detected in 9 cases of papilloma by type-specific primer sets, but none of them were positive for HPV type 16 or 18. However, by using the highly sensitive PCR technique, we failed to demonstrate the HPV DNA of HPV types 6, 11, 16, and 18 in any of the 20 malignant epithelial tumors of conjunctiva. We conclude that HPV-6 or HPV-11 is present in a substantial percentage of conjunctival papillomas, which is in accordance with findings of previously reported studies. In contrast, malignant conjunctival carcinomas are not associated with HPV infection; other pathogenic mechanisms, such as UV light, probably are more important in the cause of these malignant lesions.
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Affiliation(s)
- Hock-Liew Eng
- Department of Pathology, Kaohsiung Medical Center, Chang Gung University and Memorial Hospital, Taiwan, Republic of China
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20
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Sjö NC, Heegaard S, Prause JU, von Buchwald C, Lindeberg H. Human papillomavirus in conjunctival papilloma. Br J Ophthalmol 2001; 85:785-7. [PMID: 11423448 PMCID: PMC1724043 DOI: 10.1136/bjo.85.7.785] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM To examine conjunctival papillomas for the presence of human papillomavirus (HPV) and koilocytosis. METHODS Archival paraffin embedded tissue from 55 conjunctival papillomas was analysed for the presence of HPV by polymerase chain reaction and subsequent filter hybridisation. Histological sections of the 55 papillomas were evaluated for the presence of koilocytosis. RESULTS HPV was present in 48 of 52 (92%) beta globin positive papillomas. HPV type 6/11 were found in 40 of 47 investigated papillomas and a double infection with HPV 6/11 and 16 was identified in a single papilloma. In six papillomas the HPV type could not be identified. Koilocytosis was present in 22 of 55 papillomas (40%). CONCLUSION There is a strong association between HPV and conjunctival papillomas. HPV type 6/11 is the most common HPV type in conjunctival papilloma. The sensitivity of koilocytosis as an indicator of HPV in conjunctival papilloma is low.
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Affiliation(s)
- N C Sjö
- Eye Pathology Institute, University of Copenhagen, Denmark
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21
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Abstract
CONTEXT Many factors like exposure to UV radiation, climatic conditions, genetic predisposition, immunological state and, more recently, the presence of HPV have been implicated in the genesis of some lesions of the conjunctiva, especially the carcinoma. OBJECTIVE To evaluate the presence of HPV DNA in acquired lesions of the conjunctiva and in normal mucosa. TYPE OF STUDY Cross-sectional study. SETTING A public university referral center (the Ophthalmology Service of the A.C. Camargo Hospital - A. Prudente Foundation, São Paulo). PARTICIPANTS Thirty patients with acquired lesions of the conjunctiva and 60 matched controls (by age and sex) were evaluated in this study, from June 1993 to March 1995. PROCEDURES The detection of HPV DNA in the normal conjunctiva and in acquired lesions was done by the PCR technique and dot blot hybridization. The material was collected by scraping the normal mucosa and the surface of the lesions. A fragment of fresh frozen tissue and paraffin embedded specimens of each lesion were also included. MAIN MEASUREMENTS The association between the HPV infection and the presence or absence of conjunctival lesions. RESULTS Sequences of HPV DNA were detected in 4 of the 31 lesions evaluated (12.9%) and in the healthy mucosa of one individual of the control group (1.6%). HPV type 16 was detected in 2 carcinomas and in the normal mucosa of one individual of the control group. HPV type 11 was demonstrated in 2 papillomas of one patient with lesions in both eyes. CONCLUSIONS The low frequency of HPV DNA found in the lesions of this sample and the detection of the viral genome in the normal mucosa indicate that there is a weak possibility of association between HPV infection and the carcinoma of the conjunctiva.
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Affiliation(s)
- M A Palazzi
- Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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22
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Shields CL, Lally MR, Singh AD, Shields JA, Nowinski T. Oral cimetidine (Tagamet) for recalcitrant, diffuse conjunctival papillomatosis. Am J Ophthalmol 1999; 128:362-4. [PMID: 10511035 DOI: 10.1016/s0002-9394(99)00265-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To report the efficacy of cimetidine for treatment of conjunctival papillomatosis. METHODS An 11-year-old boy had an 8-year history of diffuse conjunctival papillomas, treated previously with standard measures of excisional biopsy and cryotherapy. He developed spontaneous conjunctival bleeding and diffuse tumor recurrence over the entire conjunctival surface. Oral cimetidine liquid (30 mg/kg/day) was prescribed. RESULTS Within 2 months, dramatic tumor regression was noted, with nearly complete resolution by 4 months. The patient had no local or systemic side effects from the medication. CONCLUSIONS Oral cimetidine possesses immune modulation properties and may be useful in some cases of virus-induced conjunctival papillomatosis.
