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Amato M, Santonocito S, Bruno MT, Polizzi A, Mastroianni A, Chaurasia A, Isola G. Oral and periodontal manifestation related during human papilloma virus infections: Update on early prognostic factors. Heliyon 2024; 10:e31061. [PMID: 38813162 PMCID: PMC11133762 DOI: 10.1016/j.heliyon.2024.e31061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/11/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024] Open
Abstract
Human Papilloma Virus (HPV) is considered one of the most common sexually transmitted infections and has been shown to play an important role in the pathogenesis of squamous cell carcinomas (SCC) of the cervix and head and neck. Manifestations of HPV infections can be manifold, ranging from asymptomatic infections to benign or potentially malignant lesions to intraepithelial neoplasms and invasive carcinomas. The heterogeneity of clinical manifestations from HPV infection depends on the interactions between the viral agent and the host, a direct consequence of the ability on the part of HPV is to remain silent and to evade and convey the action of the host immune system. The oral mucosa represents one of the tissues for which HPV has a distinct tropism and is frequently affected by infection. While much information is available on the role that HPV infection plays in the development of SCC in the oral cavity, there is less information on asymptomatic infections and benign HPV-induced oral lesions. Therefore, the purpose of this review is to analyze, in light of current knowledge, the early clinical and bio-humoral prognostic features related to the risk of HPV malignant transformation, focusing on subclinical conditions, benign lesions, and the correlation between oral infection and infection in other districts. The data show that the main risk associated with HPV infection is related to malignant transformation of lesions. Although HPV-driven OPSCC is associated with a better prognosis than non-HPV-driven OPSCC, primary prevention and early detection of the infection and affected genotype are essential to reduce the risk of malignant neoplastic complications and improve the prognosis.
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Affiliation(s)
- Mariacristina Amato
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Maria Teresa Bruno
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
- Research Center of “Human Papilloma Virus” University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| | - Alessandro Mastroianni
- Dentistry Unit, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, 00133, Rome, Italy
| | - Akhilanand Chaurasia
- Department of Oral Medicine & Radiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
- Research Center of “Human Papilloma Virus” University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
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Anaya-Saavedra G, Vázquez-Garduño M. Oral HPV-associated dysplasia: is koilocytic dysplasia a separate entity? FRONTIERS IN ORAL HEALTH 2024; 5:1363556. [PMID: 38433947 PMCID: PMC10904607 DOI: 10.3389/froh.2024.1363556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
Oral epithelial dysplasia associated with high-risk HPV infection has received different names since its initial description, such as oral Bowenoid lesions, HPV-associated intraepithelial neoplasia, and oral koilocytic dysplasia. Some features, identified in more or less quantity in some of the descriptions, like apoptotic keratinocytes, karyorrhexis, and mitosoid figures, are intricately connected to viral transcriptional status and, consequently, viral load. Since the variety in terminology has introduced diagnostic confusion within medical and research communities, establishing a uniform and standardized approach to diagnosing HPV-oral epithelial dysplasia is crucial for accurate and early diagnoses and holds significant implications for patient outcomes, particularly in high-risk individuals.
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Affiliation(s)
- Gabriela Anaya-Saavedra
- Oral Pathology and Medicine Postgraduate Program, Health Care Department, Metropolitan Autonomous University, Mexico City, Mexico
| | - Marcela Vázquez-Garduño
- Oral Pathology and Medicine Postgraduate Program, Health Care Department, Metropolitan Autonomous University, Mexico City, Mexico
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Novack R, Chapman E, Gao J, Horst B, Hoang LN, Ng TL, Ko YCK. Utilization of p53 and p16 Immunohistochemistry in the Classification of Human Papillomavirus-Associated, p53 Wild-Type, and p53 Abnormal Oral Epithelial Dysplasia. Mod Pathol 2023; 36:100348. [PMID: 37820765 DOI: 10.1016/j.modpat.2023.100348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
p53 immunohistochemistry (IHC) has recently been shown to be a clinically useful marker for predicting risk of progression to invasive squamous cell carcinoma in oral epithelial dysplasia (OED). The literature supports the use of p53 IHC as a marker to identify TP53 mutation in in situ and invasive vulvar lesions and as a surrogate marker for high-risk human papillomavirus (HPV) infection, but there is little documentation for similar use in OED. The purpose of this study was to determine whether p53 IHC is a reliable surrogate marker for detecting both TP53 mutation and high-risk HPV infection in OED. We studied 57 cases of OED (11 mild, 18 moderate, and 28 severe), and all were stained for p16 and p53 IHC. High-risk HPV RNA in situ hybridization (ISH) was performed in selected cases (all p16-positive cases and all OED showing abundant apoptotic cells and karyorrhectic cells; N = 27). Targeted next-generation sequencing (NGS) was performed in 33 p16-negative cases and all high-risk HPV RNA ISH-negative cases (N = 36). We identified 21 cases with p53 basal sparing patterns (mid-epithelial and markedly reduced [null-like]), 14 cases with p53 wild-type patterns (scattered basal and patchy basal/parabasal), and 22 cases with p53 abnormal patterns (18 overexpression, 3 null, and 1 novel cytoplasmic pattern). Among cases with p53 basal sparing patterns, 20 were positive for p16 (20/21, 95%), and all were positive for high-risk HPV RNA ISH (21/21, 100%). The 36 sequenced cases had IHC patterns concordant with TP53 mutation status in 92% (33/36) of lesions. This study demonstrates that p53 IHC expression patterns are sensitive and specific for detection of both high-risk HPV infection and TP53 mutation. Coupled with selective p16 IHC testing, this IHC panel can accurately subclassify OED into HPV-associated, p53 wild-type (conventional), and p53 abnormal OED.
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Affiliation(s)
- Rachel Novack
- Department of Anatomical Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Erin Chapman
- Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Jiangyuan Gao
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Basil Horst
- Department of Anatomical Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn N Hoang
- Department of Anatomical Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tony L Ng
- Department of Anatomical Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yen Chen Kevin Ko
- Department of Anatomical Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Laboratory Medicine and Pathology, BC Oral Biopsy Service, Vancouver General Hospital, Vancouver, British Columbia, Canada.
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Roza ALOC, Fonsêca TC, Mariz BALA, Penafort PVM, Martínez-Flores R, Marshall-Baburizza M, Niklander SE, Lopes MA, Torres SR, Agostini M, Abrahão AC, de Almeida OP, Vargas PA, Romañach MJ. Human Papillomavirus-Associated Oral Epithelial Dysplasia: Report of 5 Illustrative Cases from Latin America. Head Neck Pathol 2023; 17:921-931. [PMID: 37843735 PMCID: PMC10739682 DOI: 10.1007/s12105-023-01589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Human papillomavirus-associated oral epithelial dysplasia (HPV-OED) is a distinct oral epithelial disorder characterized by viral cytopathic changes caused by transcriptionally active high-risk HPV. The aim of the present study was to report 5 additional cases from Latin America. METHODS Clinical data from five patients with HPV-OED were obtained from the archives of three oral pathology services from Brazil and Chile. All cases were submitted to morphological, p16 expression and in situ hybridization (ISH) for HPV analyses. RESULTS Four patients were male and one patient was female, with a mean age of 55.4 years. Four patients were HIV seropositive and two were smokers. Three cases affected the buccal mucosa and commissure, one of which had an additional plaque in the soft palate, and one case each occurred on the floor of mouth and lower labial mucosa. Most cases presented as well-demarcated white plaques with a verrucous surface. One case presented multiple lesions ranging from normal to white-colored slightly elevated plaques with a cobblestone surface. Peripheral mucosal pigmentation was observed in two cases. All five cases presented with the characteristic microscopic features of HPV-OED, including severe dysplasia with numerous karyorrhectic and apoptotic cells, full-thickness "block positivity" for p16 and high Ki-67 index (> 90%) sharply demarcated from the adjacent non-dysplastic epithelium. Wide-spectrum DNA ISH-HPV was positive in 4 cases. All patients were treated with conservative surgical excision with no signs of recurrence after a mean of 39-month follow-up. CONCLUSION This represents the first series of HPV-OED from Latin America; most cases presented as well-demarcated papillary white plaques affecting the buccal mucosa and commissure of HIV-positive middle-aged men, two of them exhibiting peripheral pigmentation caused by reactive melanocytes. The typical microscopic findings of HPV-OED were observed in all cases, which also showed strong p16 positivity in a continuous band through the full thickness of the epithelium and high Ki67.
