Detection of human papillomavirus in cutaneous extragenital Bowen's disease in immunocompetent patients

INTRODUCTION: A specific link between human papillomavirus (HPV) types 16, 18, 31, and 33 and genital carcinomas and between HPV type 5 and cutaneous extragenital carcinomas in patients with epidermodysplasia verruciformis and renal transplant has been previously found. The aim of this prospective study was to detect HPV in cases of cutaneous extragenital Bowen's disease (BD) from non-immunosuppressed patients. PATIENTS AND METHODS: Twelve cases of cutaneous extragenital BD or Bowen's carcinoma (BC), seen in the period 1994-1996 and confirmed by histologic examination, were included in the study. Tissue sections were studied by in situ hybridization with a mixture of HPV DNA probes and specific HPV DNA probes. In addition, study on fresh materiel from 1995 included: Southern blot hybridization with various usual HPV probes (6, 11, 16, 18, 31, 33, 35, 39, 42), polymerase chain reaction (PCR) with hybridization using consensus HPV probes and probes specific for HPV types 6, 11, 16, 18 and 33. In positive samples with conventional PCR, in situ PCR with probes specific for HPV types 6/11 and 16 was performed on tissue sections. RESULTS: In situ hybridization was negative in all the cases. Southern blot hybridization was negative in our 9 studied cases. Three cases studied by consensus PCR were positive. PCR with specific HPV probes revealed positivity on two of these cases: HPV 6 in one, and HPV 16 in another. In situ PCR was positive with a mixed 6/11 HPV probe in the third positive consensus PCR case. DISCUSSION: Our study revealed the presence of HPV in 3 out of 12 cases of cutaneous extragenital BD and BC. HPV type 16, found in BC of skull, was the most usually found type in the literature. HPV types 6/11, detected in 2 cases, were rarely found in cutaneous extragenital BD and BC and these results are in favor of the oncogenic effect of these virus types. In our study, in situ hybridization and Southern blot hybridization were negative in all the cases; HPV was only found in 3 cases by conventional PCR and in 1 case by in situ PCR. The low range of detection of HPV in cutaneous extragenital BD may be due to the used methods, to difficulties related to sampling and/or to a low number of copies of the HPV genoma.     

尖锐湿疣皮损中人乳头瘤病毒基因分型研究

目的 采用反向杂交研究尖锐湿疣皮损中人乳头瘤病毒(HPV)的感染状况。方法 提取尖锐湿疣新鲜标本的HPVDNA,采用PGMY09/11引物系统进行聚合酶链反应(PCR)。PCR产物在标记有37种HPV型特异性探针的尼龙膜条带上进行HPVDNA杂交分型。所有DNA模板采用HPV6和11型特异性引物进行PCR检测验证。数据经SPSS11.0统计软件分析。结果 杂交结果显示201例标本HPVDNA均为阳性,共发现31种HPV基因型,其主要的HPV基因型名称及所占比例分别如下:HPV11(53.7%,108/201)、HPV6(43.8%,88/201)、HPV16(6.5%,13/201)、HPV52(6.0%,12/201)、HPV33和HPVcp6108(均为5.5%,11/201)、HPV42(5.0%,10/201)等。60.2%(121/201)的标本由单一型HPV感染,39.8%的标本由混合型HPV感染。HPV6和11型特异性引物PCR结果显示HPV6和11的阳性率分别为45.8%和56.2%,与杂交结果比较,一致性分别为98.5%和96.5%,资值分别为0.97和0.93,P值均<0.001。结论 至少有31种HPV基因型与尖锐湿疣相关。HPV11阳性率最高,HPV68、40、54、67、73、82、35、64和83在尖锐湿疣中少见,HPVcp6108在尖锐湿疣中首次发现,且阳性率较高(与HPV33并列第5位)。HPV26、69、70、71、72和IS39可能与尖锐湿疣不相关。尖锐湿疣中单一型和混合型HPV阳性率分别为60.2%(121/201)和39.8%(80/201)。     

Oncogenic human papillomaviruses in extra-genital Bowen disease revealed by in situ hybridization]

