Detection of human papillomavirus DNA in oral mucosal lesions using in situ DNA-hybridization applied on paraffin sections

The in situ DNA hybridization technique, carried out under stringent conditions, was used to detect human papillomavirus (HPV) DNA of types 6, 11, and 16 in paraffin sections of 32 surgically treated oral mucosal lesions. Expression of HPV structural proteins was analyzed by means of the immunoperoxidase (IP-PAP) method. A total of 10 (31.3%) of the 32 lesions proved to express HPV antigens, which were found in 4 of 7 squamous cell papillomas, in 2 of 2 classic condylomas, in 2 of 10 papillary hyperplasias, and in 2 of 3 leukoplakia lesions. Two of the squamous cell papillomas contained HPV 6 DNA, and 4 additional lesions were positive for HPV 11 DNA. In one of the condylomas, a double infection by HPV 6 and 11 was found, while the second was positive for HPV 11 alone. Both the HPV antigen-positive papillary hyperplasias contained HPV 6 DNA, as did the HPV antigen-positive leukoplakia lesions. Of the latter, one was infected by HPV 6 and 11. DNA of the "high-risk" HPV 16 was contained in two lesions: one lichen planus lesion and one of the two squamous cell carcinomas. The results confirm the previously reported evidence of HPV involvement in oral mucosal lesions. The implications of these findings are discussed in terms of the well-established premalignant character of oral leukoplakia and oral lichen planus, although far less commonly versus leukoplakia, with special emphasis on the discovery of the "high-risk" HPV 16 in the latter as well as in oral cancer.(ABSTRACT TRUNCATED AT 250 WORDS)     

Human papillomavirus (HPV) DNA sequences in oral precancerous lesions and squamous cell carcinoma demonstrated by in situ hybridization

A series of routinely processed, paraffin-embedded biopsies from 73 surgically treated oral precancerous lesions (OPL) (22 cases), and oral squamous cell carcinomas (SCC) (51 cases), was first screened using an in situ DNA hybridization technique with a human papillomavirus (HPV) DNA probe cocktail containing the 35S-labelled DNA of HPV types 6, 11, 13, 16, 18 and 30. The specific HPV types in lesions shown to contain HPV DNA in this procedure were further analysed by using in situ hybridization and the 6 HPV DNA probes separately. A total of 12/73 (16.4%) of the lesions proved to contain HPV DNA; 6/51 (11.8%) carcinomas and 6/21 (28.6%) dysplasias. The most frequent sites of HPV DNA-positive lesions were palate (4/7; 57%), followed by the floor of the mouth (2/8; 25%), the tongue and gingiva (11.8%). HPV 13 or HPV 30 were not found in any of the lesions studied. HPV 11 DNA was demonstrated in 2 mild dysplasia lesions, but not in carcinomas. One additional mild dysplasia proved to contain HPV 6 DNA. HPV 16 DNA was present in 5 biopsies; 3 carcinomas and 2 dysplasias. In one of the HPV 16-positive carcinomas, HPV 18 DNA was simultaneously present. HPV 18 alone was found in 3 additional carcinomas and in one moderate dysplasia lesion. The results confirm the recently reported evidence on HPV involvement in OPL and oral cancer. The implications of these findings are discussed in terms of the possible HPV etiology of oral SCC. The use of the in situ DNA hybridization as a powerful tool (enabling the localization of specific HPV DNA sequences and the proper classification of the lesion at the same site) in the study of routinely processed oral biopsies is strongly advocated.     

