Intranuclear virus particles in human genital wart tissue: observations on the ultrastructure of the epidermal layer

Condyloma acuminatum recurrence can be reduced by lesional autotransplantation.. [DOI: 10.21203/rs.3.rs-3920846/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background Condyloma acuminatum (CA), also known as a genital wart (GW), is a sexually transmitted disease caused by human papillomavirus (HPV). HPV lesions, recurrence tendency, and risk of malignant formation are primarily dependent on the person’s immunity level. GW recurrence is a major challenge in CA treatment.The aim of this study was to explore how lesional autotransplantation (LT) can be used to treat coronary anemia and decrease its recurrence. Methods We treated CA through the preparation and implantation of tissue from nine CA patients in our dermatology clinic. Transplantation of small pieces of HPV lesions to the subcutaneous fat of the inguinal region was carried out with the help of a simple surgical method under local anesthesia. Patients were followed up for six to eight months. We searched PubMed and the Web of Science for treatment options for CA to compare our treatment method recurrence rate with existing treatment options. Results During three months of follow-up, seven patients experienced no recurrence of condyloma lesions, while two patients experienced recurrence of small lesions of condyloma acuminatum. The recurrence rate of CA once treated by autotransplantation was relatively low compared to that of other CA treatment options. Conclusions Transplantation of HPV lesions to the inguinal area reduces the recurrence rate in sexually active individuals. The 2/9 recurrence after implantation could be due to poor hygiene, sexual relationships or immune factors.

Differentiated Oral Epithelial Cells Support the HPV Life Cycle

Human Papillomavirus (HPV) associated oral disease continues to increase, both in the context of immune competence and of immune suppression. There are few models of oral HPV infection and current models are laborious. We hypothesized that differentiated oral epithelial cells could support the HPV life cycle. Clinical HPV16 cloned episomes were introduced into differentiated oral epithelial cells (OKF6tert1). Viral and cellular gene expression was assessed in the presence or absence of sodium butyrate, a differentiating agent that moved the cells to full terminal differentiation. Detection of keratin 10, cross-linked involucrin, and loricrin in the presence and absence of sodium butyrate confirmed terminal differentiation. Increasing sodium butyrate concentrations in the absence of HPV, were associated with decreased suprabasal markers and increased terminal differentiation markers. However, in the presence of HPV and of increasing sodium butyrate concentrations, both mitotic and suprabasal markers were increased and the terminal differentiation marker, loricrin, decreased. In this unique differentiated state, early and late viral gene products were detected including spliced mRNAs for E6*, E1^E4, and L1. E7 and L1 proteins were detected. The ratio of late (E1^E4) to early (E6/E7) transcripts in HPV16+ OKF6tert1 cells was distinct compared to HPV16+ C33a cells. Consistent with permissive HPV replication, DNA damage responses (phospho-chk2, gamma-H2AX), HPV E2-dependent LCR transactivation, and DNase-resistant particles were detected and visualized by transmission electron microscopy. In sum, monolayers of differentiated immortalized oral epithelial cells supported the full HPV life cycle. HPV may optimize the differentiation state of oral epithelial cells to facilitate its replication.

The Virus in Oral Condyloma Acuminatum

Condyloma acuminatum, a wart type which usually occurs in the anogenital areas of humans, has occasionally been reported to occur in the oral cavity.Papilloma virus particles have been demonstrated in lesions of anogenital location. This report is concerned with the findings of similar virus particles in abundance in oral condylomata.

Specimens were excised from the palate of the patient, fixed in glutaraldehyde and osmium tetroxide and post-contrasted with uranyl acetate and lead citrate.

In 4 out of 5 sites, with a parakeratotic surface appearance, intranuclear viral particles were found. The virus particles are circular (23%) to slightly oval in shape with a mean diameter of 46.8 x 49.3 nm (minimum diameter 45 nm, maximum diameter 52 nm).

Viral Particles in Cervical Condylomatous Lesions

Intranuclear viral particles morphologically identical with papovavirions were observed in large numbers in koilocytotic epithelial cells of 4 of 8 cases of cervical condylomatosis.