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Affiliation(s)
| | - Thamyres Campos Fonsêca
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | - René Martínez-Flores
- Unit of Oral Pathology and Oral Medicine, School of Dentistry, Universidad Andres Bello, Viña del Mar, Chile
| | - Maureen Marshall-Baburizza
- Unit of Oral Pathology and Oral Medicine, School of Dentistry, Universidad Andres Bello, Viña del Mar, Chile
| | - Sven Eric Niklander
- Unit of Oral Pathology and Oral Medicine, School of Dentistry, Universidad Andres Bello, Viña del Mar, Chile
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Sandra Regina Torres
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Aline Corrêa Abrahão
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
- Department of Oral Diagnosis and Pathology, Federal University of Rio de Janeiro School of Dentistry (FO-UFRJ), Av. Carlos Chagas Filho 373, Prédio do CCS Bloco K, 2° andar Sala 56. Ilha da Cidade Universitária 21.941-902, Rio de Janeiro, Brazil.
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Human Papillomavirus-Associated Oral Cavity Squamous Cell Carcinoma: An Entity with Distinct Morphologic and Clinical Features. Head Neck Pathol 2022; 16:1073-1081. [PMID: 35802245 PMCID: PMC9729477 DOI: 10.1007/s12105-022-01467-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/15/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND HPV-associated oral cavity squamous cell carcinoma (SCC) is not well-characterized in the literature, and also has a clinical significance that is poorly understood. METHODS We gathered a cohort of oral cavity (OC) SCC with nonkeratinizing morphology, either in the invasive or in situ carcinoma (or both), tested for p16 by immunohistochemistry and high risk HPV E6/E7 mRNA by RTPCR (reference standard for transcriptionally-active high risk HPV) and gathered detailed morphologic and clinicopathologic data. RESULTS Thirteen patients from two institutions were proven to be HPV-associated by combined p16 and high risk HPV mRNA positivity. All 13 patients (100%) were males, all were heavy smokers (average 57 pack/year), and most were active drinkers (9/11 or 81.8%). All 13 (100%) involved the tongue and/or floor of mouth. All had nonkeratinizing features, but maturing squamous differentiation varied widely (0-90%; mean 37.3%). Nonkeratinizing areas had high N:C ratios and larger nests, frequently with pushing borders, and minimal (or no) stromal desmoplasia. The carcinoma in situ, when present, was Bowenoid/nonkeratinizing with cells with high N:C ratios, full thickness loss of maturation, and abundant apoptosis and mitosis. HPV was type 16 in 11 patients (84.6%) and type 33 in two (15.4%). Nine patients had treatment data available. These underwent primary surgical resection with tumors ranging from 1.6 to 5.2 cm. Most had bone invasion (6/9-66.7% were T4a tumors), and most (6/9-66.7%) had extensive SCC in situ with all 6 of these patients having final margins positive for in situ carcinoma. CONCLUSIONS HPV-associated OCSCC is an uncommon entity that shows certain distinct clinical and pathologic features. Recognition of these features may help pathologic diagnosis and could potentially help guide clinical management.
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Louredo BVR, Prado-Ribeiro AC, Brandão TB, Epstein JB, Migliorati CA, Piña AR, Kowalski LP, Vargas PA, Lopes MA, Santos-Silva AR. State-of-the-science concepts of HPV-related oropharyngeal squamous cell carcinoma: a comprehensive review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:190-205. [PMID: 35725962 DOI: 10.1016/j.oooo.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
High-risk (HR) human papillomavirus (HPV) infection is recognized as a primary etiologic factor of anogenital cancers and more recently of a subgroup of oropharyngeal squamous cell carcinomas (OPSCC). The incidence of HPV-related OPSCC has increased dramatically in several developed countries in the past 3 decades and is currently the most common cancer caused by HR-HPV in the United States and Germany, surpassing cervical cancer. Consequently, the patient's demographic and clinicopathologic profile has shifted to nonsmoking and nondrinking younger men with higher schooling level and with a history of multiple oral sex partners. Patients with HPV-related OPSCC often show better treatment outcomes and higher survival rates than their HPV-unrelated counterparts, which has led to a change in tumor staging for HPV-related cases. HPV vaccination is emerging as an effective primary prevention strategy, and systematic screening of HPV DNA in blood and salivary oral rinse samples of HR patients is being examined to determine if it may provide a surveillance method and support early diagnosis of HPV-related OPSCC. In this context, a narrative review was conducted to provide an overview of the state-of-the-art of HPV-related OPSCC, including epidemiology, risk factors, clinicopathologic and molecular features, screening, prevention, management, and prognosis.
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Affiliation(s)
| | - Ana Carolina Prado-Ribeiro
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP), School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Thaís Bianca Brandão
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP), School of Medicine, University of São Paulo (USP), São Paulo, Brazil; Oral Medicine Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Joel B Epstein
- Department of Dentistry, Cedars-Sinai Health System, Los Angeles, California, USA; Department of Dentistry, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | | | | | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center (ACCCC), Sao Paulo, Brazil; Department of Head and Neck Surgery, São Paulo State Cancer Institute (ICESP), School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Márcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.
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Muller S, Tilakaratne WM. Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Tumours of the Oral Cavity and Mobile Tongue. Head Neck Pathol 2022; 16:54-62. [PMID: 35312982 PMCID: PMC9018914 DOI: 10.1007/s12105-021-01402-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/07/2021] [Indexed: 12/22/2022]
Abstract
The fifth chapter of the upcoming fifth edition of the 2022 World Health Organization Classification of Tumours of the Head and Neck titled Tumours of the oral cavity and mobile tongue, has had some modifications from the 2017 fourth edition. A new section "Non-neoplastic Lesions", introduces two new entries: necrotizing sialometaplasia and melanoacanthoma. The combined Oral potentially malignant disorders and Oral epithelial dysplasia section in the 2015 WHO has now been separated and submucous fibrosis and HPV-associated dysplasia are also discussed in separate sections. Carcinoma cuniculatum and verrucous carcinoma are described in dedicated sections, reflecting that the oral cavity is the most common location in the head and neck for both these entities which have distinct clinical and histologic features from conventional squamous cell carcinoma. This review summarizes the changes in Chapter 5 with special reference to new additions, deletions, and sections that reflect current clinical, histological, and molecular advances.
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Affiliation(s)
- Susan Muller
- Atlanta Oral Pathology, Emory at Decatur Hospital, Emory University School of Medicine, Decatur, GA, USA.
| | - Wanninayake M Tilakaratne
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Thankappan P, Ramadoss MN, Joseph TI, Augustine PI, Shaga IB, Thilak J. Human Papilloma Virus and Cancer Stem Cell markers in Oral Epithelial Dysplasia-An Immunohistochemical Study. Rambam Maimonides Med J 2021; 12:RMMJ.10451. [PMID: 34709167 PMCID: PMC8549839 DOI: 10.5041/rmmj.10451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To study the correlation between the putative cancer stem cell (CSC) markers aldehyde dehydrogenase 1 (ALDH1), cluster of differentiation 44 (CD44), sex-determining region Y-box 2 (SOX2), and octamer-binding protein 4 (OCT4) and human papilloma virus (HPV) infection using p16, the surrogate marker of HPV in oral epithelial dysplasia (OED) and normal mucosa. METHODS Five sections each from 40 histopathologically diagnosed cases of different grades of OED and 10 cases of normal oral mucosa without dysplasia were immunohistochemically stained with p16, ALDH1, CD44, SOX2, and OCT4, respectively. RESULTS Expression of ALDH1 and SOX2 was significantly increased in OED cases, whereas CD44 and OCT4 expression was increased in normal mucosa. P16-positive OED cases showed upregulation of ALDH1 and OCT4 expression as compared to p16-negative cases, while CD44 and SOX2 expression was downregulated in p16-positive OED cases; however, the results were not statistically significant. CONCLUSION The present study indicated a suggestive link between p16 and cancer stem cell marker expression in HPV-associated OED, and that p16 has a significant role in CSC progression in OED. This is the first study to evaluate the expression of putative CSC markers in HPV-associated OED. However, low study numbers are a potential limiting factor in this study.