Human papillomavirus (HPV) DNA sequences in oral precancerous lesions and squamous cell carcinoma demonstrated by in situ hybridization

A series of routinely processed, paraffin-embedded biopsies from 73 surgically treated oral precancerous lesions (OPL) (22 cases), and oral squamous cell carcinomas (SCC) (51 cases), was first screened using an in situ DNA hybridization technique with a human papillomavirus (HPV) DNA probe cocktail containing the 35S-labelled DNA of HPV types 6, 11, 13, 16, 18 and 30. The specific HPV types in lesions shown to contain HPV DNA in this procedure were further analysed by using in situ hybridization and the 6 HPV DNA probes separately. A total of 12/73 (16.4%) of the lesions proved to contain HPV DNA; 6/51 (11.8%) carcinomas and 6/21 (28.6%) dysplasias. The most frequent sites of HPV DNA-positive lesions were palate (4/7; 57%), followed by the floor of the mouth (2/8; 25%), the tongue and gingiva (11.8%). HPV 13 or HPV 30 were not found in any of the lesions studied. HPV 11 DNA was demonstrated in 2 mild dysplasia lesions, but not in carcinomas. One additional mild dysplasia proved to contain HPV 6 DNA. HPV 16 DNA was present in 5 biopsies; 3 carcinomas and 2 dysplasias. In one of the HPV 16-positive carcinomas, HPV 18 DNA was simultaneously present. HPV 18 alone was found in 3 additional carcinomas and in one moderate dysplasia lesion. The results confirm the recently reported evidence on HPV involvement in OPL and oral cancer. The implications of these findings are discussed in terms of the possible HPV etiology of oral SCC.(ABSTRACT TRUNCATED AT 250 WORDS)     

Detection of human papillomavirus-genomic DNA in oral epithelial dysplasias, oral smokeless tobacco-associated leukoplakias, and epithelial malignancies

Human papillomavirus (HPV) is an infectious agent that is increasingly associated with mucosal cancers, in particular cancer of the cervix. The present investigation was undertaken in an attempt to determine whether HPV could be easily detected in biopsies of oral tissues, specifically oral squamous cell carcinomas, oral epithelial dysplasias, smokeless tobacco keratoses, verrucous hyperplasia, and verrucous carcinoma. In situ DNA hybridization methods were used to isolate specific HPV genomes. Among 100 instances of benign leukoplakia, only 4% of non-tobacco-related and 10% of smokeless tobacco-related lesions harbored viral sequences. We were able to detect viral sequences in dysplastic lesions 3% of the time. Alternatively, 17% and 20% of the verrucous hyperplasias and verrucous carcinomas were positive for viral nucleic acids. Six percent of the squamous cell carcinomas harbored HPV. On the basis of these findings, it is concluded that HPV of known genotype can be identified in oral premalignant and malignant neoplasms.     

The prevalence and distribution of human papillomavirus genotypes in oral epithelial hyperplasia: proposal of a concept

Background:  Evidence is accumulating for the aetiological role of human papillomavirus (HPV) in the pathogenesis of potentially malignant oral mucosal lesions and squamous cell carcinomas.
Methods:  Paraffin tissue sections from 49 patients with 'white patches' of the oral mucosa were investigated histologically, by broad-spectrum PCR followed by genotyping and chromogenic in situ hybridisation (CISH).
Results:  Histologically, 33 flat hyperplasias and 16 papillary hyperplasias were diagnosed. Twenty-two of 28 samples studied (78.6%) were positive for HPV DNA by PCR and six were negative. The following HPV types were detected in decreasing order of prevalence: HPV 35, HPV 6, HPV16, HPV 53, HPV 18, HPV 51 and HPV 55. Seventeen samples (60.7%) contained high-risk HPV DNA. Using CISH, ≥ 1 HPV signals were detected at least in a few epithelial cells in 95% of cases studied. All but one case were positive with the high-risk HPV probe and all HPV infections contained low viral load. Concordant positive results both by PCR and CISH were detected in 14 of 19 cases (73.7%) analysed.
Conclusions:  The high prevalence of HPV infection in hyperplastic 'white patches' of the oral mucosa supports the putative role of HPV at an early stage of oral carcinogenesis. These results further indicate that the majority of white oral mucosal lesions – flat, exophytic, wart-like or papillary proliferations – could be considered as the clinical manifestations of oral HPV infection. This finding has clinical relevance regarding therapy and patient management and may help in elucidating the role of HPV infection in oral carcinogenesis.     

In situ DNA hybridization analysis of oral papillomas, leukoplakias, and carcinomas for human papillomavirus.

