Papillomavirus-induced anogenital lesions in 121 HIV seropositive men. Clinical, histological, viral study, and evolution]

OBJECTIVE: To determine the prevalence of the Human Papillomavirus (HPV) in Human Immunodeficiency Virus (HIV) infected men, using clinical examination and molecular hybridization in situ. PATIENTS AND METHODS: From May 1995 to May 1997 we studied the prevalence, clinical and histological characteristics, the types and the evolution of the HPV lesions among 121 HIV-infected men. The HPV DNA was determined by molecular hybridization in situ, using biotinylated probes which recognized HPV types 6/11, 16/18 and 31/33/35 in 79 p. 100 (5/19) of the patients (17 biopsies). RESULTS: Sixteen per cent (19/121) of the patients are HPV infected: genital warts in 37 p. 100 (7/19), anal warts in 37 p. 100 (7/19), and ano-genital warts in 26 p. 100 (5/19) of the patients. In every case of anal codyloma, intracanalar lesions were found. In 47 p. 100 (9/19) of the cases, histological exam showed an intra-epithelial neoplasia. The HPV types 6/11, 16/18 and 31/33/51 were positive in 53 p. 100 (9/17), 35 p. 100 (6/17) and 35 p. 100 (6/17) biopsies respectively. High-risk types of HPV have been noted in 71 p. 100 (12/17) of the biopsies. The evolution of the clinical lesions was: recovering in 47 p. 100 (9/19) of the patients (after 3 months of treatment), recurrence in 16 p. 100 (3/19) of the anal warts (after 1 to 3 months of treatment), stabilization in 16 p. 100 (3/19) of the genital warts (after 6 months of treatment) and extension in 11 p. 100 (2/19) of the anogenital warts (after 3 months of treatment). CONCLUSION: The high prevalence of condyloma and dysplasia emphasizes the importance of the anogenital exam in HIV-positive patients. In case of anal lesions, anuscopy and biopsy are required. We insist on the need to closely follow these patients with HPV lesions in order to adapt treatment. Anal cytology and HPV-DNA detection by Hybrid Capture Assay, should be developed for screening and prevention of the malignant transformation of HPV lesions in this population.     

鲍温样丘疹病中hTERT蛋白表达与高危型HPV感染的相关性研究

目的研究hTERT蛋白在鲍温样丘疹病中的表达及与高危型HPV存在的相关性。方法通过原位杂交法研究HPV的存在和免疫组化法检测hTERT蛋白在鲍温样丘疹病中的表达,并探讨hTERT蛋白表达与高危型HPV存在的相关性。结果在26例鲍温样丘疹病标本中,18例(69.2%)为HPV16/18阳性,其中1例HPV16/18阳性标本也有HPV6/11阳性。3例(11.5%)为HPV31/33/35阳性,2例(7.7%)为未定型HPV阳性,21例有高危型HPV存在的标本是hTERT阳性,16例高危型HPV感染的标本呈现了强而弥漫性hTERT蛋白表达。hTERT蛋白表达与高危型HPV的存在显著相关。结论高危型HPV可能诱导了hTERT蛋白的高表达。     

HPV and p53 in cervical cancer.

OBJECTIVE--To determine the prevalence of HPV 16 and 18 E6 by DNA detection and p53 abnormal protein expression in cervical cancers in Hong Kong. MATERIALS AND METHODS--Seventy-three squamous cell cervical cancer biopsy were analysed. Detection of HPV DNA was carried out by the polymerase chain reaction and Southern blotting (PCR/SB) technique using primers to the HPV16 & 18 E6 region and consensus primers to the L1 region. Abnormal expression of the p53 protein was detected by immunohistochemical staining (IHS) using the antibody CM1 on frozen sections of 55 cervical cancer samples. Forty-six samples were analysed for both the presence of HPV DNA and abnormal expression of p53. RESULTS--67.2% of the 64 samples showed the presence of HPV 16 E6 DNA and 39.1% showed the presence of HPV 18 E6 DNA. 32.8% showed the presence of both HPV 16 and 18 E6 DNA. No HPV DNA was shown in 10.9% of samples. Only 3.6% (2) of 55 samples showed positive IHS with CM1. One occurred in a HPV negative sample and the other in a HPV positive sample. CONCLUSION--A high prevalence of HPV DNA was detected in cervical cancer in Hong Kong using the PCR/SB technique. However, abnormal expression of p53 was uncommon amongst patients with or without HPV 16 or 18 infection.     