BACKGROUND: The association between mucosal oncogenic human papillomaviruses (HPV) and bowenoid papulosis or genital Bowen's disease is well documented. In contrast this association with extra-genital Bowen's disease is poorly studied. The aim of this study was to detect oncogenic (16/18, 31/33/51) and non oncogenic (8/11) mucosal HPV using a in situ hybridization method in 28 skin biopsy specimens of extra-genital Bowen's disease.PATIENTS AND METHODS: Twenty-eight cases of extra-genital Bowen's disease seen in the period 1990-96 in the Dermatology department were included: 19 women and 9 men (mean age: 72 years). Bowen's disease locations were: hands and feet (8 cases), limbs (11 cases), face (8 cases), trunk (1 case). Blinded histopathologic examination confirmed the diagnosis of Bowen's disease and signs of HPV infection (koilocytosis). In situ hybridization was performed using three biotinylated probes detecting HPV types 6/11, 16/18, 31/33/51.RESULTS: Oncogenic HPV genoma was detected in 8 skin samples (28.6 p. 100). In all these cases, 16/18 probe was positive and in two cases, both 16/18 and 31/33/51 probes were positive; 4/8 Bowen's diseases of the extremities were positive for HPV. Koilocytes were found in 6/8 of skin samples with positive HPV detection.DISCUSSION: Mucosal oncogenic HPV are detected by in situ hybridization in 28.6 p. 100 of extra-genital Bowen's disease. In situ hybridization is an easier technique than Southern-Blot hybridization which is the gold standard. Five studies reported similar results and three studies reported different results that we discuss. A precise understanding of oncogenic HPV implication in the development of extra-genital Bowen's disease could lead to the development of new therapeutic strategies (topical cidofovir or imiquimod).     

Papillated Bowen disease, a distinct variant

Bowen disease usually presents as an irregular, asymptomatic, scaly or crusted erythematous plaque that can occur anywhere on the skin. An unusual clinicopathologic variant is described which presents as a well-circumscribed, papillated, exophytic and endophytic, sometimes keratotic lesion. This papillated variant of Bowen disease exhibits keratinocytes with prominent perinuclear halos suggestive of koilocytic change associated with human papillomavirus (HPV) infections. Classic Bowen disease has been associated in previous studies with a variety of HPV types, especially types 16, 18, and 31. Twenty-six patients with papillated Bowen disease were evaluated. The patients included 15 males and 11 females, ranging in age from 33 to 87 years old. Fifty-four percent (14) of the lesions involved the head and neck, 8% (2) involved the trunk, and the remaining 38% (10) involved extremities (including 3 lesions from the hands). Lesions were examined using in situ hybridization with widely screening genomic probes for HPV types 6, 11, 16, 18, 30, 31, 33, 35, 45, 51, and 52. None of the specimens contained HPV DNA from the more common oncogenic HPV types. Given the striking histologic appearance of these lesions, however, this does not exclude HPV infection detectable by more sensitive screening methods such as polymerase chain reaction. Papillated Bowen disease is distinct from other variants, including the verrucous-hyperkeratotic type.     

Detection of human papillomavirus DNA in nongenital seborrhoeic keratoses

The histological similarities of seborrhoeic keratoses and common warts led to the investigation of the possible occurrence of human papillomavirus DNA (HPV-DNA) in a large number of nongenital seborrhoeic keratoses using the in situ hybridization technique. All specimens derived from normal skin (n=173) were negative for the applied HPV-DNA probe, whereas the HPV genome was detected in 34 of 173 seborrhoeic keratosis specimens (19.65%). Of 34 HPV-positive specimens, 15 contained types 6/11 and 14 types 31/33/35, and 5 showed no positive reaction to the applied types. These results suggest that a considerable percentage of nongenital seborrhoeic keratoses may be related to an HPV infection.Dedicated to Professor Dr. H. Ippen on the occasion of his 70th birthday     

Determinants of low-risk and high-risk cervical human papillomavirus infections in Montreal University students