Twenty-one papillomas, 23 ordinary benign keratoses, 13 smokeless tobacco keratoses, 10 verrucous hyperplasias, 10 verrucous carcinomas, 17 squamous cell carcinomas, 3 epithelial dysplasias, and 6 lichen planus lesions were evaluated for human papillomavirus (HPV) types 6/11, 16/18, and 31/33/35, with biotinylated double-stranded DNA probes by in situ hybridization. Sixty-two percent (13/21) of oral squamous papillomas were positive for HPV DNA. HPV DNA types 6 and 11 demonstrated the strongest reactivity. Of the 13 cases, 10 also showed some reactivity with HPV-16/18 and -31/33/35. None of the cases of keratoses, epithelial dysplasia, squamous cell carcinoma, verrucous hyperplasia, verrucous carcinoma, or lichen planus were positive for HPV DNA. This study confirms the consistent and frequent finding of HPV DNA in oral squamous cell papillomas and the inconsistency of being able to identify HPV DNA in keratotic, premalignant, or cancerous lesions of the oral mucous membranes.     

端粒酶hTR基因在口腔癌前病变及鳞癌中的表达

目的探讨端粒酶ｈＴＲ基因在口腔癌前病变及鳞癌中的表达。方法用原位杂交技术检测８２例标本,其中正常口腔粘膜７例,上皮单纯性增生７例,上皮异常增生３０例,原位癌、鳞癌３８例。结果正常口腔粘膜及上皮单纯性增生组织中ｈＴＲ表达较弱,阳性细胞主要位于基底层,检出率２８．５６％（４／１４）。癌前病变中随着异常增生程度的增加,ｈＴＲ表达逐渐增强,阳性细胞逐步由基底层向棘层波及,检出率６０％（１８／３０）。原位癌及鳞癌均有较强的ｈＴＲ表达,检出率为８１．５８％（３１／３８）。结论端粒酶的激活可能出现在口腔癌前病变的晚期阶段,在口腔鳞癌的形成过程中起了关键性作用。     

In situ hybridization analysis of human papillomavirus DNA in oral mucosal lesions.

Commercial biotinylated DNA probes specific for human papillomavirus (HPV) types 6 and 11; 16 and 18; and 31, 33, and 35 were used for in situ hybridization analysis of 105 oral mucosal specimens from 5 cases of verruca vulgaris, 15 cases of condyloma acuminatum, 30 cases of squamous papilloma, 20 cases of hyperkeratosis/acanthosis, 15 cases of epithelial dysplasia, 5 cases of carcinoma in situ, and 15 cases of squamous cell carcinoma. Positive hybridization signals were found in 26 specimens (24.8%). Only HPV-6/11 was detected. HPV DNA occurred significantly more often (p less than 0.005, chi-square analysis) in condyloma acuminatum (100%) and verruca vulgaris (100%) than squamous papilloma (13.3%), hyperkeratotic/acanthotic lesions (10%), and malignant and premalignant lesions (0%). The tongue (19.1%) and labial epithelium (17.1%) were infected most frequently. Nuclear reaction products indicating HPV infection were associated primarily with koilocytes. These results demonstrate the usefulness of commercial biotinylated probes for HPV DNA analysis in routine paraffin-embedded lesion specimens. They confirm HPV involvement in benign lesions of the oral mucosa but fail to associate HPV infection with oral cancer and precancer.     

人乳瘤病毒16型和EB病毒感染与口腔鳞癌关系

用多聚酶链反应技术为２１例口腔鳞癌及癌旁正常组织成对标本中的人乳头瘤病毒１６型（ＨＰＶ１６）和ＥＢ病毒（ＥＢＶ）ＤＮＡ作检测。结果口腔鳞癌和癌旁正常组织ＨＰＶ１６ＤＮＡ阳性率分别为５２．４％和１４．３％，ＥＢＶ为８５．７％和３３．３％，ＨＰＶ１６和ＥＢＶ均为阳性者分别为４７．６％和９．５％，癌组织和癌旁正常组织间统计学上均有显著性差异。提示口腔粘膜ＨＰＶ１６或ＥＢＶ感染均与口腔鳞癌发生有关。ＨＰＶ１６和ＥＢＶ在口腔粘膜感染可能有协同致口腔鳞癌作用。     