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Affiliation(s)
- Prasanth Thankappan
- Department of Oral and Maxillofacial Pathology, Sree Mookambika Institute of Dental Sciences, Kulasekharam, Kanyakumari District, Tamil Nadu, India
- To whom correspondence should be addressed. E-mail:
| | - Madhavan Nirmal Ramadoss
- Department of Oral and Maxillofacial Pathology, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India
| | - Tharmasahayam Isaac Joseph
- Department of Oral and Maxillofacial Pathology, Sree Mookambika Institute of Dental Sciences, Kulasekharam, Kanyakumari District, Tamil Nadu, India
| | - Percy Ida Augustine
- Department of Oral and Maxillofacial Pathology, Sree Mookambika Institute of Dental Sciences, Kulasekharam, Kanyakumari District, Tamil Nadu, India
| | - Isaacjoseph Bevin Shaga
- Department of Orthodontics and Dentofacial Orthopedics, Rajas Dental College, Tirunelveli District, Tamil Nadu, India
| | - Jashree Thilak
- International Cancer Center, Neyyoor, Kanyakumari District, Tamil Nadu, India
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Overview of Oral Potentially Malignant Disorders: From Risk Factors to Specific Therapies. Cancers (Basel) 2021; 13:cancers13153696. [PMID: 34359597 PMCID: PMC8345150 DOI: 10.3390/cancers13153696] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) is a very aggressive cancer, representing one of the most common malignancies worldwide. Oral potentially malignant disorders (OPMDs) regroup a variegate set of different histological lesions, characterized by the potential capacity to transform in OSCC. Most of the risk factors associated with OSCC are present also in OPMDs' development; however, the molecular mechanisms and steps of malignant transformation are still unknown. Treatment of OSCC, including surgery, systemic therapy and radiotherapy (alone or in combination), has suffered a dramatic change in last years, especially with the introduction of immunotherapy. However, most cases are diagnosed during the advanced stage of the disease, decreasing drastically the survival rate of the patients. Hence, early diagnosis of premalignant conditions (OPMDs) is a priority in oral cancer, as well as a massive education about risk factors, the understanding of mechanisms involved in malignant progression and the development of specific and more efficient therapies. The aim of this article is to review epidemiological, clinical, morphological and molecular features of OPMDs, with the purpose to lay the foundation for an exhaustive comprehension of these lesions and their ability of malignant transformation and for the development of more effective and personalized treatments.
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10
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Pritzker KPH, Darling MR, Hwang JTK, Mock D. Oral Potentially Malignant Disorders (OPMD): What is the clinical utility of dysplasia grade? Expert Rev Mol Diagn 2021; 21:289-298. [PMID: 33682567 DOI: 10.1080/14737159.2021.1898949] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Oral epithelial dysplasia is considered a potential histologic precursor of subsequent squamous cell cancer. As standard clinical practice, pathologists grade dysplasia to assess risk for progression to malignancy. Except for the most advanced grade, severe dysplasia, dysplasia grading has failed to correlate well with the risk to develop invasive cancer. The questions of what process dysplasia grading best represents and what clinical utility dysplasia grading may have are explored. AREAS COVERED This narrative review is based on PubMed search with emphasis on papers since 2010. Epithelial dysplasia as a precursor lesion of cancer and dysplasia grading as a risk assessment tool for progression to cancer are discussed. The close clinical association of dysplasia with known carcinogens, alcohol, and tobacco products is presented. EXPERT OPINION Oral epithelial dysplasia is often, associated with prolonged exposure to tobacco and alcohol products. With reduction of carcinogen exposure, dysplasia is known to regress in some cases. It is proposed that histologic dysplasia grade together with macroscopic images of dysplastic clinical lesions be used as an educational tool to incentivize patients to reduce their known carcinogen exposure. This strategy has the potential to reduce lesion progression thereby reducing the disease burden of oral cancer.
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Affiliation(s)
- Kenneth P H Pritzker
- Professor Emeritus, Laboratory Medicine and Pathobiology; Surgery University of Toronto, Toronto, Ontario, Canada.,Proteocyte Diagnostics Inc., Toronto, Canada.,Department of Pathology and Laboratory Medicine, Pathology & Laboratory Medicine Mount Sinai Hospital, Toronto, Canada
| | - Mark R Darling
- Professor, Department of Pathology and Laboratory Medicine, Schulich Faculty of Medicine and Dentistry, Western University London Ontario, Canada
| | | | - David Mock
- Department of Pathology and Laboratory Medicine, Pathology & Laboratory Medicine Mount Sinai Hospital, Toronto, Canada.,Professor, Pathology/Oral Medicine & Dean Emeritus, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.,Department of Dentistry, Dentistry Mount Sinai Hospital, Toronto, Canada
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11
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Sathasivam HP, Nayar D, Sloan P, Thomson PJ, Odell EW, Robinson M. Dysplasia and DNA ploidy to prognosticate clinical outcome in oral potentially malignant disorders. J Oral Pathol Med 2021; 50:200-209. [PMID: 33151583 DOI: 10.1111/jop.13121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/02/2020] [Accepted: 09/12/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Oral potentially malignant disorders are a clinical conundrum as there are no reliable methods to predict their behaviour. We combine conventional oral epithelial dysplasia grading with DNA ploidy analysis to examine the validity of this approach to risk assessment in a cohort of patients with known clinical outcomes. METHODS Sections from diagnostic biopsies were assessed for oral epithelial dysplasia using the WHO grading system, and DNA ploidy analysis was performed using established methods. Patients reviewed for a minimum of 5 years who did not develop oral squamous cell carcinoma were classified as "non-transforming" cases. Patients that developed oral squamous cell carcinoma ≥ 6 months after the initial diagnostic biopsy were classified as having "malignant transformation." RESULTS Ninety cases were included in the study. Seventy cases yielded informative DNA ploidy results. Of these 70 cases, 31 progressed to cancer. Oral epithelial dysplasia grading and DNA ploidy status were both significantly associated with clinical outcome (P < 0.05). Severe dysplasia had a hazard ratio of 3.50 (CI: 1.46, 8.45; P = 0.005) compared to cases with mild dysplasia. Aneuploidy had a hazard ratio of 2.09 (CI: 1.01, 4.32; P = 0.046) compared to cases with a diploid/tetraploid status. Receiver operating characteristic analysis gave an area under the curve of 0.617 for DNA ploidy status and 0.688 when DNA ploidy status was combined with dysplasia grading. CONCLUSION Our findings suggest that combining dysplasia grading with DNA ploidy status has clinical utility which could be used to develop novel management algorithms.
