The Association of Human Papillomavirus in Benign and Malignant Laryngeal Lesions-a Pilot Study

Laryngeal squamous cell carcinoma disguised as asthma

Head and neck squamous cell carcinoma (HNSCC) with laryngeal involvement can lead to significant airway obstruction and compromise. This case report details a female patient in her 60s with a history of asthma who presented with refractory dyspnoea and persistent hoarseness, initially attributed to asthma. After multiple emergency room visits and treatment with bronchodilators and steroids, further investigation revealed an exophytic mass in the larynx, diagnosed as SCC. Despite normal pulmonary function tests, imaging indicated significant airway narrowing. The patient underwent a tracheostomy to secure her airway and was subsequently referred for curative surgery. This case underscores the importance of considering HNSCC in patients with unexplained respiratory symptoms, regardless of smoking history, and highlights the need for thorough investigation to prevent complications from advanced disease. Early multidisciplinary intervention is crucial in managing such cases effectively.

A Self-Amplifying Human Papillomavirus 16 Vaccine Candidate Delivered by Tobacco Mosaic Virus-Like Particles

Virus-like particles (VLPs) are naturally occurring delivery platforms with potential for mRNA vaccines that can be used as an alternative to lipid nanoparticles. Here we describe a self-amplifying mRNA vaccine based on tobacco mosaic virus (TMV) expressing a mutated E7 protein from human papillomavirus 16 (HPV16). E7 is an early gene that plays a central role in viral replication and the oncogenic transformation of host cells, but nononcogenic mutant E7 proteins can suppress this activity. Immunization studies involving the delivery of self-amplifying mutant E7 mRNA packaged with TMV coat proteins confirmed the elicitation of E7-specific IgG antibodies. Additional in vitro splenocyte proliferation and cytokine profiling assays indicated the activation of humoral and cellular immune responses. We conclude that TMV particles are suitable for the delivery of mRNA vaccines and can preserve their integrity and functionality in vitro and in vivo.

Demographic and Clinical Characteristics of Benign Laryngeal Lesions: Insights from a Decade of Experience in a Tertiary Hospital

Background

Benign laryngeal lesions, characterized by non-cancerous growths in the larynx, significantly impact voice quality and respiratory function. These lesions, which include vocal cord polyps, nodules, papillomas, and cysts, often result from factors such as vocal abuse, viral infections, and chronic inflammation. While studies on benign laryngeal lesions are well-documented globally, data specific to Northern Nigeria remains sparse. This study aims to analyze the demographics, clinical features, treatment modalities, and outcomes of benign laryngeal lesions over a decade in a tertiary otolaryngology center in Northern Nigeria.

Methodology

A retrospective review of 176 cases of benign laryngeal lesions was conducted over 10-years (2011-2020). Data were collected on patient demographics, clinical presentation, risk factors, lesion characteristics, and treatment outcomes. All patients underwent flexible laryngoscopy, with a subset receiving CT scans and histopathological examination. The study excluded malignant lesions.

Results

The study population comprised 123 males (69.9%) and 53 females (30.1%), with a male-to-female ratio of 2.3:1. The age range of patients was from 1.5 to 69 years, with a mean age of 34.74 years (±16.64). The most common presenting symptom was hoarseness (94.8%), and most lesions were vocal cord polyps (52.3%), followed by vocal cord nodules (34.7%) and juvenile-onset respiratory papilloma (6.8%). The glottic region was the most frequent site of lesion occurrence (94.9%). Treatment primarily involved voice rest (43.2%), direct laryngoscopy with excision (22.2%), and microlaryngeal surgery (8.0%). Treatment outcomes showed a cure rate of 40.9%, with a recurrence rate of 29.0%.

Conclusion

This study provides valuable insights into the demographic and clinical profiles of patients with benign laryngeal lesions in Northern Nigeria. The findings indicate a predominance of vocal cord polyps, significant gender disparity, and the effectiveness of surgical interventions. These results align with regional and international data but highlight the need for more localized studies to better understand the epidemiology and management of these lesions in Northern Nigeria. Further research should explore specific risk factors and the longterm outcomes of different treatment modalities.

Human Papillomavirus-Attributable Head and Neck Cancers in India-A Systematic Review and Meta-Analysis

PURPOSE

Head and neck cancer accounts for about one third of the global burden in India. Mucosal high-risk human papillomavirus (HPV) has been hypothesized as a contributory risk factor for head and neck cancer (HNC) but its prevalence in Indian patients is not well established. Therefore, this systematic review and meta-analysis aimed to estimate the prevalence of HPV in HNC in India and their attributable fraction by considering the biomarkers of carcinogenesis, p16, and HPV E6/E7 mRNA.

METHODS

A systematic literature search was done in Medline via PubMed, Embase, Scopus, ScienceDirect, ProQuest, and Cochrane to identify studies on HPV and HNC in the Indian population, published between January 1990 and October 2022. Fifty-four eligible studies were identified and relevant clinical information was collected. Meta-analysis was conducted to estimate the pooled prevalence of HPV DNA, p16INK4a, and E6/E7 mRNA percent positivity by random-effect logistic regression model using Metapreg, STATA 18.

RESULTS

Thirty-four high-quality studies were taken for meta-analysis. The pooled prevalence of HPV in HNC was 20% (95% CI, 12 to 32) with a high level of heterogeneity (I2 = 90.79%). The proportion of HPV in oropharyngeal cancer (OPC; 22% [95% CI, 13 to 34]) and laryngeal cancer (LC; 29% [95% CI, 17 to 46]) was higher than in oral cancer (OC; 16% [95% CI, 8 to 30]). The HPV-attributable fraction of OPC, considering the E6/E7 mRNA and p16 positivity, was 12.54% and 9.68%, respectively, almost similar to LC (11.6% and 9.57%), while it was much lower in OC (3.36% and 4%).

CONCLUSION

The HPV-attributable fraction is considerably lower for OC, suggesting a negligible causative role of HPV in OC. A significant proportion of OPC and LC are attributed to HPV; however, their exact causative role is unclear because of the presence of other known risk factors.