Loss of the adenomatous polyposis coli gene and human papillomavirus infection in oral carcinogenesis

Recent evidence suggests that loss of heterozygosity (LOH) of the adenomatous polyposis coli (APC) gene plays a role in colorectal tumorigenesis and other cancers. However, little is known as to whether the APC gene contributes to the pathogenesis of oral squamous cell carcinoma. To assess involvement of both the APC gene and the human papillomavirus (HPV) in the development of oral pre-malignant and malignant lesions, we analysed DNA from 14 paired oral normal and pre-malignant or malignant paraffin-embedded biopsy specimens, and DNA from cultured normal and HPV 16-immortalised oral epithelial cells for the presence of LOH of APC and for HPV infection, using PCR based techniques. LOH of APC occurred in 80% of cases of oral epithelial dysplasia, 67% of carcinoma in situ, 50% of invasive squamous cell carcinoma cases, and in the HPV 16-immortalised oral epithelial cells. HPV was detected in half of the biopsy specimens, with HPV 16 as the dominant type. More than half of the carcinoma cases were found to contain both LOH of APC and HPV infection. These results suggest that LOH of APC is an early event during oral tumorigenesis. Our findings also suggest a strong correlation between HPV infection, particularly HPV 16, and LOH of the APC gene in oral squamous cell carcinomas.     

Loss of intercellular substance antigens in oral hyperkeratosis, epithelial dysplasia, and squamous cell carcinoma

Tissues from 20 oral squamous cell carcinomas and 32 leukoplakic lesions were investigated for the presence of intercellular substance antigens by the indirect immunofluorescent technique using sera from patients with proven pemphigus vulgaris. The leukoplakic lesions included 19 hyperkeratoses without histologic evidence of dysplasia and 13 hyperkeratoses with varying degrees of epithelial dysplasia. Oral tissues from 20 healthy subjects were included as a control group. The great majority of squamous cell carcinomas (95%) showed partial or complete loss of the intercellular substance antigen reactivity. Similarly, hyperkeratoses with dysplasia demonstrated, in 92% of the cases, decreased or complete absence of intercellular substance antigen reactivity. Furthermore, the degree of antigenic loss seemed to be directly related to the degree of cellular anaplasia. On the other hand, in the hyperkeratosis group without histologic signs of epithelial dysplasia, retention of normal intercellular substance antigenic pattern was observed in 73.7% of the cases as compared to the control specimens. The authors suggest that further studies are necessary to assess what value lies in determining the loss of epithelial antigens in predicting the malignant potential of dysplastic oral epithelium.     

口腔鳞状细胞癌中人乳头瘤病毒感染的检测

目的检测人乳头瘤病毒(HPV)在口腔鳞状细胞癌中感染及其与口腔癌发生的相关性.方法采用PCR方法,检测30例口腔鳞状细胞癌及5例正常口腔黏膜中HPV 16和18感染.结果 7/30例标本中检测出HPV 16(23.3%);10/30例标本中检测出HPV 18(33.3%).3/30例标本中存在HPV 16和18共感染(10%).5例正常口腔黏膜中未发现HPV 16和HPV 18感染.在检测HPV 16时发现一条新片断(186 nt),经测序此序列与人5号染色体的核酸序列65-175存在99%同源.结论 HPV 16和18可能与口腔鳞状细胞癌的发生密切相关.     

Painless verrucoid plaque on the lower lip

Verruca vulgaris is an uncommon oral lesion which is caused by an infectious agent, HPV. These growths have many clinical features in common with other oral lesions, the most serious of which are verrucous carcinoma and verrucoid squamous cell carcinoma. These various lesions can usually be separated on the basis of clinical and microscopic features. In some cases, however, immunohistochemical studies and DNA hybridization studies may be necessary before an exact diagnosis can be made.     