外阴HPV相关疾病中p~(53),cyclinD1和ki67蛋白表达及其与HPV感染的关系

目的 探讨人乳头瘤病毒(HPV)在外阴HPV相关疾病—尖锐湿疣(CA)、外阴上皮内瘤变(VIN)和外阴鳞状细胞癌(VSCC)中的感染情况及与p53,cyclinD1,ki67蛋白表达的关系。方法 在110例外阴HPV相关疾病中应用核酸分子快速导流杂交基因分型技术检测HPV16/18,HPV6/11的表达,同时用免疫组化SP法检测p53,cyclinD1,ki67蛋白的表达,并与10例正常组织进行对照。结果 HPV16/18在CA组,VIN组及VSCC组的阳性表达率均高于正常对照组,而且其阳性表达率随外阴上皮恶性程度增加而增加;HPV6/11在CA组及VINⅠ组的阳性表达率均高于VINⅡ组及VINⅢ组和正常对照组;以上差异均有统计学意义(P均<0.05)。HPV6/11在VSCC组无阳性表达,HPV16/18感染与p53,ki67表达呈正相关,与cyclinD1表达无相关性。HPV6/11感染与p53,cyclinD1,ki67表达无相关性。结论 HPV16/18感染与重度外阴上皮内瘤变及外阴鳞状细胞癌密切相关;HPV6/11感染是尖锐湿疣及轻度外阴上皮内瘤变的重要病因。HPV16/18感染与p53,ki67蛋白表达呈正相关,它们在外阴鳞状上皮恶变过程中有着协同的作用。     

尖锐湿疣皮损中HPV类型及p53、bcl—2分子表达研究

目的 探讨尖锐湿疣(CA)中HPV（人乳头瘤病毒）感染类型及其p53和bcl－2（B细胞淋巴瘤样因子2）分子在HPV6／11阳性尖锐湿疣发病中的可能作用。方法 用PCR法检测了22例CA皮损中HPV6／11和HPV16／18,用免疫组化方法检测了尖锐湿疣组织中p53和bcl－2分子的表达。结果 （1）所有标本均为HPV6／11阳性,未检测出HPV16／18;（2）40．9％的尖锐疣皮损在表皮角质形成细胞中有p53蛋白的表达,但阳性细胞数量较少,主要散在分布于基底层;（3）bcl－2蛋白在CA及鳞状细胞癌中未见表达。结论 （1）HPV6／11是CA的主要致病病毒;（2）CA中部分出现p53分子表达提示这部分细胞可能已出现恶性转化倾向;（3）bcl-2可能与角质形成细胞来源的良性增生性疾病以及恶性肿瘤关系不大。     

尖锐湿疣人乳头瘤病毒颗粒、核酸及抗原检测

42例尖锐湿疣进行了HPV-DNA序列,HPV抗原和电镜检查。36例(85.7%)HPV-DNA序列检测阳性。其中单一型感染9例,混合型感染27例。以HPV_(11)阳性最多,计32例,HPV_(6b)26例,HPV_(16)19例,HPV_(18)6例。HPV抗原阳性28例(66.7%)。15例查见病毒颗拉(35.7%)。总计阳性率为90.5%(38/42例)。文中对三项检查结果作了比较和分析。     

外阴恶性肿瘤中P21~(WAF1/CIP1) P53及HPV6/11 HPV16/18的检测和意义

目的　探讨P2 1WAF1/CIP1,P5 3及HPV6/11,16/18与外阴恶性肿瘤的关系。方法　P2 1WAF1/CIP1,P5 3用免疫组化SP法检测 ;HPV6/11,16/18用原位杂交法 (ISH)检测。结果　P2 1WAF1/CIP1,P5 3在外阴恶性肿瘤组、外阴上皮内瘤变 (VIN)组、正常对照组中的阳性检测率分别为 40 .0 0 % (12 /3 0 )、63 .3 3 % (19/3 0 ) ,5 2 .3 8% (11/2 1) ,47.62 % (10 /2 1) ,0 (0 /10 )和 0 (0 /10 ) ;外阴病变各组P2 1WAF1/CIP1,P5 3与正常组比较差异均有显著性 (P均 <0 .0 5 ) ;HPV6/11、16/18在外阴恶性肿瘤组、VIN组中的阳性检测率分别为 60 .0 0 % (18/3 0 )和 3 3 .3 3 % (10 /3 0 ) ,42 .86% (9/2 1)和 2 8.5 7% (6/2 1) ,正常对照组没有检测出 ;HPV 6/11阳性率外阴恶性肿瘤组、VIN组与正常组比较差异均有显著性 (P均 <0 .0 5 ) ;外阴恶性肿瘤组HPV16/18阳性率与正常组比较差异有显著性 (P <0 .0 5 )。结论　P2 1WAF1/CIP1P5 3及HPV感染在外阴恶性肿瘤的发生发展中可能起一定的作用     