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Affiliation(s)
- Hans Prakash Sathasivam
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cancer Research Centre, Institute for Medical Research, National Institute of Health, Setia Alam, Malaysia
| | - Deepa Nayar
- King's College London, Guy's Hospital, London, UK
| | - Philip Sloan
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter J Thomson
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, Hong Kong
| | | | - Max Robinson
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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12
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Abreu PM, Valle IB, Damasceno TCD, Có ACG, Pansini PF, Podestá JRV, Souza ED, Rocha RM, Curado MP, Mehanna H, von Zeidler SV. Human Papillomavirus E6/E7 mRNA detection by in situ hybridization in oral cavity squamous cell carcinoma. Arch Oral Biol 2020; 116:104746. [DOI: 10.1016/j.archoralbio.2020.104746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/23/2020] [Accepted: 05/01/2020] [Indexed: 02/06/2023]
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13
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Rooper LM, Windon MJ, Hernandez T, Miles B, Ha PK, Ryan WR, Van Zante A, Eisele DW, D’Souza G, Fakhry C, Westra WH. HPV-positive Squamous Cell Carcinoma of the Larynx, Oral Cavity, and Hypopharynx: Clinicopathologic Characterization With Recognition of a Novel Warty Variant. Am J Surg Pathol 2020; 44:691-702. [PMID: 31934915 PMCID: PMC7885126 DOI: 10.1097/pas.0000000000001433] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Human papillomavirus (HPV) is a principal driver for most oropharyngeal squamous cell carcinomas (OPSCCs), where it is strongly associated with improved survival. HPV is much less frequently detected in squamous cell carcinomas arising in nonoropharyngeal sites (non-OPSCCs), and its pathogenic role and prognostic value in these tumors is unclear. We evaluated the clinicopathologic features of 52 non-OPSCCs considered HPV-positive based upon p16 immunohistochemistry and direct HPV detection using RNA in situ hybridization (ISH), DNA ISH, or real-time DNA polymerase chain reaction. The HPV-positive non-OPSCCs were from the larynx (n=27), oral cavity (n=21), and hypopharynx (n=4). While most cases (n=34, 65%) showed classic histologic features of HPV-positive OPSCC, including endophytic growth, minimal keratinization, and hyperchromatic nuclei without koilocytic changes, a subset (n=13, 25%) were characterized by exophytic growth, exuberant surface hyperkeratosis and parakeratosis, marked nuclear pleomorphism, and prominent koilocytic atypia. These antithetical features were highly reminiscent of the warty variant of HPV-positive squamous cell carcinoma described in anogenital sites. Compared with tumors without warty features, the warty tumors presented at lower stage and were not associated with lymph node metastasis, local recurrence, or distant spread (4 y disease-free survival of 100% vs. 66%, P=0.069). The presence of transcriptionally active HPV as detected by RNA ISH suggests a pathogenic role for HPV in these nonoropharyngeal sites. While most HPV-positive non-OPSCCs are morphologically similar to their tonsillar counterparts, this study highlights a previously unrecognized warty variant that may be associated with a highly favorable clinical outcome.
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Affiliation(s)
- Lisa M. Rooper
- Department of Pathology, The Johns Hopkins University School of Medicine
- Department of Oncology, The Johns Hopkins University School of Medicine
| | - Melina J. Windon
- Department of Otolaryngology, The Johns Hopkins University School of Medicine
| | - Tahyna Hernandez
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brett Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrick K. Ha
- Department of Otolaryngology, University of California at San Francisco, San Francisco, CA
| | - William R. Ryan
- Department of Otolaryngology, University of California at San Francisco, San Francisco, CA
| | - Annemieke Van Zante
- Department of Pathology, University of California at San Francisco, San Francisco, CA
| | - David W. Eisele
- Department of Oncology, The Johns Hopkins University School of Medicine
- Department of Otolaryngology, The Johns Hopkins University School of Medicine
| | - Gypsyamber D’Souza
- Department of Otolaryngology, The Johns Hopkins University School of Medicine
- Department of Epidemiology, The Johns Hopkins University School of Public Health, Baltimore, MD
| | - Carole Fakhry
- Department of Oncology, The Johns Hopkins University School of Medicine
- Department of Otolaryngology, The Johns Hopkins University School of Medicine
| | - William H. Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
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14
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More P, Kheur S, Patekar D, Kheur M, Gupta AA, Raj AT, Patil S. Assessing the nature of the association of human papillomavirus in oral cancer with and without known risk factors. Transl Cancer Res 2020; 9:3119-3125. [PMID: 35117675 PMCID: PMC8798937 DOI: 10.21037/tcr.2020.03.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/23/2020] [Indexed: 12/14/2022]
Abstract
Background Published studies assessing the association of human papillomavirus (HPV) and oral cancer, often include cases with additional confounders such as alcohol, tobacco, thus, precluding the assessment of HPV as a independent risk factor. Further apart from eliciting the mere presence of HPV, it is vital that the nature of the association is delineated for eliciting a causal inference. Thus, the present study assessed the presence and nature of the association of HPV in oral cancer cases with and without known risk factors. Methods The study compares the prevalence of HPV in oral cancer cases with known risk factors (group 1, n=15) to oral cancer (group 2, n=15) and oral epithelial dysplasia (group 3, n=15) cases with no known risk factors using PCR. Cases which are positive for HPV were subjected to p16 and p53 immunostaining to determine potential causal inference. Results HPV 16 was detected in only 1 case of group I, 3 cases of group II, and was absent in group III. HPV 18 was negative in all the 3 groups. All the HPV positive cases were negative for p16 and positive for p53 immunostaining. Conclusions Only a minor proportion of oral cancer cases without risk factors were positive for HPV 16. Even among these HPV 16 positive cases, the immunostaining profile (p53 positive and p16 negative) excludes the involvement of E6 and E7 mediated carcinogenesis. Thus even the weak HPV association noted in the present study cases may not be of causal nature.
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Affiliation(s)
- Pravin More
- Department of Oral Pathology and Microbiology, M. A. Rangoonwala College of Dental Sciences, Pune, India
| | - Supriya Kheur
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Deepali Patekar
- Department of Oral Pathology and Microbiology, Saraswati Dhanwantari Dental College and Hospital, Parbhani, India
| | - Mohit Kheur
- Department of Maxillofacial Prosthodontics, M. A. Rangoonwala College of Dental Sciences, Pune, India
| | - Archana A Gupta
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - A Thirumal Raj
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai, India
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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15
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Hendawi N, Niklander S, Allsobrook O, Khurram SA, Bolt R, Doorbar J, Speight PM, Hunter KD. Human papillomavirus (HPV) can establish productive infection in dysplastic oral mucosa, but HPV status is poorly predicted by histological features and p16 expression. Histopathology 2020; 76:592-602. [PMID: 31617604 DOI: 10.1111/his.14019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/04/2019] [Accepted: 10/14/2019] [Indexed: 01/14/2023]
Abstract
AIMS Previous studies have reported the presence of high-risk human papillomavirus (HR-HPV) in a subset of dysplastic oral epithelial lesions. Many cases show a histological spectrum of atypia similar to that seen in non-human papillomavirus (HPV) severe epithelial dysplasia, but some studies have suggested that HPV status can be inferred on the basis of histological features. We aimed to assess the utility of such histological features and p16 as surrogate markers of HPV infection in a retrospective cohort of 33 cases of severe epithelial dysplasia, with matched clinicopathological data and histological features. METHODS AND RESULTS Tissue sections were assessed for the expression of p16, minichromosome maintenance 2, HPV E4 and HPV L1 by the use of immunohistochemistry. HPV16/18 E6 and E7 expression was assessed by the use of RNA in-situ hybridisation (RNAScope). In the cohort, 18.2% of cases (6/33) were HR-HPV-positive, with no age/gender differences between the HPV-positive and HPV-negative groups. HPV E4 and HPV L1 were expressed in surface keratinocytes in four of six (66%) HPV-positive cases, indicative of productive HPV infection. Lack of p16 expression was predictive of HPV-negative status, but sensitivity and specificity varied according to the cut-off. Histologically, the presence of karyorrhectic nuclei and abnormal mitotic figures was higher in HPV-positive lesions (P < 0.05), but the predictive specificity and sensitivity were suboptimal (sensitivity, 0.75; specificity, 0.52). CONCLUSIONS This study demonstrates, for the first time, that a minority of severely dysplastic oral lesions harbour productive, biologically relevant HPV infection. Consideration should be given to the specific assessment of HPV status in severe epithelial dysplasia cases, as both p16 status and the presence of karyorrhectic cells are poor predictive markers of HPV status.