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Affiliation(s)
- C L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Abstract
This article reviews options in dealing with tumors of the cornea and conjunctiva, nictitating membrane neoplasms, and eyelid neoplasms. Orbital tumors, optic nerve and other intraocular tumors are also discussed.
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Affiliation(s)
- W C Rebhun
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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Nolan GR, Hirst LW, Bancroft BJ. Efficacy of a training programme designed to teach cervical smear screeners to identify ocular surface squamous neoplasia using conjunctival impression cytology. Cytopathology 1997; 8:388-96. [PMID: 9439891 DOI: 10.1111/j.1365-2303.1997.tb00569.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ocular surface squamous neoplasia (OSSN) is a recently proposed term introduced to encompass both intraepithelial neoplasia and invasive squamous cell carcinoma of the conjunctiva and cornea. A teaching programme incorporating a manual, slide sets, and an evaluation test was developed. The aim was to teach experienced cervical smear screeners to evaluate ocular surface specimens collected by conjunctival impression cytology, with a minimum of individual tuition. The use of the manual was well accepted and half of the original six candidates were able to master the new skill adequately within 8 h. It was considered that the differences between the cytology of OSSN and the equivalent lesions of the uterine cervix are sufficient to prevent some experienced screeners acquiring these skills rapidly.
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Affiliation(s)
- G R Nolan
- Pathology Department, Royal Brisbane Hospital, Queensland, Australia
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25
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Tabrizi SN, McCurrach FE, Drewe RH, Borg AJ, Garland SM, Taylor HR. Human papillomavirus in corneal and conjunctival carcinoma. AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY 1997; 25:211-5. [PMID: 9296295 DOI: 10.1111/j.1442-9071.1997.tb01394.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the role of human papillomavirus (HPV) types, 6, 11, 16 and 18 in corneal and conjunctival carcinoma, we examined 88 dysplastic corneal and conjunctival specimens and 66 controls that had been formalin-fixed and paraffin-embedded. METHODS Sections were graded for histological abnormality by light microscopy and the presence of HPV DNA was determined by polymerase chain reaction using LI consensus primers. RESULTS Human papillomavirus DNA was detected in 34 (39%) dysplasias and in five (7.5%) controls. Of dysplasias that were HPV-positive, 20 (59%) contained either types 16 or 18, 13 (38%) contained only types 6/11, while combinations of HPV types were present in 11 (32%). A histological correlation was found with HPV positivity (all genotypes) and unusually large ('epithelioid') dysplastic cells. CONCLUSION The present study demonstrates a lower incidence of HPV in corneal and conjunctival carcinoma than previously reported, but shows an unexpectedly high incidence of HPV 6/11 in conjunctival carcinomas.
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Affiliation(s)
- S N Tabrizi
- Department of Microbiology, Royal Women's Hospital, Carlton, Victoria, Australia.
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27
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Nakamura Y, Mashima Y, Kameyama K, Mukai M, Oguchi Y. Detection of human papillomavirus infection in squamous tumours of the conjunctiva and lacrimal sac by immunohistochemistry, in situ hybridisation, and polymerase chain reaction. Br J Ophthalmol 1997; 81:308-13. [PMID: 9215061 PMCID: PMC1722165 DOI: 10.1136/bjo.81.4.308] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Squamous tumours of the ocular surface, including the lacrimal pathway, range from benign lesions to invasive carcinomas. Some of these tumours are associated with human papillomavirus (HPV) infection, with the types of HPV differing among papillomas and dysplastic or malignant lesions. METHODS The relation between squamous tumours of the conjunctiva and lacrimal sac and HPV infection was investigated in 17 individuals with such tumours. Nine of the 17 tumours were benign, four were dysplastic lesions, and four were carcinomas. RESULTS Eight specimens showed positive immunohistochemical staining with antibodies to HPV; four of these eight were papillomas, three were dysplastic lesions, and one was a carcinoma. Koilocytosis was detected in seven of these eight tumours. Five of the eight specimens positive for immunohistochemical staining were also positive for HPV DNA by in situ hybridisation, and all eight were positive for HPV DNA by the polymerase chain reaction (PCR) method. CONCLUSION Approximately 50% of squamous tumours of the ocular surface and lacrimal sac were associated with HPV infection. This is the first report, to our knowledge, of the detection of HPV in the field of ophthalmology by a combination of immunohistochemistry, in situ hybridisation, and PCR.