Lymphomatoid papulosis in childhood with exclusive acral involvement [letter]

Abstract: Lichen sclerosus (LS) is a skin disease that may affect both sexes at all ages and at any site. Its etiology remains unknown. The observation of focal koilocytotic-like changes in the stratum malpighii in prepuce samples of LS in children prompted us to investigate the presence of HPV-DNA. Twenty-three paraffin-embedded samples of LS lesions from children aged 4 to 14 years were studied using nested-PCR and in situ hybridization (ISH). Twelve out of 23 cases amplified HPV-DNA (8 cases corresponded to HPV-DNA type 6; 2 cases each to HPV-DNA types 16 and 18). ISH detected HPV sequences in the nuclei of koilocytotic and some parakeratotic cells in 13 cases (9/13 also HPV-DNA positive by PCR). Our results demonstrated the presence of HPV-DNA in roughly 70% of cases of LS of the prepuce in children. We highlight the observation of koilocytotic-like changes in the prepuce and its association with HPV. The possible pathogenetic significance between the virus and the lesion is not settled.     

尖锐湿疣凹空细胞的观察

本文对９７例尖锐湿疣（ＣＡ）进行聚合酶链反应检测人乳头瘤病毒（ＨＰＶ）ＤＮＡ及光镜下观察凹空细胞的特征。结果显示，９５例有凹空细胞，占９７．９４％。凹空细胞多分布在棘层的中、上层。根据核的改变将凹空细胞分为九型，以镰刀形核、毛虫样核和核大浓染型出现例数最多，分别为７５／９５、７４／９５和６１／９５，此三型对ＣＡ最有诊断价值。ＨＰＶ６、１１阳性９３例（９５．８８％），ＨＰＶ１６、１８、３１、３３、５２ｂ、５８阳性２例（２．０６％），ＨＰＶ６、１１、１６、１８、３１、３３、５２ｂ、５８阴性２例（２．０６％），但有典型的凹空细胞。２例ＣＡ无凹空细胞而ＨＰＶ６、１１为阳性。     

尖锐湿疣组织中人乳头状瘤病毒感染与生存素和增殖细胞核抗原的表达

目的 探讨人乳头状瘤病毒（HPV）6／11、16／18在尖锐湿疣（CA）组织中的感染情况及其与生存素和增殖细胞核抗原（PCNA）表达的关系。方法 HPV分型PCR检测试剂盒检测HPV6／11、16／18在41例尖锐湿疣组织、23例正常皮肤组织中的表达情况，同时用SP免疫组化法检测生存素及PCNA蛋白的表达。结果 ①正常对照组未检测到HPV6／11、16／18感染；HPV6／11在尖锐湿疣中的感染率为87．80％（36／41），与正常对照组比较差异有统计学意义（P〈0．005）；HPV16／18在尖锐湿疣中的感染率为19．51％（8／41），与正常对照组比较差异无统计学意义（P〉0．05）。②生存素和PCNA在尖锐湿疣组织中的阳性率分别为53．66％（22／41）和87．80％（36／41），在正常皮肤组织中的阳性率分别为8．70％（2／23）和47．83％（11／23）。尖锐湿疣组中生存素和PCNA表达的阳性率与正常对照组比较差异均有统计学意义．且尖锐湿疣中两者的阳性表达呈正相关（P=0．009）。③生存素及PCNA在有HPV6／11感染患者中的表达明显强于无HPV6/11感染患者。结论 HPV感染可上调生存素与PCNA的表达。     

Human papillomavirus-DNA loads in actinic keratoses exceed those in non-melanoma skin cancers