Oral mucosal changes in women with genital HPV infection

Sixty different types of human papillomavirus (HPV) are currently recognized. Of these, HPV types 1, 2, 4, 6, 7, 11, 13, 16, 18, 30, 32 and 57 have been identified in oral squamous cell lesions. The prevalence and incidence of clinical HPV infections of oral mucosa are incompletely established, and the figures on subclinical and latent infections are completely lacking. Similarly, no data exist on transmission of oral HPV infections. A long-term prospective follow-up study was started to assess the oral mucosal changes related to HPV infection in women with genital HPV infections. The aim was to elucidate whether genital HPV infections predispose the oral mucosa to this virus. This study reports the clinical, histologic and cytologic findings of oral mucosa as related to the genital status of 334 women prospectively followed-up in Kuopio University Central Hospital since 1981. At the time of examination, 5% presented with hand warts. Clinical wart in oral cavity was found in three patients (0.9%) only. Oral mucosa was clinically normal in 207 of 334 (62%) patients examined. Biopsies (n = 255) were taken from the buccal mucosa beneath the linea alba and above the sulcus in the region of the first molar, or from a lesion whenever present. Cytologic scrapings were taken from both sides of the buccal mucosa. Koilocytes were found in 0.9% of the cytologic scrapings, and in 9.4% of the biopsies. Altogether, four squamous cell papillomas and five flat condylomas were found in the biopsies. Morphologic changes suggestive for HPV were present in 25 biopsies. Hyperkeratosis proved to be a frequent finding (34%) in these biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)     

Human herpesvirus-6 (HHV-6) DNA and virus-encoded antigen in oral lesions

Archival oral tissues comprising 51 squamous cell carcinomas, 18 non-malignant lesions and 7 normal mucosa samples were investigated for human herpesvirus-6 (HHV-6)-encoded antigens and HHV-6 DNA. The virus-specific antigens were detected by an immunohistochemical method using monoclonal antibodies. Two further techniques used for HHV-6 DNA detection included the polymerase chain reaction (PCR) with virus-specific primers and in situ hybridization using digoxigenin-labelled oligonucleotides specific for HHV-6A and HHV-6B genotypes. A high proportion (79-80%) of the squamous cell carcinomas were positive for HHV-6 with the various detection methods. In cases of lichen planus and leukoplakia a high prevalence rate (67-100%) was noted with in situ hybridization and immunohistochemical techniques but a lower proportion (22–33%) was detected with the PCR method. All 7 normal tissues tested were negative for HHV-6. The HHV-6 variant B was found in 60% of the oral carcinoma tissues analysed. The study demonstrates the frequent presence of HHV-6 in neoplastic and non-malignant lesions of the oral cavity. While the role of HHV-6 in oral mucosal tissues remains to be determined, the in vitro tumorigenic potential of the virus suggests a possible role in the etiopathogenesis of oral lesions.     

Use of quantum dots to detect human papillomavirus in oral squamous cell carcinoma

Objective:  To examine the association of oral squamous cell carcinoma with human papillomavirus (HPV) using quantum dots (QD) in situ hybridization (ISH).
Methods:  Expression of HPV16/18 was analyzed in a representative collection of 21 oral squamous cell carcinomas by tissue microarrays. The presence of HPV16/18 high risk was detected by applying QDISH which is compared with conventional ISH.
Results:  Seven cases out of 21 (33.3%) were positive for QDISH while 1 out of 21 (4.8%) was positive for ISH, although all of HPV DNA were localized in the nuclei in the spinous and basal cell layer of the epithelium. The difference between these two methods was significant ( P  < 0.05).
Conclusions:  These results demonstrate that the QD might be an efficient method for determination of HPV infection and HPV-associated oral squamous cell carcinoma.     