BACKGROUND: Previous studies have been inconsistent about the degree of sexual transmissibility of cervical human papillomavirus (HPV) infection. The authors hypothesize that risk factors for HPV infection vary according to HPV type. GOAL: To estimate the prevalence of HPV infection in asymptomatic women and to identify risk factors for overall HPV infection and HPV infection by oncogenic and nononcogenic type. STUDY DESIGN: A cross-sectional survey was conducted at the McGill University clinic in Montreal. Cervical specimens were collected from 489 female students presenting at the clinic for a routine Papanicolaou test. Data on potential risk factors was obtained by questionnaire. Human papillomavirus DNA was detected by the polymerase chain reaction using consensus primers (MY09/11) followed by hybridization with generic and type-specific probes using Southern blot and dot blot techniques. RESULTS: The overall HPV prevalence was 21.8%. A low-risk HPV infection was found in 6.2% of the women, 11.8% had a high-risk HPV infection (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58), 7.1% had an unknown HPV type, and 2.7% had a multiple type infection. Two profiles emerged for sexual activity and risk of HPV infection according to oncogenic risk after multivariate analysis. Lifetime frequency of sexual intercourse and lifetime number of oral sex partners was associated with high-oncogenic-risk HPV infections; however, HPV infection with low-oncogenic-risk types was invariant with respect to markers of sexual activity. CONCLUSION: These results suggest that there are differences in epidemiologic correlates of transmission between low-risk and high-oncogenic-risk HPV types based on oncogenicity. This finding has important implications for primary prevention of HPV infection and cervical cancer precursors.     

Evaluation of a solution chemiluminescent hybridization assay for identification of human papillomavirus from paraffin-embedded tissues

Aims To evaluate the use of the Digene Hybrid Capture^TM system, a chemiluminescent hybridization assay for the analysis of low and intermediate/high risk human papillomavirus (HPV) DNA, on paraffin-embedded tissues and to investigate possible reasons for reaction failure. Methods Fifty cervical biopsies were tested by an in situ hybridization (ISH) method using probes for HPV 6/11. 16/18, 31/33/51 and by the Digene Hybrid Capture^TM system. Results The ISH was able to detect HPV in 23 out of the 50 biopsies. Eight samples were positive with the HPV 6/11 probe, 4 with the 16/18 probe. 6 with the 31/33/51 probe and 5 had mixed infections. With the Hybrid Capture^TM system, having taken the mixed infections into account. 40 samples gave concordant results, while total and partial discordances were observed in 6 and 4 samples respectively. The relative sensitivity of the new assay was 91.6% and specificity 84.2% for low risk HPVs; and 80% and 94.3% respectively for intermediate/high risk HPVs. Agreement rates on HPV positivity for either low risk or intermediate/high risk types were 86% and 94% respectively in comparison with ISH results. Conclusion The Hybrid Capture^TM system is simple, reliable in use and suitable for routine discrimination of HPVs in tissue sections from paraffin-embedded blocks. It might thus be of clinical value in the diagnosis and prognosis of HPV infection.     

人乳头瘤病毒DNA在角化棘皮瘤中的表达

目的 探讨角化棘皮瘤组织中人乳头瘤病毒（HPV）感染率,及HPV DNA阳性细胞的分布特征。方法 原位杂交方法检测46例KA和34例正常人皮肤石蜡切片组织标本中HPV6/11、16/18、31/33亚型。结果 31例角化棘皮瘤黏膜型HPV DNA阳性,总阳性率67.39%,两种以上HPV混合感染达83.87％（26/31）,各亚型均以游离型为主;阳性信号位于细胞核内或核边缘,阳性细胞多分布于火山口底部棘层的浅中部及其周围唇部,分布形式多为带状、片状或灶状聚集。正常皮肤对照组HPV DNA各亚型检测均阴性。结论 角化棘皮瘤患者HPV6/11、16/18、31/33感染率高于正常人群,且以游离形式存在为主,推测HPV感染在角化棘皮瘤的发病机制中起作用。     

Papillomavirus infection among abortion applicants and patients at a sexually transmitted disease clinic.