Recent studies suggest a role of cutaneous human papillomaviruses (HPV) in non-melanoma skin cancer (NMSC) development. In this study viral DNA loads of six frequent HPV types were determined by quantitative, type-specific real-time-PCR (Q-PCR) in actinic keratoses (AK, n=26), NMSC (n=31), perilesional tissue (n=22), and metastases of squamous cell carcinomas (SCC) (n=8) which were previously shown to be positive for HPV5, 8, 15, 20, 24, or 36. HPV-DNA loads in AK, (partially microdissected) NMSC, and perilesional skin ranged between one HPV-DNA copy per 0.02 and 14,200 cell equivalents (median: 1 HPV-DNA copy per 344 cell equivalents; n=48). In 32 of the 79 HPV-positive skin biopsies and in seven of the eight metastases viral loads were even below the detection limit of Q-PCR. Low viral loads in NMSC were confirmed by in situ-hybridization showing only a few HPV-DNA-positive nuclei per section. Viral loads in SCC, basal cell carcinomas, and perilesional tissue were similar. But, viral loads found in AK were significantly higher than in SCC (p=0.035). Our data suggest that persistence of HPV is not necessary for the maintenance of the malignant phenotype of individual NMSC cells. Although a passenger state cannot be excluded, the data are compatible with a carcinogenic role of HPV in early steps of tumor development.     

Abnormal expression and mutation of p53 in cervical cancer--a study at protein, RNA and DNA levels.

OBJECTIVES: The objectives of this study are to document the status of p53 expression and mutation in cervical cancer at protein, RNA and DNA levels and to relate this to the presence of HPV. MATERIALS AND METHODS: Biopsy specimens from one hundred and three squamous cell carcinoma of the cervix and histologically normal ectocervix were analysed. Fresh tissues were extracted for protein, RNA and DNA and flash frozen tissue cryostat sectioned for immunohistochemical staining. HPV DNA status was determined by PCR using L1 consensus primers and typed for HPV 16 and 18 with E6 specific primers. p53 expression was determined at the protein level by Western blotting on protein extracts and at RNA level by Northern blotting. RESULTS: There was no p53 overexpression or mutation detectable in the protein extracts. Three of 65 (4.6%) of the carcinomas were positive for p53 by immunostaining with the polyclonal antibody CM1. Overexpression at the RNA level was detected in 2 of 32 (6.3%) carcinomas. p53 mutation was screened for by PCR/SSCP (single strand conformation polymorphism) followed by sequencing to define the site of mutation. Two of the cervical cancers (2.0%) showed mutation in p53 in exons 7 or 8. The mutation rate in HPV positive tumours was 1.2% (1/81) and in HPV negative tumours was 5.2% (1/19). CONCLUSION: p53 overexpression or mutation does not seem to play a significant role in cervical carcinomas.     

Differential p53-mediated responses to solar-simulated radiation in human papillomavirus type 16-infected keratinocytes

In immunocompromised patients, cooperative effects of human papillomavirus (HPV) and ultraviolet (UV) radiation have been postulated in the development of non-melanoma skin cancers. The tumor suppressor p53 is a key component of the cellular response to genotoxic agents, such as UV radiation. We have previously demonstrated that in HPV16-infected cells, a higher E6* level was associated with a higher resistance to UV and oxidative stress. Using the two same SKv cell lines, the aim of the present study was to investigate p53 and p21 expression and cell death in HPV-infected keratinocytes in response to UV irradiation and to determine the role of HPV oncoprotein levels on the p53-mediated cellular response. We demonstrated that the weakly E6*-expressing level SKv-e cell line presented both higher cytotoxicity and apoptosis to UV. This high sensitivity was associated with both p53 and p21 nuclear accumulation, while a high E6* level and resistance were associated with no p53 accumulation and a p21 nuclear down-regulation after UV. Moreover, in SKv-e cell line, p21 promoter activation was p53 dependent. Our results suggest that an alteration and/or a modulation of the p53-p21 pathway in response to UV could be determinant for HPV-infected keratinocyte survival and HPV-associated carcinogenic process.     

Human papillomavirus infection in vulvar lesions of lichen sclerosus et atrophicus

Summary Human papillomaviruses (HPV) types 6, 11, 16 and 18 infections were investigated in 18 vulvar lesions of lichen sclerosus et atrophicus (LSA) using in situ DNA hybridization and polymerase chain reaction (PCR) on formalin-fixed paraffin-embedded specimens. Four out of 18 specimens were found to be infected with HPV type 16 using the PCR technique. Interestingly, three of these four patients were in a premenopausal state. This difference proved to be the only distinguishing feature in a comparison of HPV type 16-infected patients with non-infected patients. In situ hybridization revealed no positive result in any case and PCR demonstrated no HPV-DNA type 6, 11 or 18. Patients with HPV type 16-infected lesions may be regarded as at risk of developing vulvar cancer. Therefore, long-term follow-up of this subgroup is particularly important.     