Two Landmark Studies Published in 1976/1977 Paved the Way for the Recognition of Human Papillomavirus as the Major Cause of the Global Cancer Burden

Two groundbreaking reports were published in Acta Cytologica at the transition of 1976 to 1977. One appeared in the last issue of 1976 [Meisels and Fortin: Acta Cytol 1976;20:505-509] and the other in the first issue of 1977 [Purola and Savia: Acta Cytol 1977;21:26-31]. Today, 40 years later, it is not an overstatement to conclude that these are the two most influential studies ever published in this journal. Two reports with a similar content being published so close together (in the same journal) raised the question "Which of the two reports was truly submitted first?" In this commentary, this enigma is clarified beyond reasonable doubt, based on the well-considered testimonial of Prof. Leopold G. Koss, the reviewer of one of the two papers. To fully appreciate the significance of the novel discovery made in these two reports, it is essential to align them in the right context, both retrospectively and prospectively. This commentary will assist the reader by summarizing the existing knowledge on human papillomavirus (HPV) before these two milestone papers appeared, and describe the incredibly rapid progress that they evoked during the subsequent decades, which made HPV the single most important human tumor virus. As the final proof of virus-cancer causality, prophylactic HPV vaccines have been effective in preventing (a) virus transmission and HPV infection, (b) benign HPV-induced tumors (genital warts), and (c) cervical intraepithelial neoplasia (CIN). Formal evidence of the prevention of cervical cancer by these HPV vaccines still awaits confirmation, and the same applies to the eventual prevention of human cancers at other anatomic sites, part of the global burden of oncogenic HPVs.

The role of cytopathology in diagnosing HPV induced oropharyngeal lesions

HPV detection in fine needle aspirates from suspected head and neck metastasis may be useful in clinching the diagnosis of HPV related oral squamous cell carcinoma. Ascertaining the HPV status of a particular tumor on cytological specimens could be useful for prognostication as HPV-related tumors appear to have a better prognosis and clinical outcome. The various techniques of detection are reviewed.

Immune response in cervical dysplasia induced by human papillomavirus: the influence of human immunodeficiency virus-1 co-infection - review

Human immunodeficiency virus (HIV-1) has become an important risk factor for human papillomavirus (HPV) infection and the development of HPV associated lesions in the female genital tract. HIV-1 may also increase the oncogenicity of high risk HPV types and the activation of low risk types. The Center for Disease Control and Prevention declared invasive cervical cancer an acquired immunodeficiency virus (AIDS) defining illness in HIV positive women. Furthermore, cervical cancer happens to be the second most common female cancer worldwide. The host's local immune response plays a critical factor in controlling these conditions, as well as in changes in the number of professional antigen-presenting cells, cytokine, and MHC molecules expression. Also, the production of cytokines may determine which arm of the immune response will be stimulated and may influence the magnitude of immune protection. Although there are many studies describing the inflammatory response in HPV infection, few data are available to demonstrate the influence of the HIV infection and several questions regarding the cervical immune response are still unknown. In this review we present a brief account of the current understanding of HIV/HPV co-infection, emphasizing cervical immune response.

HPV in the male patient

Human papillomavirus (HPV) is a DNA-containing virus associated with a wide variety of clinical and subclinical diseases. These HPV lesions may resolve spontaneously or progress to benign (condyloma acuminata) or malignant (genital carcinoma) neoplasms. The incidence of HPV genital infection has risen dramatically over the past 30 years, and it is now the most common viral sexually transmitted disease. Many therapeutic options are available to the urologist with new treatments currently being investigated. The history, etiology, pathogenesis, carcinogenesis, and guidelines for evaluation and management are discussed.

Synthesis of infectious human papillomavirus type 18 in differentiating epithelium transfected with viral DNA

The lack of a permissive system for the propagation of viral stocks containing abundant human papillomavirus (HPV) particles has hindered the study of infectivity and the early stages of HPV replication. The organotypic (raft) culture system has permitted the study of a number of the differentiation-specific aspects of HPV, including amplification of viral DNA, expression of late genes, and viral morphogenesis. However, these investigations have been limited to a single virus type, namely, HPV type 31 (HPV31). We have artificially introduced linearized HPV18 genomic DNA into primary keratinocytes by electroporation, followed by clonal expansion and induction of epithelial stratification and differentiation in organotypic culture. We report the synthesis of infectious HPV18 virions. Virus particles approximately 50 nm in diameter were observed by electron microscopy. HPV18 virions purified by isopycnic gradient were capable of infecting keratinocytes in vitro, as shown by the expression of multiple HPV18-specific, spliced transcripts.