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Affiliation(s)
- Y Nakamura
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Tabin G, Levin S, Snibson G, Loughnan M, Taylor H. Late recurrences and the necessity for long-term follow-up in corneal and conjunctival intraepithelial neoplasia. Ophthalmology 1997; 104:485-92. [PMID: 9082277 DOI: 10.1016/s0161-6420(97)30287-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The purpose of the study was to elucidate the natural history of corneal-conjunctival intraepithelial neoplasia (CIN) and suggest treatment and follow-up guidelines. METHODS The records of all histologically proven cases of CIN at the Royal Victorian Eye and Ear Hospital between 1979 and 1994 were reviewed. RESULTS Seventy-nine eyes of 76 patients had a pathologic diagnosis of CIN and were observed for up to 15 years. The lesion recurred in 31 eyes (39%) overall. There was no statistical difference shown in the likelihood of recurrence based on histologic classification. Complete excision was attempted in each case. In 18 eyes, dysplastic cells were evident at the excision margin. Ten (56%) of these tumors recurred, compared to a 33% recurrence rate in completely excised lesions. The time to the first recurrence ranged from 33.0 days to 11.5 years between the first and second surgeries, with 11 lesions recurring after more than 4 years. Incompletely excised lesions reappeared more rapidly (average, 2.5 years) than did those with clear surgical margins (average, 3.8 years). Seven cases progressed to invasive squamous cell carcinoma and four cases led to blindness or removal of the eye. CONCLUSIONS This study suggests that excision margin at the time of surgery is the most important factor in predicting recurrence. The slow growth of the recurrent lesions combined with the ever-present malignant potential leads the authors to suggest that all patients with a history of CIN warrant annual follow-up for the remainder of their lives.
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Affiliation(s)
- G Tabin
- Department of Ophthalmology, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
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Abstract
Squamous cell carcinoma of the conjunctiva is a rare tumour with a multifactorial aetiology. There is strong epidemiological evidence that exposure to solar ultraviolet radiation is an important cause and that HIV infection predisposes to its development. The role of other factors, such as human papillomavirus infection, is unclear.
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Affiliation(s)
- R Newton
- Imperial Cancer Research Fund, Cancer Epidemiology Unit, Radcliffe Infirmary, Oxford, UK
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Saegusa M, Takano Y, Hashimura M, Okayasu I, Shiga J. HPV type 16 in conjunctival and junctional papilloma, dysplasia, and squamous cell carcinoma. J Clin Pathol 1995; 48:1106-10. [PMID: 8567996 PMCID: PMC503036 DOI: 10.1136/jcp.48.12.1106] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIMS To clarify the role of human papillomavirus (HPV) infection in the development of papilloma, dysplasia, squamous cell carcinoma, and basal cell epithelioma arising from the eyelids, including the tunica conjunctiva palpebrum (conjunctiva), its junction to epidemis of eyelid skin (junction), and eyelid skin. METHODS Sixteen cases of papilloma, four of dysplasia, four of squamous cell carcinoma, and 12 of basal cell epithelioma were examined using formalin fixed and paraffin embedded samples. Detection of HPV-DNA was performed by PCR-RFLP and in situ hybridisation (ISH) methods. RESULTS HPV-16 was detected in 12/16 papillomas (75%), 2/4 dysplasias (50%), and 1/4 squamous cell carcinomas (25%) but in none of the basal cell epitheliomas. No other HPV subtypes were found. ISH assay showed positive signals in only two cases of dysplasia and squamous cell carcinoma. The mean age of HPV-16 positive dysplasia and squamous cell carcinoma cases (81.7 years) was significantly higher than that of HPV-16 positive papilloma cases (p < 0.01). CONCLUSIONS Based on the presence of HPV-16 in both benign and malignant lesions and the age distribution, it seems likely that HPV-16 alone may be incapable of causing development of conjunctival and junctional dysplasia and squamous cell carcinoma, and that any correlation between the papilloma-squamous cell carcinoma sequence and HPV infection may be due to rare events.