The base-line prevalence of human papillomavirus (HPV) infection among applicants for first trimester induced abortion and among a sexually transmitted disease (STD) clinic population with macroscopically visible condyloma is investigated. Cervical cells were collected from 505 women applying for induced abortion. Cell scrapes were obtained from the surface of the warts from 81 female and 32 male STD patients. HPV DNA 6/11, 16/18, and 31/33/35 were detected by a dot blot technique (ViraPap and ViraType, Life Technologies, Gaithersburg, MD). Of the 505 abortion applicants, 31 (6.1%) had HPV DNA. In the STD population, 64 (79.0%) patients had positive test results for HPV DNA from cervical, introital cell scrapes, or both. Of the 32 male STD patients from whom preputial, urethral samples, or both were taken, 24 (75%) had HPV DNA. After typing, the relative proportion of HPV 6/11 was 9.7% in abortion applicants, 72.2% in female STD patients, and 91.3% in male STD patients. The relative proportion of high-risk HPV types, such as 16/18 and 31/33/35, was 89.7% among abortion applicants, 38.9% among female STD patients and 13.0% among male STD patients. The majority of abortion applicants infected with HPV were thus infected with a potentially oncogenic HPV type, and the prevalence of HPV type 16/18 and 31/33/35 was also high among female STD patients.     

Giant-sized condyloma of the breast with focal acantholytic changes

BACKGROUND: A healthy 26-year-old pregnant woman presented with a 6.0-cm exophytic mass in her left inframammary fold. The lesion was surgically excised. METHODS: Histopathologic sections of the skin lesion were reviewed in hematoxylin and eosin-stained slides. Additional sections were studied by an in situ hybridization method for human papillomavirus DNA (HPV) types 6 and 11. RESULTS: The histopathologic examination demonstrated a benign exophytic, verrucous and papillary epidermal proliferation with features of condyloma acuminatum. Reactivity to HPV DNA types 6 and 11 was demonstrated by in situ hybridization method. The epidermis adjacent to, and focally within, the neoplasm showed multiple areas of suprabasilar and intraepidermal acantholysis without dyskeratosis. CONCLUSIONS: Condylomas related to HPV 6 and 11 may be found in extragenital locations including conjunctiva, oral and nasal mucosa. To our knowledge, however, the extragenital condylomas described in the literature have not included the giant-sized variant. We describe an example of a benign, giant-sized condyloma acuminatum of the breast with nearby acantholytic alterations similar to Hailey-Hailey disease.     

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.     

Triple cancers in the urogenital area of a patient with aplastic anemia.

Three epithelial neoplastic lesions, perineal Bowenoid papulosis, uterine cervical carcinoma, and bladder transitional cell carcinoma, which occurred in a mildly immunosuppressed patient who had aplastic anemia were studied for human papillomavirus (HPV) infection. In the Bowenoid papulosis, HPV type 16 DNA was identified by polymerase chain reaction (PCR) and by in situ hybridization (ISH). In contrast, in the uterine cervical carcinoma, HPV 16 was not detected, although possibly another unidentified type of HPV in the lesion was suggested by the ISH findings. In the bladder transitional cell carcinoma, neither papillomavirus genus-specific (PGS) antigen nor HPV DNA was found.     

Human papillomavirus Type 2 DNA in oral and labial verruca vulgaris

Twenty instances of verruca vulgaris, equally divided between oral mucosa and lip vermillion, were assayed for the presence of human papillomavirus (HPV) capsid antigen and type-specific DNA employing in situ hybridization methods. All 10 cases arising on lip vermillon expressed capsid antigen and harbored HPV Type 2 genomes as assessed under conditions of high stringency DNA hybridization. Oral verrucae rarely expressed capsid antigen; HPV Type 2 genomes were encountered in 20% of the cases.     