Condyloma acuminata in infants and children. A survey of colon and rectal surgeons

PURPOSE

Condyloma acuminata are anogenital warts caused by a human papillomavirus. Human papillomavirus is a tissue-specific, site-specific, double-stranded DNA virus, which is capable of inducing high-grade genital intraepithelial neoplasia and malignancy. The incidence of anogenital warts in the pediatric age group is rising, and sexual abuse has been implicated as a potential cause.

METHODS

Accumulated data from separate questionnaires sent to practicing colorectal surgeons who are members of The American Society of Colon and Rectal Surgeons and fellows in colon and rectal training programs have been analyzed.

RESULTS

Thirty percent of those polled responded to our survey. Of the respondents, 93 percent see less than two pediatric cases per year. Seventy-two percent stated that tissue specimens would be sent routinely for histopathologic identification. Although 73 percent of surgeons consider anogenital warts a potentially sexually transmitted disease, only 26 percent reported screening for other sexually transmitted diseases. A diagnostic and therapeutic protocol is followed by 19 percent of respondents. Patient follow-up varied from six months (43 percent) to lifelong examinations (3 percent). Sixty-four percent of respondents agreed that a diagnostic and therapeutic protocol based on current knowledge would be beneficial.

CONCLUSION

We conclude that colon and rectal surgeons have a low exposure to anogenital warts in infants and children. Furthermore, we believe that a diagnostic and therapeutic protocol based on the current literature would be helpful.

Human papillomavirus-associated oral epithelial dysplasia (koilocytic dysplasia): an entity of unknown biologic potential

Intraepithelial neoplasia of the female genital tract has long been associated with human papillomavirus infection. To date, there have been no previously published studies of oral dysplasia that have identified light microscopic features predictive of the presence of human papillomavirus. We identified a variant of oral epithelial dysplasia, koilocytic dysplasia, that exhibited light microscopic features suggestive of HPV infection. To determine if these microscopic features were specifically correlated with human papillomavirus infection, DNA in situ hybridization for human papillomavirus 6/11, 16/18, and 31/33/51 was performed on 31 lesions diagnosed histologically as koilocytic dysplasia. Seventeen matched control cases of conventional oral epithelial dysplasia were also analyzed for human papillomavirus. Human papillomavirus DNA was detected significantly more often (p < 0.001) in koilocytic dysplasia (80.6%) than conventional oral epithelial dysplasia (0.0%). Positive cases of koilocytic dysplasia contained either intermediate-risk (31/33/51) or high-risk (16/18) human papillomavirus types whether or not they contained low-risk human papillomavirus types (6/11). The histologic and clinical presentation of koilocytic dysplasia was unique. Lesions demonstrated koilocytes and other microscopic characteristics of human papillomavirus infection, as well as features of conventional epithelial dysplasia. A striking male predominance was noted, as was a relatively young average age of presentation (39.0 years). On the basis of our preliminary analysis, we conclude that oral koilocytic dysplasia represents a unique pathologic entity and that the presence of human papillomavirus can be predicted on light microscopy with at least 80% accuracy. The clinical significance and potential for malignant transformation of koilocytic dysplasia remain to be investigated.

Symptomatic genital papillomavirus infection in a community. Incidence and clinical picture

BACKGROUND

Incidence of condyloma acuminatum is not well known. Descriptive data are usually based on selected groups of patients. This study aims at giving incidence of the clinically defined disease in a well-defined area, thought to be representative for Sweden outside the capital city.

METHODS

Data from people with condyloma acuminatum seeking medical attention were collected during a two-year period, 1989-90, in a middle-sized urban area in Sweden. A person with symptoms and a clinical picture consistent with condyloma was considered a case.

RESULTS

Overall incidence was 2.4 per 1000. The highest age specific incidence occurred in the age group 20-24 years, 12 per 1,000. Women 15-19 years old had an incidence of 14 per 1,000. The total female to male ratio was 1.3.

CONCLUSIONS

Women more often than men had a mixture of exo- and endophytic condylomata. Condyloma as another and complementary indicator of changing sexual behavior deserves further interest.