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Affiliation(s)
- Naeima Hendawi
- Unit of Oral and Maxillofacial Medicine and Pathology, University of Sheffield, Sheffield, UK
- Department of Oral Pathology, University of Benghazi, Benghazi, Libya
| | - Sven Niklander
- Unit of Oral and Maxillofacial Medicine and Pathology, University of Sheffield, Sheffield, UK
- Facultad de Odontologia, Universidad Andres Bello, Viña del Mar, Chile
| | - Olive Allsobrook
- Unit of Oral and Maxillofacial Medicine and Pathology, University of Sheffield, Sheffield, UK
| | - Syed Ali Khurram
- Unit of Oral and Maxillofacial Medicine and Pathology, University of Sheffield, Sheffield, UK
| | - Robert Bolt
- Unit of Oral and Maxillofacial Medicine and Pathology, University of Sheffield, Sheffield, UK
| | - John Doorbar
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Paul M Speight
- Unit of Oral and Maxillofacial Medicine and Pathology, University of Sheffield, Sheffield, UK
| | - Keith D Hunter
- Unit of Oral and Maxillofacial Medicine and Pathology, University of Sheffield, Sheffield, UK
- Oral Pathology and Biology, University of Pretoria, Pretoria, South Africa
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16
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Alsabbagh A, Robins TL, Harriman A, Jackson-Boeters L, Darling MR, Khan ZA, McCord C. Surrogate markers for high-risk human papillomavirus infection in oral epithelial dysplasia: A comparison of p16, Ki-67, and ProExC. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:246-259.e1. [PMID: 31902664 DOI: 10.1016/j.oooo.2019.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/28/2019] [Accepted: 09/29/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this study was to determine the utility of surrogate markers of human papillomavirus (HPV) infection in the diagnosis of HPV-associated oral epithelial dysplasia (OED). STUDY DESIGN Twelve cases of oral dysplasia with histologic features of HPV infection were stained with surrogate markers for HPV (p16, Ki-67, and ProExC) on immunohistochemistry. A second group of 12 cases of oral dysplasia without histologic features of HPV infection was used for comparison. Reverse transcriptase polymerase chain reaction (RT-PCR) was used to confirm the presence of high-risk HPV (HR HPV) in p16-positive cases. RESULTS All of the surrogate markers showed a statistically significant association with HPV-positive OED (P < .001). The agreement between p16 and HPV positivity was the strongest (κ = 1.00), whereas Ki-67 showed very good association with HPV (κ = 0.83), and ProExC showed good association (κ = 0.75). In each case, the agreement was statistically significant (P < .001). Overall, each of the 3 markers showed good sensitivity; however, ProExC showed the lowest specificity. CONCLUSIONS The clinicopathologic features of 12 cases of HPV OED are reported. Diffuse p16 positivity is an accurate and reliable method for predicting HR HPV infection in both high and low grade cases of epithelial dysplasia with histopathologic features of HPV OED. The use of Ki-67 and ProExC did not demonstrate any additional diagnostic benefit in the diagnosis HPV OED.
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Affiliation(s)
- Amr Alsabbagh
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Terry L Robins
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ariel Harriman
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Linda Jackson-Boeters
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Mark R Darling
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Zia A Khan
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Christina McCord
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada.
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17
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Ren J, Xu W, Su J, Ren X, Cheng D, Chen Z, Bender N, Mirshams M, Habbous S, de Almeida JR, Perez-Ordonez B, Goldstein DP, Wang JR, Bratman SV, Huang SH, Jang R, Zhao Y, Waterboer T, Hung RJ, Liu G. Multiple imputation and clinico-serological models to predict human papillomavirus status in oropharyngeal carcinoma: An alternative when tissue is unavailable. Int J Cancer 2019; 146:2166-2174. [PMID: 31269236 DOI: 10.1002/ijc.32548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 02/05/2023]
Abstract
In cancer epidemiological studies, determination of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma (OPSCC) typically depends on the availability of tumor tissue testing, and/or tumor tissue access. Identifying alternative methods for estimating HPV status can improve the quality of such studies when tissue is unavailable. We developed multiple predictive models for tumor HPV status and prognosis by combining both clinico-epidemiological variables and either serological multiplex assays of HPV or multiple imputation of HPV status (HPVmi ). Sensitivity, specificity and accuracy of these methods compared to either p16 immunostaining (p16 IHC) or survival were assessed. When compared to a reference of tumor tissue p16 IHC in 783 OPSCC patients, the clinic-HPVsero model incorporating a composite of 20 HPV serological antibodies (HPVsero ) and 4 clinical factors (c-index: 0.96) performed better than using HPVsero (c-index: 0.92) or HPVmi (c-index: 0.76) alone. However, the model that contained a single HPV16 E6 antibody combined with four clinical variables, performed extremely well (clinic-s1-16E6; c-index: 0.95). When defining HPV status by HPVsero , s1-16E6, HPVmi or through p16 IHC, each of these definitions demonstrated improved overall and disease-free survival in HPV-positive OPSCC patients, when compared to HPV-negative patients (adjusted hazard ratios between 0.25 and 0.63). Our study demonstrates that when blood samples are available, a model that utilizes a single s1-16E6 antibody combined with several clinical features has excellent test performance characteristics to estimate HPV status and prognosis. When neither blood nor tumor tissue is available, multiple imputation, calibrated on local population characteristics, remains a viable, but suboptimal option.
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Affiliation(s)
- Jianjun Ren
- Department of Otolaryngology - Head and Neck Surgery, and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China.,Medical Biophysics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Xue Ren
- Department of Economic Statistics, School of Statistics and Management, Shanghai University of Finance and Economics, Shanghai, China
| | - Dangxiao Cheng
- Medical Biophysics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Zhuo Chen
- Medical Biophysics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Noemi Bender
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maryam Mirshams
- Medical Biophysics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Steven Habbous
- Medical Biophysics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology- Head and Neck Surgery, Princess Margaret Cancer Centre - University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bayardo Perez-Ordonez
- Department of Laboratory Medicine and Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology- Head and Neck Surgery, Princess Margaret Cancer Centre - University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer R Wang
- Department of Otolaryngology- Head and Neck Surgery, Princess Margaret Cancer Centre - University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Raymond Jang
- Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yu Zhao
- Department of Otolaryngology - Head and Neck Surgery, and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Medical Biophysics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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18
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Ren J, Xu W, Su J, Ren X, Bender N, Habbous S, de Almeida J, Goldstein D, Cheng D, Chen Z, Mirshams M, Rahimi M, Huang S, Spreafico A, Hansen A, Kim J, Waldron J, Perez-Ordonez B, Zhao Y, Hung R, Waterboer T, Liu G. HPV Status Improves Classification of Head and Neck Gray Zone Cancers. J Dent Res 2019; 98:879-887. [PMID: 31282843 DOI: 10.1177/0022034519853771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In epidemiologic studies, patients with head and neck squamous cell carcinoma (HNSCC) are classified mainly by the International Classification of Diseases (ICD) codes. However, some patients are of an unclear subsite, the “gray zone” cases, which could reflect ICD coding error, absence of primary subsite, or extensive primary tumors that cross over multiple subsites of the oral cavity and oropharynx. Patients with gray zone squamous cell carcinomas were compared with patients with oral cavity squamous cell carcinoma (OSCC) or oropharyngeal squamous cell carcinoma (OPSCC) and stratified by human papillomavirus (HPV) status that was determined by p16 immunostaining or HPV serology. Comparisons consisted of clinicodemographic features and prognostic outcomes presented by Kaplan-Meier curves and Cox proportional hazards regression models, reported as hazard ratios. There were 158 consecutive patients with gray zone HNSCC diagnosed at the Princess Margaret Cancer Center between 2006 and 2017: 66 had subsite coding discrepancies against the clinician’s documentation (“discrepant” cases; e.g., the diagnosis by the clinician was OSCC, while the classification by ICD coding was OPSCC), while 92 were squamous cell carcinoma of unknown primary of the head and neck (SCCUPHN) after complete diagnostic workup. Comparators included 721 consecutive OSCC and 938 OPSCC adult cases. All HPV-positive cohorts (OPSCC, discrepant, and SCCUPHN) had similar clinicodemographic characteristics and better 3- and 5-y overall survival and disease-free survival than their HPV-negative counterparts. In contrast, HPV-negative discrepant cases had prognostic outcomes most similar to HPV-negative OPSCC cases, while HPV-negative SCCUPHN had survival outcomes most similar to those of patients with OSCC in this study. HPV-positive status can improve the classification of patients with unclear or discrepant oral/oropharyngeal subsite, an improvement over classification systems that are solely clinician defined or conducted through ICD coding. However, due to clinical practice, we could not make definitive reclassification for patients with HPV-negative gray zone HNSCC.