端粒酶活性在口腔鳞状细胞癌中的表达研究

目的　了解端粒酶活性在口腔鳞状细胞癌中的表达情况并探讨端粒酶活性在口腔鳞状细胞癌演变过程中的作用。方法　对 37例口腔鳞状细胞癌、2 0例癌前病变 (白斑 )、15例口腔良性肿瘤 (乳头状瘤 )及 12例正常口腔组织 ,采用聚合酶链反应 -酶联免疫吸附法检测其端粒酶活性。结果　口腔鳞状细胞癌中的端粒酶活性阳性率明显高于良性肿瘤组织和正常组织。口腔癌前病变组与鳞状细胞癌组基本一致。结论　端粒酶可稳定染色体末端的端粒结构,端粒酶活化在口腔肿瘤恶变过程中起重要作用;端粒酶可作为判断癌变能力的良好分子生物学标志。     

Histopathologic risk factors in oral and oropharyngeal squamous cell carcinoma variants: An update with special reference to HPV-related carcinomas

Accurate identification of the microscopic risk factors of oral and oropharyngeal (OP) squamous cell carcinomas (SCC) and their morphologic variants is of at most importance, as these generally determine treatment modalities, prognosis and overall patient outcome. The great majority of oral and oropharyngeal squamous cell carcinomas are microscopically described as kerartinizing squamous cell carcinoma (KSCC). They bear certain resemblance to keratinizing stratified squamous epithelium. Tobacco habits and excessive consumption of alcoholic beverages have been considered to be the main etiologic agents in these carcinomas. The tumors occurred in older patients more commonly affected the oral tongue and floor of the mouth with well established morphologic risk factors including tumor grade, pattern of invasion and perineural involvement. Within the last 30 years however, the advent and expanding prevalence of high risk human papillomavirus (HPV) as an important etiologic agent for head and neck squamous cell carcinoma, particularly in the OP, has resulted in a significant change in the established morphologic criteria for risk assessment. The majority of HPV relate carcinomas of the OP are nonkeratinizing squamous cell carcinoma (NKSCC). These tumors are found to be more responsive to treatment with a favorable patient outcome and good prognosis. Consequently, alterations in treatment protocols aimed at de-escalation are currently being evaluated. More recently, other morphologic variants that are HPV positive are reported with increasing frequency in the OP and other head and neck sites. As a result, several clinical and pathologic questions have emerged. Importantly, whether the virus is biologically active in these tumors and involved in their pathogenesis, and second, what are the clinical implications with regard to patient management and outcome in the HPV-related variants. Examples of HPV-related squamous cell carcinoma variants that will be addressed here are: basaloid squamous cell carcinoma (BSCC), undifferentiated carcinoma (UCa), papillary squamous carcinoma (PSCC) and small cell carcinoma. Some studies have suggested favorable prognosis in some variants, analogous to that of the (NKSCC), while others showed poorer outcome. So far the number of studies on this subject is limited and the number of cases evaluated in each investigation is few. Because of that, it is prudent at this stage, not to alter management protocols as a result of identification of HPV in these variants and to await additional information Key words:Histopathologic risk-factors, oral cavity, oropharynx, squamous cell carcinoma variants, keratinizing squamous cell carcinoma, nonkeratinizing squamous cell carcinoma, HPV, basaloid squamous cell carcinoma, undifferentiated carcinoma, papillary squamous cell carcinoma, small cell carcinoma.     

端粒酶蛋白催化亚基(hTRT)mRNA在口腔鳞癌形成过程中的表达

目的:观察端粒酶催化蛋白基因hTRT在口腔粘膜恶性转化不同阶段中的表达,探讨其与口腔粘膜细胞恶性程度的关系。方法:用原位杂交技术检测82例标本,其中正常口腔粘膜7例、上皮单纯性增生7例、上皮异常增生30例、原位癌8例、口腔粘膜鳞癌30例。结果:正常口腔粘膜、上皮单纯性增生组织中hTRT的mRNA表达较弱,阳性信号仅局限于上皮基底层及副基底层间,阳性率21.4%(3/14);上皮异常增生中hTRTmRNA阳性表达见于多层上皮细胞,并随细胞异形性增高而表达增强,阳性率46.7%(14/30);口腔粘膜鳞癌组织中hTRT的mRNA有较强阳性表达,阳性率81.6%(31/38)。结论:端粒酶hTRT基因的表达与口腔粘膜细胞的恶性程度密切相关,端粒酶的重新激活在口腔鳞癌的形成过程中起了关键性作用