Human papillomavirus type 6 associated Buschke-Loewenstein tumor (giant condyloma acuminatum)

The term "Buschke-Loewenstein tumor" has been used for tumors with exophytic, wart-like excrescences in the anogenital region. This broadly includes giant condyloma acuminatum and verrucous carcinoma. We report a 44-year-old Japanese man with a giant condyloma acuminatum Buschke-Loewenstein tumor on the right femoinguinal area. The lesion was a huge grape-like nodule composed of multiple small nodules, reaching 135 x 65 x 40 mm in size. Histologically, it showed a regularly acanthotic papilloma with numerous koilocytes in the upper squamous and granular layers. Ultrastructural findings included gradual differentiation from basal cell layers to uppermost corneocytes without disorganized relationships in the epithelial-stromal junction or cellular atypia. Human papillomavirus type 6 DNA was detected in the tumor tissues by polymerase chain reaction and restriction enzyme analysis, although immunohistochemical staining for papillomavirus common antigen was negative.

Expression of human papillomavirus type 11 L1 protein in insect cells: in vivo and in vitro assembly of viruslike particles

The L1 coat protein of human papillomavirus type 11 (HPV-11) was expressed in Sf-9 insect cells with the recombinant baculovirus vector Ac11L1. Viruslike particles (VLPs) were identified by electron microscopy in the nucleus and cytoplasm of Sf-9 cells infected with Ac11L1. The L1 protein was purified from Ac11L1-infected insect cells. The purified protein spontaneously assembled in vitro into various aggregates, including particles appearing similar to empty virions. Reaction of VLP-containing insect cell extracts with antisera directed against either denatured or nondenatured capsid epitopes in Western blot (immunoblot) and immuno-dot blot assays suggested that conformational epitopes present in native HPV-11 infectious virions were also present on the baculovirus-produced HPV-11 VLPs. Immuno-dot blot assays using human sera obtained from individuals with biopsy-proven condyloma acuminatum correlated closely with results previously obtained in HPV-11 whole virus particle-based enzyme-linked immunosorbent assays. These morphologic and immunologic similarities to native HPV-11 virions suggest that recombinant VLPs produced in the baculovirus system may be useful in seroepidemiology and pathogenesis studies of genital HPV infection and that they may also be potential candidates for vaccine development.

Biosynthesis of human papillomavirus from a continuous cell line upon epithelial differentiation

The study of the human pathogen papillomaviruses (HPVs) has been hampered by the inability to propagate the virus in tissue culture. The addition of 12-O-tetradecanoyl phorbol-13-acetate to the media of organotypic (raft) cultures increased expression of physiological markers of keratinocyte differentiation and concomitantly induced production of virions. Capsid production was detected in differentiated suprabasal cells. Virions approximately 54 nanometers in size were observed by electron microscopy in raft tissue cross sections in the suprabasal layers. Virions purified through isopycnic gradients were found to contain type 31b DNA and exhibited an icosahedral shape similar to that of papillomaviruses found in clinical samples.

Production of human papillomavirus and modulation of the infectious program in epithelial raft cultures. OFF

Human papillomaviruses trophic for anogenital epithelia cause benign warts, and certain genotypes are closely associated with cervical neoplasia. By using our modifications of the epithelial raft culture system, we were able to recapitulate and modulate the infectious program of a papillomavirus in vitro for the first time. Small pieces of a condyloma containing human papillomavirus type 11 were explanted onto a dermal equivalent consisting of a collagen matrix with fibroblasts and were cultured at the medium-air interface. The infected stem cells proliferated rapidly across the matrix, stratified, and differentiated, as judged by histology. The results correlated with the state of epithelial differentiation, which, in turn, was dependent on the type of fibroblast in the matrix. Under conditions where the epithelial outgrowth underwent terminal differentiation, the entire productive program took place, leading to virion assembly. In contrast, using an alternative condition where the outgrowth failed to achieve terminal differentiation, only the E-region RNAs from the E1 promoter accumulated to any appreciable extent. The proliferating cell nuclear antigen was induced in the differentiated suprabasal cells in the productive cyst growth, which also exhibited high copy viral DNA and abundant E6-E7 RNAs. Comparable cells in the nonproductive cyst outgrowth were negative for all three. These results suggest that the E6 and E7 proteins may play a role in establishing a cellular environment conducive to vegetative viral replication. The culture conditions described should be useful for genetic analysis of this family of important human pathogens and for testing potential pharmacological agents.

Reduction of vector contamination in detection of human papillomavirus DNA using full-length genomic DNA probes

Nucleic acid hybridization techniques are currently the most specific and sensitive procedures available for diagnosing and typing human papillomavirus (HPV) infection. HPV genomic DNA cloned into vector pBR322 or related vectors are commonly used as probes for detection of HPV. When isolating HPV insert DNA however, it is difficult to remove all pBR322 DNA. This can result in false positive readings when clinical specimens harbouring sequences homologous to pBR322 are screened. It was found that up to 200 ng of vector-like sequences in a clinical sample could be blocked by the addition of non-labelled, digested pBR322 sequences to the hybridization reaction.