Detection of human papillomavirus type 58 in polydactylous Bowen's disease on the fingers and toes of a woman - concurrent occurrence of invasive vulval and cervical carcinomas

The group related to human papillomavirus (HPV) type 16 (HPV-16, -31, -33, -35, -52, -58 and -67) is dominantly identified in cervical intraepithelial neoplasia and cervical carcinomas. HPV-16 has also been frequently detected in Bowen's disease on the hands and feet. We describe herein a case of polydactylous Bowen's disease on the fingers and toes of a woman who had had radical vulvectomy and hysterectomy for concomitant invasive vulval and cervical carcinomas. All the lesions, except for the lesions on the periungual side of her left index, middle and ring fingers, harbored HPV-58 DNA with more than 100 entire viral genome copies per cell detected by Southern blot hybridization. The histological localization of the viral DNA was confirmed in all the lesions by in situ hybridization. We could also retrospectively demonstrate HPV-58 DNA in her invasive vulval and cervical carcinoma tissues.     

核酸分子原位杂交检测人乳头瘤病毒与光镜诊断尖锐湿疣的比较及其图像定量分析

采用原位杂交方法对 50例尖锐湿疣组织进行 HPV6B、11型检测。其中光镜诊断为尖锐湿疣的 2 3例中 14例阳性 ,阳性率 60 .9% ;光镜诊断符合尖锐湿疣的 2 7例中 7例阳性 ,阳性率 2 5.9%。结果提示 :原位杂交方法对尖锐湿疣的诊断、鉴别诊断、防止误诊、漏诊 ,提高确诊率 ,可以提供直接可靠的依据。图像定量分析对于判断 HPV感染的程度及其 DNA含量有一定意义。     

原位分子杂交检测尖锐湿疣组织中HPV DNA的研究

本文采用HPV DNA原位分子杂交法检测了30例尖锐湿疣组织标本，结果显示HPV6/11型阳性检出率为86.6%，HPV16/18型为16.6%，HPV31/33/35则为阴性，总的阳性检出率为90%。阳性结果作见于表皮浅层外，还见于棘细胞层中下部及基底细胞层内，作者认为原位分子杂交法是目前检测HPV感染及其分型的一种敏感、特异、快速且相对简便的方法，又能进行感染的组织学定位，同时这一方法还适应于对以往病例进行回顾性调查。     

Acquisition and clearance of perianal human papillomavirus infection in relation to HIV-positivity in men who have sex with men in the Netherlands

This study was performed to establish the prevalence of perianal human papillomavirus (HPV) infection in relation to HIV-positivity in a group of men who have sex with men (MSM), and to correlate follow-up data with regard to acquisition and clearance of HPV infection. Data with regard to HPV prevalence and HIV serostatus during two visits were compared. At both visits participants underwent a routine venereological examination and swabs were taken from the perianal region for HPV DNA testing. During both visits HPV types 16, 18, 31, 33 and 52 were significantly more often detected in HIV-positive individuals. Persistence of HPV type 31 at the perianal region was significantly more often seen in HIV-positive MSM (p=0.036) while the incidence of type 16 may be associated with HIV positivity (p=0.059). In HIV-positive MSM significantly more high-risk HPV types were detected at the perianal region.     

Human papillomavirus types 16 and 39 in a vulval carcinoma occurring in a woman with Hailey-Hailey disease

A woman with Hailey-Hailey disease, suffering from carcinoma of the vulva, was examined by histology and for the presence of human papillomavirus (HPV) DNA by polymerase chain reaction (PCR) and in situ hybridization. Our diagnosis by histological examination revealed the vulval carcinoma to be a squamous cell carcinoma (SCC), adjacent to lesions of Hailey-Hailey disease and severe dysplasia/carcinoma in situ [vulval intraepithelial neoplasia (VIN) III]. The PCR with consensus primers for the L1 region (L1-PCR) successfully amplified HPV DNA using total DNA extracted from formalin-fixed and paraffin-embedded tissue specimens. Restriction fragment length polymorphism analysis and sequencing of L1-PCR products revealed HPV types 16 and 39. HPV 16-specific primers for the E6 region identified HPV 16 DNA. In situ hybridization analysis with biotinylated HPV 16 and 39 DNA probes revealed the presence of the HPV 39 genome in the nuclei of the tumour cells in the SCC. These results indicate that HPV 16 and 39 are associated with lesions in vulval carcinoma. Regarding the patient's susceptibility to infection in the case of Hailey-Hailey disease, there is a possibility that HPV was inoculated into the lesions of Hailey-Hailey disease and induced those of VIN III and SCC.