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Affiliation(s)
- J. Ren
- Department of Otolaryngology–Head and Neck Surgery, National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
- Medical Biophysics, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Canada
| | - W. Xu
- Department of Biostatistics, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, Toronto, Canada
| | - J. Su
- Department of Biostatistics, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, Toronto, Canada
| | - X. Ren
- Department of Economic Statistics, School of Statistics and Management, Shanghai University of Finance and Economics, Shanghai, China
| | - N. Bender
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S. Habbous
- Medical Biophysics, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Canada
| | - J.R. de Almeida
- Department of Otolaryngology–Head and Neck Surgery, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Canada
| | - D.P. Goldstein
- Department of Otolaryngology–Head and Neck Surgery, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Canada
| | - D. Cheng
- Medical Biophysics, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Canada
| | - Z. Chen
- Medical Biophysics, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Canada
| | - M. Mirshams
- Medical Biophysics, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Canada
| | - M. Rahimi
- Medical Biophysics, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Canada
| | - S.H. Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - A. Spreafico
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - A. Hansen
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - J. Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - J. Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - B. Perez-Ordonez
- Department of Laboratory Medicine and Pathology, University Health Network, University of Toronto, Toronto, Canada
| | - Y. Zhao
- Department of Otolaryngology–Head and Neck Surgery, National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - R. Hung
- Prosserman Centre for Population Health Research, Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - T. Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - G. Liu
- Medical Biophysics, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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19
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Saleh W, Cha S, Indraneel B, Moreb J, Katz J. HPV-related oral dysplasia in a multiple myeloma patient after stem cell transplantation. SPECIAL CARE IN DENTISTRY 2018; 39:51-55. [PMID: 30431178 DOI: 10.1111/scd.12344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/12/2018] [Accepted: 10/21/2018] [Indexed: 11/29/2022]
Abstract
The development of dysplastic changes in oral epithelial lesions is a potential long-term complication after hematopoietic stem cell transplantation (HSCT). This may be related to mechanisms including radiation and chemotherapy regimens, chronic graft-versus-host disease (cGVHD), inflammation, and prolonged immunosuppression. The current case describes a 54-year-old male with multiple myeloma treated by autologous and allogenic HSCT followed by development of cGVHD (mouth, skin and the eyes) with the complaint of diffuse white lesions on the buccal mucosa, tongue, and palate. A biopsy performed with histopathological analysis revealed moderate to severe epithelial dysplasia with hyperkeratosis, positive for p16INK4A as a surrogate marker for human papillomavirus (HPV). Our finding suggests a possible association of oral dysplasia and HPV in patients after receiving allogenic HSCT with the necessity of more clinical follow-ups for those patients that may be at a higher risk for the development of oral dysplasia associated with HPV.
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Affiliation(s)
- Wafaa Saleh
- Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, Florida.,Oral Medicine and Periodontology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Seunghee Cha
- Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, Florida
| | - Bhattacharyya Indraneel
- Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, Florida
| | - Jan Moreb
- Department of Hematology/Oncology, College of Medicine, University of Florida, Gainesville, Florida
| | - Joseph Katz
- Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, Florida
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20
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Khanal S, Shumway BS, Zahin M, Redman RA, Strickley JD, Trainor PJ, Rai SN, Ghim SJ, Jenson AB, Joh J. Viral DNA integration and methylation of human papillomavirus type 16 in high-grade oral epithelial dysplasia and head and neck squamous cell carcinoma. Oncotarget 2018; 9:30419-30433. [PMID: 30100997 PMCID: PMC6084396 DOI: 10.18632/oncotarget.25754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/25/2018] [Indexed: 12/19/2022] Open
Abstract
This study evaluated the integration and methlyation of human papillomavirus type 16 (HPV16) in head and neck squamous cell carcinoma (HNSCC) and its oral precursor, high-grade oral epithelial dysplasia (hgOED). Archival samples of HPV16-positive hgOED (N = 19) and HNSCC (N = 15) were evaluated, along with three HNSCC (UMSCC-1, -47 and -104) and two cervical cancer (SiHa and CaSki) cell lines. HgOED cases were stratified into three groups with increasing degrees of cytologic changes (mitosis, karyorrhexis and apoptosis). The viral load was higher and the E2/E6 ratio lower (indicating a greater tendency toward viral integration) in group 3 than in groups 1 or 2 (p = 0.002, 0.03). Methylation was not observed in hgOED cases and occurred variably in only three HNSCC cases (26.67%, 60.0% and 93.3%). In HNSCC cell lines, lower E7 expression correlated with higher levels of methylation. HgOED with increased cytologic change, now termed HPV-associated oral epithelial dysplasia (HPV-OED), exhibited an increased viral load and a tendency toward DNA integration, suggesting a potentially increased risk for malignant transformation. More detailed characterization and clinical follow-up of HPV-OED patients is needed to determine whether HPV-OED is a true precursor to HPV-associated HNSCC and to clarify the involvement of HPV in HNSCC carcinogenesis.
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Affiliation(s)
- Sujita Khanal
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Brian S Shumway
- Department of Surgical and Hospital Dentistry, University of Louisville School of Dentistry, Louisville, KY, USA
| | - Maryam Zahin
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Rebecca A Redman
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA.,Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, USA
| | - John D Strickley
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA.,Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Patrick J Trainor
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Shesh N Rai
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Shin-Je Ghim
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | | | - Joongho Joh
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA.,Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, USA.,Center for Predictive Medicine, University of Louisville, Louisville, KY, USA
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21
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Speight PM, Khurram SA, Kujan O. Oral potentially malignant disorders: risk of progression to malignancy. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:612-627. [PMID: 29396319 DOI: 10.1016/j.oooo.2017.12.011] [Citation(s) in RCA: 261] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 01/08/2023]
Abstract
Oral potentially malignant disorders (OPMDs) have a statistically increased risk of progressing to cancer, but the risk varies according to a range of patient- or lesion-related factors. It is difficult to predict the risk of progression in any individual patient, and the clinician must make a judgment based on assessment of each case. The most commonly encountered OPMD is leukoplakia, but others, including lichen planus, oral submucous fibrosis, and erythroplakia, may also be seen. Factors associated with an increased risk of malignant transformation include sex; site and type of lesion; habits, such as smoking and alcohol consumption; and the presence of epithelial dysplasia on histologic examination. In this review, we attempt to identify important risk factors and present a simple algorithm that can be used as a guide for risk assessment at each stage of the clinical evaluation of a patient.
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Affiliation(s)
- Paul M Speight
- Unit of Oral & Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
| | - Syed Ali Khurram
- Unit of Oral & Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, Australia
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22
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Lerman MA, Almazrooa S, Lindeman N, Hall D, Villa A, Woo SB. HPV-16 in a distinct subset of oral epithelial dysplasia. Mod Pathol 2017; 30:1646-1654. [PMID: 28799537 DOI: 10.1038/modpathol.2017.71] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/20/2017] [Accepted: 05/20/2017] [Indexed: 12/19/2022]
Abstract
Human papillomavirus (HPV) 16 is the most common high-risk HPV type identified in oropharyngeal and cervical neoplasia. Recently, HPV-associated oral epithelial dysplasia with specific histopathologic features and demographics similar to HPV-oropharyngeal carcinoma has been identified. The objective of this study was to evaluate histopathologically all cases of HPV-oral epithelial dysplasia seen in one center and identify HPV types in a subset of cases. Cases with specific histopathology for HPV-oral epithelial dysplasia that were positive both by immunohistochemical studies for p16 and by in situ hybridization for high-risk types of HPV were further analyzed using QIAamp DNA Tissue Kits (Qiagen, Hilden, Germany). DNA was extracted, amplified, and digested with restriction enzymes and run on a polyacrylamide gel. Digestion patterns were visually compared with a database of known HPV digestion patterns for identification. There were 53 specimens included in the analysis. There were 47 males and six females (7.8:1), with a median age of 55 years (range 41-81). The most common site of involvement was the tongue/floor of mouth (77% of cases). Of the 53 cases, 94% exhibited parakeratosis and/or hyperkeratosis. All the cases featured karyorrhexis, apoptosis, and characteristics of conventional carcinoma in situ. The quantity of DNA extracted was sufficient for analysis in 22 cases. HPV-16 was identified in 20/22 (91%) cases. One case was associated with HPV-33 and one with HPV-58 (5% each). Eight of the 53 cases (15%) were associated with invasive squamous cell carcinomas.