Demonstration of human papillomavirus DNA by nucleic acid in situ hybridization in paired histologically abnormal cervical biopsies obtained at the same patient visit

Fifty-four pairs of cervical biopsies ranging from minimal dysplasia to severe dysplasia were studied for the presence of human papillomavirus DNA by in situ hybridization. Two assays were performed on each biopsy. A 16 hour hybridization was used in one assay, while a 40 hour hybridization was utilized in the second assay. Increasing the hybridization time to 40 hours did not significantly increase the detection rate of HPV compared to the rate found using the 16 hour hybridization. Also, no difference in the detection rate of HPV was found by using one biopsy of the pair over the other biopsy of the pair. However, the performance of a single in situ assay on only one biopsy from each patient significantly underestimated the true prevalence of HPV. A single assay only detected 21/33 (64%) patients with HPV. Implications of multiple testing of all histologically abnormal biopsies is discussed in relation to prospective follow-up studies determining the usefulness of HPV typing in patient management.

Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection

Papillomavirus DNA has been reported recently in the vapor (smoke plume) derived from warts treated with carbon dioxide laser; this raises concerns for operator safety. We therefore have studied a group of human and bovine warts to define further the potential risk of wart therapy and to test whether a surgical mask could reduce exposure. Half of each wart was treated with carbon dioxide laser and the other half with electrocoagulation. The vapor produced by each form of therapy was collected with a dry filter vacuum apparatus and analyzed for the presence of papillomavirus. Vapor from human plantar warts was analyzed for the presence of human papillomavirus DNA, because there is no infectivity assay for human papillomavirus. Of plantar warts treated, five of eight laser-derived vapors and four of seven electrocoagulation-derived vapors were positive for human papillomavirus DNA. Greater amounts of papillomavirus DNA were usually recovered in the laser vapor than in the electrocoagulation vapor from the same wart. Bioassay readily detected infectious bovine papillomavirus in the vapor from bovine warts treated with either modality; more virus was present in laser-derived material. A surgical mask was found capable of removing virtually all laser- or electrocoagulation-derived virus, strongly suggesting that such masks can protect operators from potential inhalation exposure to papillomavirus.

Condyloma acuminatum of the bladder in two autopsy cases

Condyloma acuminatum is a very rare lesion occurring in the bladder. We report two cases of condyloma acuminatum of the bladder found at autopsy, one in a 96-year-old woman and the other in an 80-year-old man. Both had papillary or polypoid tumorous lesions in the trigone and neck of the bladder. The lesions were composed of nodular or papillary growths of squamous epithelium. The epithelium exhibited koilocytosis and the nuclei showed immunohistochemical staining for human papillomavirus antigen.

Cytologic and histologic manifestations of human papillomavirus infection of the female genital tract and their clinical significance

The historical developments in the recognition of the role of human papillomavirus (HPV) infection in cells and tissues of the female genital tract are briefly summarized. The identification of a specific marker cell, the koilocyte, has led to initial studies of frequency and biologic significance of neoplastic lesions of the uterine cervix associated with HPV. By molecular virology techniques, over 40 types of HPV have been identified and their tissue affinity determined. Types 6, 11, 16, 18, and 31 are most commonly associated with anogenital lesions, among them a broad spectrum of cervical intraepithelial neoplasia (CIN). While current evidence suggests that lesions associated with HPV Types 6 and 11 are potentially less harmful to the patient than lesions associated with HPV Types 16 and 18 (which have been identified also in invasive cervical carcinomas and cell lines derived therefrom), a major long term prospective study may be required to confirm this view. A factor that complicates the issue still further is the recent observation that HPV DNA of all four types has been identified in 11% of women and 5.5% of men free of disease. Infection with multiple viral types (including Types 16 and 18) was common in this apparently healthy population. Although HPV must be considered as a prime candidate for a transforming virus, current evidence suggests that the infection with the virus is per se an insufficient condition for the development of precancerous lesions or cancer of the uterine cervix and that another factor or factors may be necessary for these events to take place. Some of these possible cofactors such as age, repeated infections, and the immune status of the patient are discussed. A great deal of additional work is required before the precise role of HPV virus in the genesis of carcinoma of the uterine cervix, vulva, and vagina is firmly documented.