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Affiliation(s)
- M Saegusa
- Department of Pathology, Kitasato University School of Medicine, Kanagawa, Japan
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Abstract
Ocular surface squamous neoplasia presents as a spectrum from simple dysplasia to carcinoma in situ to invasive squamous cell carcinoma involving the conjunctiva as well as the cornea. It is a distinct clinical entity, although it has been known by a variety of different names throughout the literature. Most commonly it arises in the limbal region, occurring particularly in elderly males who have lived in geographic areas exposed to high levels of ultraviolet-B radiation. Symptoms range from none to severe pain and visual loss. The development of preoperative diagnostic techniques, such as impression cytology, are of value in clinical decision making and follow-up management. Simple excision with adequate margins is currently the best established form of treatment despite trials of other modalities. The course of this disease may be evanescent, but is more frequently slowly progressive and may require exenteration and occasionally may lead to death.
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Affiliation(s)
- G A Lee
- Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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32
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Nakamura Y, Mashima Y, Kameyama K. Human papilloma virus DNA detected in case of inverted squamous papilloma of the lacrimal sac. Br J Ophthalmol 1995; 79:392-3. [PMID: 7742294 PMCID: PMC505112 DOI: 10.1136/bjo.79.4.392] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Merisier H, Cochereau I, Hoang-Xuan T, Toublanc M, Ruggeri C. Multiple molluscum contagiosum lesions of the limbus in a patient with HIV infection. Br J Ophthalmol 1995; 79:393-4. [PMID: 7742295 PMCID: PMC505113 DOI: 10.1136/bjo.79.4.393] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Lee GA, Williams G, Hirst LW, Green AC. Risk factors in the development of ocular surface epithelial dysplasia. Ophthalmology 1994; 101:360-4. [PMID: 8115157 DOI: 10.1016/s0161-6420(94)31328-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Ocular surface epithelial dysplasia involves a spectrum of diseases ranging from only minor eye irritation to blindness and potentially death. METHODS A case-control study involving 60 patients with ocular surface epithelial dysplasia treated between 1972 and 1991 and 60 age- and sex-matched individuals was conducted to compare relative ultraviolet light exposures over their lifetimes. A standardized self-administered ultraviolet exposure questionnaire was used for assessment. RESULTS Risk factors identified include phenotypic features such as fair skin (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.1, 25.6), pale iris (OR, 1.8; 95%; CI, 0.9, 3.8), and propensity to sunburn (OR, 3.8; 95% CI, 0.7, 19.7), history of previous skin cancers removed (OR, 15; 95% CI, 2.0, 113.6), and being outdoors more than 50% of time in the first 6 years of life while living 30 degrees or less from the equator (OR, 7.5; 95% CI, 1.8, 30.6). CONCLUSION These risk factors suggest that ocular surface epithelial dysplasia is an ultraviolet light-related disease.
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Affiliation(s)
- G A Lee
- Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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35
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Tuppurainen K, Raninen A, Kosunen O, Kankkunen JP, Kellokoski J, Syrjänen S, Mäntyjärvi M, Syrjänen K. Squamous cell carcinoma of the conjunctiva. Failure to demonstrate HPV DNA by in situ hybridization and polymerase chain reaction. Acta Ophthalmol 1992; 70:248-54. [PMID: 1319099 DOI: 10.1111/j.1755-3768.1992.tb04132.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Squamous cell carcinoma of the conjunctiva is a distinct rarity, often arising at the corneoscleral limbus and initially resembling pterygium or chronic keratoconjunctivitis. In this paper we report 4 patients with conjunctival squamous cell carcinoma/carcinoma in situ, which comprise all the cases found in the files of Kuopio University Hospital during 1959-1991. The clinical appearance, diagnosis and treatment of the lesions are described. All biopsies were studied for the presence of Human papillomavirus (HPV) DNA (recently demonstrated in conjunctival squamous cell papillomas, precancer lesions and carcinomas) by using in situ DNA hybridization (ISH) and polymerase chain reaction (PCR). Both techniques failed to demonstrate the DNA of any of the following HPV types: HPV 6, 11, 16 and 18 in any of the lesions. The results are discussed in the light of the recently proposed HPV etiology of these lesions.