Detection of human papillomavirus (HPV) DNA in oral squamous cell carcinomas by in situ hybridization and polymerase chain reaction

Summary A series of 156 formalin-fixed, paraffin-embedded biopsies from 40 patients with surgically-treated oral squamous cell carcinomas was analysed for the presence of human papillomavirus (HPV) infection by histopathological evaluation, in situ DNA hybridization and polymerase chain reaction (PCR). Epithelial changes suggesting a HPV lesion within, or adjacent to, the carcinoma lesions were found in 16 out of 40 patients (40%). Morphological signs of a flat HPV lesion were found in four cases (10%), those of inverted type in three cases (7.5%), and those of papillary type in nine cases (22.5%). HPV DNA was demonstrated in one of the lesions by in situ hybridization with biotin-labelled DNA cocktail probe containing HPV types 6, 11, 16 and 18. With the PCR technique, samples from 11 (27.5%) of the 40 patients proved to contain HPV DNA. Of these, HPV 6 was demonstrated in one case, HPV 16 in ten cases and HPV 18 in one case. HPV DNA was exclusively detected in the biopsies showing carcinoma tissue or its adjacent precancer lesions. No viral DNA was found in the biopsies derived from the tumour-free resection margins. These results provide further evidence to support the concept of HPV involvement in the aetiology of oral squamous cell carcinomas, most probably acting synergistically with other carcinogens.     

原位杂交检测鲍温样丘疹病及Bowen病中HPV16 DNA

采用生物素标记的核酸探针原位杂交技术,检测了30例鲍温样丘疹病、15例Bowen病中16型人乳头瘤病毒(HPV16)感染的组织定位及染色模式。结果显示,30例鲍温样丘疹病中,HPV16阳性13例;15例Bowen病中,HPV16阳性6例。鲍温样丘疹病、Bowen病中HPV16感染累及棘细胞全层;主要为核内团块状着色。Bowen病中,HPV16感染尚累及基底层细胞且存在HPV的点状染色模式。提示鲍温样丘疹病与Bowen病比较,HPV16感染的组织定位及染色模式均有所不同。     

尖锐湿疣患者角质形成细胞中活化型细胞外信号调控蛋白激酶和活化型p38的检测

目的 探讨尖锐湿疣皮损角质形成细胞中活化型细胞外信号调控蛋白激酶(p-ERK)和活化型p38(p-p38)的表达。方法 采用原位杂交方法诊断HPV6/11相关尖锐湿疣50例;采用免疫组化EnVision二步法检测50例尖锐湿疣皮损中p-ERK和p-p38的表达及分布,并以25例正常人皮肤(包皮)作为对照。结果 ①p-ERK和p-p38在尖锐湿疣角质形成细胞中的表达较正常人上皮中均有不同程度的增强,前者u=4.113,P<0.01;后者u=4.497,P<0.01,其表达主要分布于棘细胞层,阳性信号均定位于胞核。②尖锐湿疣皮损中,p-ERK与p-p38的表达呈显著正相关(r=0.42,P<0.01)。结论 HPV6/11阳性尖锐湿疣患者中,p-ERK和p-p38的表达较正常人皮肤明显增强,提示在HPV6/11感染时,角质形成细胞中激酶ERK和p38的激活增加,可能通过ERK和p38MAPK通路起作用。     

MDM2蛋白和MDM2 mRNA在尖锐湿疣中的表达

目的 研究尖锐湿疣中MDM2蛋白及MDM2 mRNA的表达情况,探讨MDM2在尖锐湿疣增殖及癌变中的作用。方法 分别采用免疫组化染色及原位杂交方法检测外阴尖锐湿疣和正常人皮肤组织中MDM2蛋白及mRNA的表达情况,同时用PCR法检测人乳头瘤病毒(HPV)型别。结果 32例外阴尖锐湿疣中MDM2蛋白阳性表达18例(56.25%),MDM2 mRNA阳性表达22例(68.75%)。MDM2蛋白与mRNA共同阳性表达14例。PCR检测示尖锐湿疣皮损中HPV6/11型28例(87.5%),HPV16/18型4例(12.5%)。在18例MDM2蛋白阳性表达的标本中,HPV6/11型15例,HPV16/18型3例。在22例MDM2 mRNA阳性表达的标本中,HPV6/11型18例,HPV16/18型4例。而正常人皮肤中MDM2蛋白及MDM2 mRNA均未见表达。结论 MDM2的异常表达可能与尖锐湿疣过度增殖及癌变有关。