Prediction of human papilloma virus antigen in cervical squamous epithelium by koilocyte nuclear morphology and "wart scores": confirmation by immunoperoxidase

Koilocytes (balloon cells) in cervical squamous epithelium can be distinguished by their nuclear morphology as members of two populations A and B. The proposition that population A was infected with human papilloma virus (HPV) and population B was not, was examined immunohistologically. A peroxidase-antiperoxidase technique using polyclonal HPV antibody failed to support the hypothesis and showed small fractions of both populations to be infected with the virus (A = 5 of 25; B = 2 of 19). Nuclear morphology alone is thus inadequate to distinguish infected from non-infected koilocytes, or balloon cells. When a number of well established histological changes in squamous epithelia infected with HPV were examined, graded, and summated to obtain a "wart score," however, a reasonably accurate prediction of HPV infection emerged.

Cytologic detection of condylomas and cervical intraepithelial neoplasia of the uterine cervix with histologic correlation

Human papillomavirus (HPV) has been implicated as an important etiologic factor in cervical carcinoma. This study evaluates the efficacy of cytology as a screening tool in the detection of cervical lesions with koilocytotic features. Cervical smears and biopsy specimens from 76 women seen between January 1983 and October 1985 were reviewed. The histologic categories consisted of koilocytotic lesions (flat condylomas) with minimal cellular atypia, CIN I, II, III, with surface koilocytes showing cellular atypia (atypical koilocytosis), CIN III with a contiguous lesion as defined in categories 1 and 2, negative biopsies. Histologically, five cases showed flat condylomas with minimal cellular atypia, 65 showed cervical intraepithelial neoplasia (CIN) with atypical koilocytosis and two showed negative biopsies. Cytologically, in all cases of flat condyloma with minimal cellular atypia (5+5), CIN I with atypical koilocytosis (39/39), and CIN III with a contiguous condylomatous lesion (4/4) both koilocytes and, in the latter two categories, dysplastic cells were identified in the cervical smears. In 7/9 cases of CIN II and 9/17 cases of CIN III with atypical koilocytosis, smears showed both atypical koilocytes and dysplastic cells. In the remaining ten cases, however, there was cytologic underestimation of the histologic diagnosis of CIN, particularly when the lesion was focal. The data suggests that although cytology does detect a high percentage of cervical lesions with koilocytotic features (64/76, 84% in this study), it may not detect focal CIN II, CIN III lesions associated with condylomatous lesions in the same biopsy specimen. Therefore, it is proposed that all women with cytologic evidence of koilocytosis on cervical smears are deserving of a colposcopic examination.

Oral condyloma planus (hairy leukoplakia) among homosexual men: a clinicopathologic study of thirty-six cases

Thirty-six cases of oral condyloma planus (hairy leukoplakia) occurring in homosexual men are reported. The average age is 36.6 years, with a range from 24 to 51 years, and the disorder exhibits a predilection for the fourth decade. More than 86% of the cases are localized to the tongue (72% lateral border, 14% ventral surface). Microscopically, surface candidiasis could be detected with periodic acid-Schiff staining in 88% of the instances. Parakeratosis with koilocytotic atypia was the characteristic histologic finding; however, comparison with twenty-five cases of leukoplakias exhibiting parakeratosis and twenty-five cases of candidiasis among heterosexual individuals disclosed that koilocytotic changes are not specific for condyloma planus. Follow-up data were obtained in thirty-two cases with a mean of 11 months. During this period six patients died or were hospitalized with a diagnosis of acquired immunodeficiency syndrome.

Replication of Epstein-Barr virus within the epithelial cells of oral "hairy" leukoplakia, an AIDS-associated lesion

We conducted a study to identify the viruses in tissue specimens of oral "hairy" leukoplakia, a lesion that is found in immunosuppressed male homosexuals and that is associated with the subsequent development of the acquired immunodeficiency syndrome. When stained for papillomavirus core antigen, 49 of 67 biopsy specimens (73 per cent) yielded positive results in epithelial-cell nuclei. Electron microscopy showed papillomavirus-like particles in all of 25 specimens, and the herpes-type virus described in a previous report was seen in 23 of the 25 specimens. Three specimens had both types of particle in the same individual epithelial cells. Immunofluorescence for herpes simplex virus, varicella-zoster virus, and cytomegalovirus gave negative results in all cases, but 19 of 20 specimens showed intense nuclear staining in epithelial cells for the viral capsid antigen of Epstein-Barr virus (EBV). DNA hybridization using EBV probes in Southern blots demonstrated EBV DNA in all of 13 specimens and found 200 or more viral DNA molecules per cellular genome in 11 of the 13. The whole EBV genome was also demonstrated in the specimens and found to be in linear virion form. We conclude that EBV replicates within the epithelial cells in hairy leukoplakia.