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Affiliation(s)
- K Tuppurainen
- Department of Ophthalmology, University of Kuopio, Finland
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36
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Abstract
Human papillomaviruses have long been identified as the cause of common warts and condylomata acuminata. Evidence is now accumulating that human papillomaviruses may be involved in not only benign, but also in malignant neoplasms. They might also be significant in the malignant transformation of cutaneous neoplasms. This review examines the oncogenic potential of human papillomaviruses when they are found in carcinomas in various anatomic areas, including the skin.
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Affiliation(s)
- M B Quan
- University of California, Los Angeles Division of Dermatology 90024
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37
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Odrich MG, Jakobiec FA, Lancaster WD, Kenyon KR, Kelly LD, Kornmehl EW, Steinert RF, Grove AS, Shore JW, Gregoire L. A spectrum of bilateral squamous conjunctival tumors associated with human papillomavirus type 16. Ophthalmology 1991; 98:628-35. [PMID: 1648188 DOI: 10.1016/s0161-6420(91)32218-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Three patients with bilateral tumors presenting as multiple keratinizing and verrucous lesions of the bulbar and tarsal conjunctiva were determined by DNA amplification and hybridization studies to harbor human papillomavirus type 16 (HPV-16). Results of biopsy in two patients showed infiltrating squamous cell carcinoma in one eye and dysplasia or carcinoma in situ in the fellow eye. In the third patient, focal, inflamed, hypertrophic, papillary lesions with pseudoglandular invaginations of the surface epithelium were found in the tarsal conjunctivae of both eyes. These are the first documented cases of bilateral conjunctival tumors associated with human papillomavirus.
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Affiliation(s)
- M G Odrich
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston
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Napora C, Cohen EJ, Genvert GI, Presson AC, Arentsen JJ, Eagle RC, Laibson PR. Factors Associated with Conjunctival Intraepithelial Neoplasia: A Case Control Study. Ophthalmic Surg Lasers Imaging Retina 1990. [DOI: 10.3928/1542-8877-19900101-09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kulke R, Gross GE, Pfister H. Duplication of enhancer sequences in human papillomavirus 6 from condylomas of the mamilla. Virology 1989; 173:284-90. [PMID: 2554574 DOI: 10.1016/0042-6822(89)90245-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Human papillomavirus (HPV) 6 usually induces tumors of the genital, oral, or laryngeal mucosa. An HPV 6-related DNA of 8.2 kb was detected in an extrachromosomal state in atypically located condylomas of the mamilla and was molecularly cloned. The identity of the cloned HPV DNA and the viral DNA in the biopsy was confirmed by comparative Pstl cleavage analysis, which showed typical HPV 6 DNA fragment patterns except for 0.2-kb larger B fragments. Sequencing revealed an exact 236-bp duplication encompassing nucleotides 7681 to 7896 of HPV 6b. This tandem repeat is just upstream from the putative early promoter and contains a 20-bp insertion at position 7720, which constitutes an enhancer element described by R. F. Rando, W. D. Lancaster, P. Han, and C. Lopez (Virology 155, 545-556, 1986). A Hinfl-Pstl fragment containing the whole duplication was cloned into an enhancer-dependent CAT expression vector and led to three- to sevenfold increased CAT activity when compared with the monomeric sequence in C127 cells and BPV1 transformed C127 cells. This indicates that the duplication within the HPV 6 isolate from the mamilla may influence early gene expression and possibly tissue tropism.