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Affiliation(s)
- Mark A Lerman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Soulafa Almazrooa
- Department of Diagnostic Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Neal Lindeman
- Department of Pathology, Harvard Medical School, Boston, MA, USA.,Center for Advanced Molecular Diagnostics, Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Dimity Hall
- Department of Quality Control, Thermo Fisher Scientific, Bedford, MA, USA
| | - Alessandro Villa
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.,Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA
| | - Sook-Bin Woo
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.,Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Pathology, StrataDx, Lexington, MA, USA
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23
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Mirzaei H, Goudarzi H, Eslami G, Faghihloo E. Role of viruses in gastrointestinal cancer. J Cell Physiol 2017; 233:4000-4014. [PMID: 28926109 DOI: 10.1002/jcp.26194] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/08/2017] [Indexed: 12/22/2022]
Abstract
Gastrointestinal cancers are a global public health problem, which represent a vast majority of all cancer-caused deaths in both men and women. On the other hand, viral pathogens have been long implicated as etiological factors in the onset of certain human cancers, including gastrointestinal tumors. In this regard, Human Papilloma Virus (HPV), Epstein-Barr Virus (EBV), and John Cunningham Virus (JCV) have been more strongly suggested to be involved in gastrointestinal carcinogenesis; so that, the association of HPV with oropharyngeal and anal cancers and also the association of EBV with gastric cancer have been etiologically confirmed by epidemiological and experimental investigations. Although, the association of other viruses is less evident, but may rely on co-factors for their oncogenic roles. Therefore, to improve the prevention and treatment of these classes of cancer, their association with viral agents as potential risk factors should be investigated with care. In this respect, the present review has focused on the existing literature on the subject of viral involvement in gastrointestinal tumorgenesis, by covering and discussing various gastrointestinal cancers, corresponding viral agents and their oncogenic aspects and then summarizing evidences either supporting or rejecting a causal role of these pathogens in gastrointestinal malignancies.
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Affiliation(s)
- Habibollah Mirzaei
- Department of Virology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hossein Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gita Eslami
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Faghihloo
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Abstract
The pathology laboratory has a central role in providing human papillomavirus (HPV) tests for patients with head and neck cancer. There is an extensive literature around HPV testing and a large number of proprietary HPV tests, which makes the field difficult to navigate. This review provides a concise contemporary overview of the evidence around HPV testing in head and neck cancer and signposts key publications, guideline documents and the most commonly used methods in clinical practice.
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Affiliation(s)
- Max Robinson
- Oral Pathology, Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK.
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25
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Khanal S, Trainor PJ, Zahin M, Ghim SJ, Joh J, Rai SN, Jenson AB, Shumway BS. Histologic variation in high grade oral epithelial dysplasia when associated with high-risk human papillomavirus. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:566-585. [PMID: 28407985 DOI: 10.1016/j.oooo.2017.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Reported cytologic alterations associated with high-risk human papillomavirus (HR-HPV) in oral epithelial dysplasia (HPV-OED) need further characterization. STUDY DESIGN Archival cases of high-grade oral epithelial dysplasia (hgOED) (N = 38) were assigned a cytologic score (CS) based on the average number of mitotic, karyorrhectic, and apoptotic cells per high-power field. Three groups were then generated on the basis of increasing CS: Focal (group 1, N = 14), Intermediate (group 2, N = 12), and Diffuse (group 3, N = 12). Polymerase chain reaction-based HPV genotyping and p16 immunohistochemistry were performed. RESULTS HR-HPV was found significantly more in group 3 (83.3%) compared with groups 1 and 2 (group 1&2; 42.9% and 41.7%, respectively; P = .047). HPV16 predominated in HR-HPV-positive cases (90.5%). By location, the tongue or the floor of mouth was associated with all groups (P = .04). Increasing CS was associated with a slightly younger age (P = .04) and increased expression of p16 (P = .005). CS and p16 expression were not sensitive but were highly specific predictors for HR-HPV presence. Based on limited follow-up information, HPV-OED does not differ in clinical aggressiveness compared with conventional OED. CONCLUSIONS Increased CS in hgOED is strongly associated with HR-HPV (mostly HPV16) and p16 expression. CS and p16 expression are specific predictors of HR-HPV presence. Further molecular study and long-term follow-up of HPV-OED are needed.
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Affiliation(s)
- Sujita Khanal
- James Graham Brown Cancer Center, Department of Biochemistry and Molecular Genetics, University of Louisville, Louisville, KY, USA
| | - Patrick J Trainor
- Research Associate, Biostatistics Shared Facility, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Maryam Zahin
- Postdoctoral Associate, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Shin-Je Ghim
- Assistant Professor, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Joongho Joh
- Assistant Professor, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Shesh N Rai
- Professor, Wendell Cherry Chair in Clinical Trial Research; Director, Biostatistics Shared Facility, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Alfred Bennett Jenson
- Senior scientist, Professor of Vaccinology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Brian S Shumway
- Associate Professor, Oral and Maxillofacial Pathology, Department of Surgical and Hospital Dentistry, University of Louisville School of Dentistry, Louisville, KY, USA.
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26
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Wenig BM. Squamous cell carcinoma of the upper aerodigestive tract: dysplasia and select variants. Mod Pathol 2017; 30:S112-S118. [PMID: 28060368 DOI: 10.1038/modpathol.2016.207] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 12/26/2022]
Abstract
Upper aerodigestive tract (UADT) mucosal premalignant lesions include non-keratinizing and keratinizing intraepithelial dysplasia. The keratinizing type of intraepithelial dysplasia represents the majority of UADT dysplasias. Historically, grading of UADT dysplasias has followed a three tier system to include mild, moderate and severe dysplasia. Recent recommendations have introduced a two tier grading scheme to including low-grade (ie, mild dysplasia) and high-grade (moderate and severe dysplasia/carcinoma in situ) providing for better consensus among pathologists in the interpretation of such dysplastic lesions. Squamous cell carcinoma is the most common malignant neoplasm of the UADT. Several variants of squamous cell carcinoma are recognized among which the more common types include papillary squamous cell carcinoma, verrucous carcinoma, spindle cell squamous cell carcinoma (sarcomatoid carcinoma) and basaloid squamous cell carcinoma. Each of these variants of squamous cell carcinoma poses diagnostic challenges and each correlates to specific therapy and prognosis. This review details the proposed update in the grading of UADT dysplasia to a two-tiered system as well as providing the key diagnostic features for select variants of squamous cell carcinoma.
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Affiliation(s)
- Bruce M Wenig
- Department of Pathology, Moffitt Cancer Center, Tampa, FL, USA
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27
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Zhang L, Lewis JS, El-Mofty SK, Gandhi M, Chernock RD. Nonkeratinizing Squamous Cell Carcinoma In Situ of the Upper Aerodigestive Tract: An HPV-Related Entity. Head Neck Pathol 2016; 11:152-161. [PMID: 27492445 PMCID: PMC5429272 DOI: 10.1007/s12105-016-0749-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022]
Abstract
The clinical and pathologic characteristics of human papillomavirus (HPV)-related premalignant lesions in the upper aerodigestive tract have not been adequately studied. There are a few reports of oral cavity HPV-related severe dysplasia with unique morphology (prominent apoptosis/karyorrhexis imparting a 'bowenoid' appearance) and a single case report of HPV-related squamous cell carcinoma in situ with nonkeratinizing histology distinct from the 'bowenoid' pattern that extensively involved the upper aerodigestive tract. The aim of this study was to characterize the morphologic and clinical features of HPV-related severe dysplasia/carcinoma in situ. All cases of upper aerodigestive tract severe dysplasia/carcinoma in situ (111 cases from 98 patients) at Washington University from July 2012 to March 2015 were categorized into histologic types: keratinizing, nonkeratinizing, mixed or 'bowenoid'. There were 83 (85 %) patients with keratinizing, 3 (3 %) nonkeratinizing and 12 (12 %) mixed patterns. The previously reported 'bowenoid' morphology was not identified. All 3 (100 %) nonkeratinizing and 6 (50 %) mixed cases were p16 and HPV RNA in situ hybridization (RNA ISH) positive (100 % concordance between p16 and RNA ISH). Only 2 of 73 keratinizing cases were p16 positive, 1 of which was also HPV RNA ISH positive (1.4 % of keratinizing cases HPV-related). Thus, nonkeratinizing morphology was a strong predictor of transcriptionally-active HPV in severe dysplasia/carcinoma in situ. HPV-related cases most commonly occurred in the floor of mouth and were frequently extensive (≥4 cm) or unresectable.