Association of HPV with human genital tumors

Human papillomaviruses (HPV) are clearly responsible for the induction of genital lesions like condylomata acuminata, bowenoid papules, and flat condylomas. Moreover, the DNA of particular virus types (HPV 16 and 18) is found in a substantial number of invasively growing squamous cell carcinomas of the genital tract, suggesting an etiologic involvement of these viruses in tumor development. Since HPV 16 and 18 as well as other papillomaviruses (HPV 6 or 11) usually present within the benign genital warts can be found in dysplastic lesions of the uterine cervix known as putative precancerous lesions, determination of the virus type might be of diagnostic relevance. Since no type-specific serologic reagents are available, viruses can be identified by nucleic acid hybridization using radioactively labeled HPV DNAs that have been molecularly cloned as probes.

Interferon for the therapy of condyloma acuminatum

Lymphoblastoid interferon, Wellferon, was used to treat patients with resistant and persistent condyloma acuminatum at initial doses of 5, 3, and 1 million unit/square meter (Mu/M2). The objectives of this study were to evaluate the efficacy and toxicity of, and tolerance to, intramuscular and intralesional interferon. Seventeen patients were treated with 5 Mu/M2, 14 patients with 1 Mu/M2, and 37 patients with 3 Mu/M2; daily administration was followed by three-times-a-week dosing. The complete response rate in patients receiving initial dose of interferon of 5 Mu/M2 was 69%, that for doses of 1 Mu/M2 was 43%, and that for doses of 3 Mu/M2 was 57%. All patients given interferon developed initial elevations of temperature of limited duration, whereas all patients given the 5 Mu/M2 dose had to have the amount reduced because of biologic side effects. However, only five of 37 (14%) of the patients given 3 Mu/M2 required a reduction in the dosage, and no patient given 1 Mu/M2 needed to have the dosage reduced. These studies suggest that interferon is efficacious in the treatment of resistant and persistent condyloma acuminatum, and that the biologic side effects were dose-related, well tolerated, and not life-threatening.

Human papillomavirus types 16 and 18 sequences in carcinoma cell lines of the cervix

A total of eight human epithelial cell lines derived from the carcinoma of the cervix were examined for the presence of human papillomaviruses (HPVs) types 16 and 18 DNA sequences. Six out of eight cell lines contain sequences hybridizing to the DNA of these viruses. Two of the cell lines contain sequences hybridizing specifically to HPV 16. One of these two cell lines contains all of the HPV 16 sequences and the other cell line is missing fragments containing early regions E2 and E4 and some of the late regions. Four of the cell lines contain sequences hybridizing specifically to HPV 18. All these cell lines are missing fragments containing early regions E2, E4, and E5. Interestingly, all the cell lines contain sequences corresponding to early regions E1, E6, and E7.

Papillomavirus infection of the anogenital region: correlation between histology, clinical picture, and virus type. Proposal of a new nomenclature

The clinical and histologic picture of 84 anogenital condylomatous and condyloma-like lesions of both sexes were analyzed in an effort to establish a correlation to the different papillomavirus (PV) types. The presence of human papillomavirus (HPV)-specific DNA sequences was confirmed through molecular hybridization and the presence of PV structure antigens was verified in thin sections by means of a group-specific anti-PV-antiserum using the peroxidase-antiperoxidase (PAP) technique. Three distinct clinical forms harboring distinct HPV types were distinguished: (1) Condylomata acuminata in which HPV-6 DNA was present in 37 of 59 samples and HPV-11 DNA in only 13 of 59 samples. HPV-16 DNA was not detected at all and 9 condylomatous lesions remained unclassified. (2) Flat condyloma-like lesions, where HPV-6 and HPV-11 were associated with lesions of low epidermal atypia in 8 and in 2 of 18 cases, respectively, and where HPV-16 was associated exclusively with 6 of 18 such lesions with severe atypia, called bowenoid papulosis. (3) Pigmented papules where HPV-16 was detected twice in lesions of bowenoid papulosis and HPV-11 in 2 of the benign pigmented lesions. The fourth clinical manifestation of genital papillomavirus infections--the so-called condylomata plana--was not available for virologic analysis. Histologically 5 different koilocytotic features were determined which could not be correlated either with one of the clinical pictures or with a specific PV type. HPV-16, however, was found frequently in non-koilocytotic lesions exhibiting the features of severe epithelial atypia known in bowenoid papulosis. The existence of PV structure antigens in these lesions could not be verified using the indirect immunoperoxidase--PAP-technique--in contrast to the koilocytotic lesions where clear evidence of the presence of HPV was proved in 36 of 56 (64.3%) of the cases.