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Affiliation(s)
- R Kulke
- Institut für Klinische und Molekulare Virologie, Universität Erlangen-Nürnberg, Federal Republic of Germany
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Mäntyjärvi M, Syrjänen S, Kaipiainen S, Mäntyjärvi R, Kahlos T, Syrjänen K. Detection of human papillomavirus type 11 DNA in a conjunctival squamous cell papilloma by in situ hybridization with biotinylated probes. Acta Ophthalmol 1989; 67:425-9. [PMID: 2801046 DOI: 10.1111/j.1755-3768.1989.tb01627.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 44-year-old man presented with an exophytic papillomatous growth in the tarsal conjunctiva of his right eye. The tumour was excised and subjected to histological examination. On light microscopy, a squamous cell papilloma without signs of dysplasia was disclosed, because the entire tissue block was cut into sections, the performance of a conventional in situ hybridization for detection of human papillomavirus (HPV) DNA was not possible. An alternative approach was used to demonstrate the presence of HPV 11 DNA in the papilloma. The cover slip was removed. The individual van Gieson-stained sections on the (routine, uncoated) slides were cut apart by glass knife, and mounted (still attached on the original slide) separately on new microscopy slides. These slides were subjected to in situ DNA hybridization with biotin-labelled DNA probes of HPV 6, 11, 16, and 18, under conditions of high stringency (Tm-17 degrees C). Special caution was taken to prevent the detachment of sections. The papilloma displayed positive hybridization with the HPV-II probe, the intense signals being localized on the nuclei of koilocytotic cells. Infection with HPV-6 (or the closely related HPV-11) appears to be responsible for the majority of the conjunctival papillomas of children and young adults reported so far. The presence of genital tract HPV types 6/11 in these lesions suggests that some of the infections might have been acquired during the passage through an infected birth canal. The presence of HPV 6/11 in adult conjunctival papillomas might reflect a) an activation of a latent infection acquired as above, or b) a new infection transmitted from other mucosal sites, the genital tract included. The role of HPV in conjunctival dysplasias and malignant transformation is not clear as yet.
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Affiliation(s)
- M Mäntyjärvi
- Department of Ophthalmology, University of Kuopio, Finland
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McDonnell JM, Mayr AJ, Martin WJ. DNA of human papillomavirus type 16 in dysplastic and malignant lesions of the conjunctiva and cornea. N Engl J Med 1989; 320:1442-6. [PMID: 2541337 DOI: 10.1056/nejm198906013202202] [Citation(s) in RCA: 131] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Human papillomaviruses are receiving attention for their role in the pathogenesis of cancer, especially cancer of the anogenital tract. Although strains of human papillomavirus are associated with benign lesions of the conjunctiva, their association with conjunctival dysplastic lesions and carcinomas has remained unclear. We examined a group of neoplastic lesions of the conjunctiva for the presence of DNA sequences for human papillomavirus types 16 and 18, using in vitro gene amplification with the polymerase chain reaction. Tissue specimens of five conjunctival dysplastic lesions and one invasive carcinoma and swab specimens of the mucosa of both corneas of a patient with unilateral corneal dysplasia contained DNA sequences related to human papillomavirus type 16. All dysplastic specimens examined were positive for DNA sequences. Viral DNA was not detected in six control specimens from patients with conjunctival melanoma, papilloma, nevus, or pterygium. We conclude that DNA from human papillomavirus type 16 is present in a substantial percentage of conjunctival premalignant and malignant lesions. It may play a part in the development of conjunctival dysplasia and carcinoma, as it does in cancers of certain other body sites.
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Affiliation(s)
- J M McDonnell
- Pathology Laboratory, Doheny Eye Institute, Los Angeles, CA 90033
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McDonnell PJ, McDonnell JM, Kessis T, Green WR, Shah KV. Detection of human papillomavirus type 6/11 DNA in conjunctival papillomas by in situ hybridization with radioactive probes. Hum Pathol 1987; 18:1115-9. [PMID: 2824322 DOI: 10.1016/s0046-8177(87)80378-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Twenty-three conjunctival papillomas and 28 conjunctival dysplasias were examined for human papillomavirus (HPV)-DNA sequences by in situ hybridization with nick-translated 35S-labeled HPV probes. Adjacent paraffin sections were hybridized with HPV type 2, 6, 16, and 18 probes at Tm - 17 degrees C. Fifteen tissues, all papillomas, displayed positive hybridization with the HPV-6 probe. Infection with HPV-6 (or the closely related HPV-11) appeared to be responsible for most of the conjunctival papillomas of children and young adults. The presence of genital tract HPV-6 in these lesions suggests that some of the infections were acquired during passage through an infected birth canal. The lack of hybridization in adult conjunctival dysplasias indicates either that HPVs are not associated with this condition or that the probes and the technique utilized were not adequate for demonstration of this association.
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Affiliation(s)
- P J McDonnell
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD 21205
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