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Affiliation(s)
- Lingxin Zhang
- Department of Pathology and Immunology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8118, St. Louis, MO USA
| | - James S. Lewis
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN USA ,Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Samir K. El-Mofty
- Department of Pathology and Immunology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8118, St. Louis, MO USA ,Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO USA
| | | | - Rebecca D. Chernock
- Department of Pathology and Immunology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8118, St. Louis, MO USA ,Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO USA
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28
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Morbini P, Benazzo M. Human papillomavirus and head and neck carcinomas: focus on evidence in the babel of published data. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2016; 36:249-258. [PMID: 27734976 PMCID: PMC5066459 DOI: 10.14639/0392-100x-853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/19/2016] [Indexed: 02/08/2023]
Abstract
Human papillomavirus (HPV)-associated squamous cell carcinoma of the oropharynx is a well-defined entity mostly affecting young to middle-aged male non-smokers. It is generally associated with a favourable outcome, and for this reason a less intensive therapeutic approach has been proposed for this subset of patients. The incidence of HPV-associated oropharyngeal cancers is rapidly increasing in most Western countries, but detailed epidemiological data are not available for the Italian population. Furthermore, among other head and neck regions, a smaller proportion of oral high-grade dysplasia and cancers seems to depend on HPV infection, whereas its role in laryngeal cancer is recognised as less relevant. HPV-dependent neoplastic transformation depends on the expression of viral oncogenes in the infected host cell that can only be directly documented through viral oncogene mRNA identification. The consensus on how to classify these patients from clinical and laboratory diagnostic points of view is still limited, with different approaches based on one or more diagnostic techniques including p16 immunostaining, in situ hybridisation and polymerase chain reation (PCR) amplification of viral DNA. The possibility of early diagnosis relying on the identification of HPV infection in oral and oropharyngeal exfoliated cells has so far provided unsatisfactory results, although viral persistence after treatment has been associated with risk of recurrence. Presently, sufficient data are not available to document the natural history and progression from tonsillar HPV infection to oropharyngeal cancer development, and to clearly define the modality of transmission and risk exposure, among which sexual behaviours appear to play a relevant role. The diffusion of HPV vaccination and its administration to both genders will undoubtedly dramatically modify the epidemiology of HPV-related head and neck cancers in the coming years.
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Affiliation(s)
- P Morbini
- Department of Molecular Medicine, Unit of Pathology, and
| | - M Benazzo
- Department of Otolaryngology, University of Pavia and Foundation IRCCS Policlinico S. Matteo, Pavia, Italy
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29
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Abstract
Increased awareness of human papillomavirus (HPV) as an etiological cause of head and neck squamous cell carcinoma has increased the interest in analysis of distinct oral sub-sites. It is currently under debate, whether HPV plays a role in the development of squamous cell carcinoma of the oral cavity (OSCC). The weakness in most published studies is the lack of performing different HPV detection tests combined with analysis for biological activity of the virus. In addition, different sub-sites of the oral cavity had been combined to a single entity, which retrospectively leads to a highly heterogeneous basis of data. In this review we mainly discuss the unclear role of HPV in OSCC development.
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Affiliation(s)
- Christian U Hübbers
- a Jean-Uhrmacher-Institute for Otorhinolaryngological Research; University of Cologne ; Cologne , Germany
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30
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Comparison of the prevalence of human papilloma virus infection in histopathologically confirmed premalignant oral lesions and healthy oral mucosa by brush smear detection. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:333-9. [DOI: 10.1016/j.oooo.2014.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 11/04/2014] [Accepted: 11/20/2014] [Indexed: 01/20/2023]
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31
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McCord C, Xu J, Xu W, Qiu X, Muhanna N, Irish J, Leong I, McComb RJ, Perez-Ordonez B, Bradley G. Association of human papilloma virus with atypical and malignant oral papillary lesions. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:722-32. [PMID: 24703405 DOI: 10.1016/j.oooo.2014.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/30/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to examine atypical and malignant papillary oral lesions for low- and high-risk human papillomavirus (HPV) infection and to correlate HPV infection with clinical and pathologic features. STUDY DESIGN Sections of 28 atypical papillary lesions (APLs) and 14 malignant papillary lesions (MPLs) were examined for HPV by in situ hybridization and for p16 and MIB-1 by immunohistochemistry; 24 conventional papillomas were studied for comparison. RESULTS Low-risk HPV was found in 10 of 66 cases, including 9 APLs and 1 papilloma. All low-risk HPV-positive cases showed suprabasilar MIB-1 staining, and the agreement was statistically significant (P < .0001). Diffuse p16 staining combined with high-risk HPV was not seen in any of the cases. A subset of HPV(-) APLs progressed to carcinoma. CONCLUSIONS Oral papillary lesions are a heterogeneous group. Low-risk HPV infection is associated with a subset of APLs with a benign clinical course. Potentially malignant APLs and MPLs are not associated with low- or high-risk HPV.
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Affiliation(s)
- Christina McCord
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
| | - Jing Xu
- Applied Molecular Profiling Laboratory, Ontario Cancer Institute, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Xin Qiu
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Nidal Muhanna
- Department of Surgical Oncology/Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Surgical Oncology/Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Iona Leong
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | | | - Grace Bradley
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Ontario Cancer Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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32
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Histopathologic features of high risk human papillomavirus-associated oral epithelial dysplasia. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:120. [DOI: 10.1016/j.oooo.2013.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
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33
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McCord C, Bradley G. Histopathologic features of high risk HPV-associated oral epithelial dysplasia. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:120-1. [DOI: 10.1016/j.oooo.2013.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 06/09/2013] [Indexed: 10/26/2022]
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34
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Chernock RD, Nussenbaum B, Thorstad WL, Luo Y, Ma XJ, El-Mofty SK, Lewis JS. Extensive HPV-related carcinoma in situ of the upper aerodigestive tract with 'nonkeratinizing' histologic features. Head Neck Pathol 2013; 8:322-8. [PMID: 24151062 PMCID: PMC4126930 DOI: 10.1007/s12105-013-0499-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/15/2013] [Indexed: 01/15/2023]
Abstract
Over the past several decades, it has become clear that human papillomavirus (HPV) is important for the development and progression of many head and neck squamous cell carcinomas, particularly those arising in the oropharyngeal tonsillar crypts. Yet, our understanding of HPV's role in premalignant squamous lesions remains relatively poor. This is in part because premalignant lesions of the oropharyngeal tonsillar crypt tissue, where most HPV-related carcinomas arise, are difficult if not impossible to identify. Recent evidence does suggest a role for HPV in a subset of premalignant lesions of the surface epithelium, especially the oral cavity, despite the rarity of HPV-related invasive squamous cell carcinomas at this site. Furthermore, these HPV-related oral cavity dysplasias appear to have unique, bowenoid histologic features described as 'basaloid' with full-thickness loss of squamous maturation, mitotic figures and apoptosis throughout. Here, we present a unique case of an HPV-related premalignant lesion (squamous cell carcinoma in situ) extensively involving the surface epithelium of the oral cavity, oropharynx and larynx that had 'nonkeratinizing' histologic features typical of HPV-related invasive squamous cell carcinoma. This case was strongly p16 positive by immunohistochemistry and harbored transcriptionally active HPV as demonstrated by E6/E7 RNA in situ hybridization. Furthermore, the patient had an excellent response to radiation treatment.
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Affiliation(s)
- Rebecca D Chernock
- Department of Pathology and Immunology, Washington University, St. Louis, MO, USA,
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