Koilocytotic lesions of the cervix: the interrelation of morphometric features, the presence of papilloma-virus antigens, and the degree of koilocytosis

We studied the interrelation of morphometric features, the presence of human papilloma virus antigens (localized by the immunoperoxidase method), and the degree of koilocytosis in koilocytotic cervical intraepithelial neoplasia. We determined the morphometric features of the cells from the deep, the middle, and the superficial layers of the affected koilocytotic epithelium and in non-koilocytotic immature metaplasia and squamous cervical epithelium. This approach allows quantification of disturbances of maturation in cervical epithelium. Our quantitative findings support the contention of other authors that human papilloma virus infection is associated with a morphologically distinct lesion, which forms a morphological continuum with neoplasia. It can be argued that, in addition to the degree of koilocytosis, nuclear enlargement and excessive cellular enlargement in the middle layer of the affected epithelium are viral-related effects. With increasing immaturity of the cervical intraepithelial neoplasia all investigated viral-related changes are less prominent. These findings suggest that in neoplastic transformation the morphological and antigen expression of human papilloma virus infection is suppressed.

Condyloma acuminatum of the bladder and ureter: case report and review of the literature

We report on a 56-year-old woman with extensive condyloma acuminatum of the external genitalia and vagina, with spread to and diffuse involvement of the urethra, bladder and distal ureters. A chronic course, failure to respond to conservative measures and evidence of malignant transformation led to radical surgical treatment.

Ultrastructure of normal, metaplastic, and abnormal human uterine cervix: use of montages to study the topographical relationship of epithelial cells

The ultrastructure of the entire thicknesses of normal and abnormal human uterine cervical epithelia is studied with the use of slit-type grids. In four normal squamous epithelial specimens, basic similarities in the maturational sequence were apparent; however, significant variation in the progression of differentiation was also obvious. Because of this variation, it was not possible to always correlate cellular structure with cellular location within the epithelial strata. Four normal specimens containing combinations of squamous, columnar, and metaplastic cells show variations in the topographical relationships of these cells and stages in the transition of reserve to squamous cells in metaplastic zones. The presence of cells with features characteristic of squamous and columnar epithelia suggests a bipotentiality of reserve cells. Six abnormal specimens share several morphologic features, which usually, but not regularly, vary quantitatively with the extent of abnormality. Because of the inconsistent gradation of cellular features with lesion severity, it was essential that numerous ultrastructural parameters be considered in order to evaluate the extent of abnormality. Cellular features peculiar to individual specimens include edema, keratinization, phagocytic squamous cells, and cells similar in appearance to koilocytes described in condylomas. Electron micrograph montages of extensive unobstructed areas of normal and abnormal cervices and higher-magnification micrographs of cell components provide improved documentation of the variation in morphology of normal and abnormal epithelia. Use of montages also results in a clear view of ultrastructural changes accompanying the transition from normal to abnormal cervical epithelium.

The use of the carbon dioxide laser in the management of condyloma acuminatum with eight-year follow-up

This paper relates our comprehensive treatment and follow-up of 242 women with condyloma acuminatum over an 8-year period. Laser treatments were carried out at an average power density of 800 W/cm2. Thirty-five patients received a general anesthetic prior to treatment. All other patients were treated in the outpatient clinic. The majority of patients had multiple involvements: 38% had condyloma acuminatum located on the cervix, vulva, and vagina. All of the patients had at least 1 disease-free year following treatment(s) with the carbon dioxide laser; 65% of those treated had at least 2 disease-free years. In many cases, the men were found to have small papillary excrescences on the penis that were not readily diagnosed with the naked eye and were detected only after colposcopic magnification was used. Once the male partner was treated and the female partner was re-treated, the effective cure rate for 1 year was 97%.