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Khachemoune A, Juan HY, Singh R. Shedding new light on actinic keratoses and squamous cell carcinoma in situ. JAAPA 2024; 37:1-6. [PMID: 38128142 DOI: 10.1097/01.jaa.0000995696.23729.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
ABSTRACT Cutaneous squamous cell carcinoma can arise from various premalignant lesions such as actinic keratosis, Bowen disease, and premalignant genital squamous cell lesions. Identification and treatment can prevent malignant transformation and death. This article describes the causes, epidemiology, and characteristics of suspicious premalignant squamous cell lesions so that clinicians can identify these lesions and refer patients for specialist treatment as appropriate.
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Affiliation(s)
- Amor Khachemoune
- Amor Khachemoune practices at the Brooklyn (N.Y.) Veterans Affairs Medical Center and SUNY Downstate's Department of Dermatology, also in Brooklyn, N.Y. Hui Yu Juan is a fourth-year medical student at the Virginia Commonwealth University School of Medicine in Richmond, Va. At the time this article was written, Rohan Singh was a third-year medical student at the University of Maryland School of Medicine in Baltimore, Md. Dr. Singh now is a first-year resident at the University of Maryland Medical Center's Department of Internal Medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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2
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Tang Y, Zhu X, Lu W, Song Y, Tao X, Cheng H. Transcriptional analysis reveals distinct gene expression profiles of three bowenoid papulosis patients. Exp Dermatol 2023; 32:1439-1450. [PMID: 37293825 DOI: 10.1111/exd.14847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
Bowenoid papulosis (BP) is a benign and possibly carcinogenic disease associated with human papillomavirus (HPV) infection, which has been increasingly recognised and paid attention to in recent years, but the potential mechanisms still remain unclear. In our study, three patients who were diagnosed with BP were enrolled into our research. Skin biopsies were taken and were separated into two parts, one part was for HE staining and the others were for RNA-sequencing (RNA-seq). All the three patents were human papillomavirus (HPV) positive and HE staining revealed typical skin histopathological changes in BP, including dyskeratosis, hyperplasia and hypertrophy of the granular and spinous layers, atypical keratinocytes. RNA-seq analysis demonstrated that a total of 486 differentially expressed genes (DEGs) were detected between the skin tissues from BP and the controls, among which, 320 genes were significantly upregulated and 166 genes were dramatically downregulated. GO enrichment revealed that antigen binding, cell cycle, immune response and keratinisation to be the most notably altered pathways, whereas KEGG analysis indicated that cell cycle cytokine-cytokine receptor interaction, ECM receptor interaction and p53 signalling pathway to be the most significantly changed signalling pathways in BP. Furthermore, metabolism-associated enrichment analysis showed that cholesterol metabolism, metabolism of xenobiotics by cytochrome p450 and pyrimidine metabolism to be the most dramatically dysregulated metabolic pathways in BP as compared to normal controls. Our study revealed that inflammation, metabolism and cell proliferation signalling pathways might be the most important pathways for BP disease, targeted inhibiting of these signals might be a potential method for BP treatment.
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Affiliation(s)
- Yi Tang
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- Department of Dermatology and Venereology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xiaoxia Zhu
- Department of Dermatology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Wei Lu
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yinjing Song
- Department of Dermatology and Venereology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xiaohua Tao
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Hao Cheng
- Department of Dermatology and Venereology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
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3
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Papastamelos C, Linder M. Human papillomavirus anogenital screening in solid organ transplant recipients: a narrative review. Arch Gynecol Obstet 2023; 307:1277-1283. [PMID: 35476141 DOI: 10.1007/s00404-022-06577-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/12/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To provide a narrative review of anogenital screening for human papillomavirus in solid organ transplant recipients. METHODS Keyword searches of PubMed and Ovid MEDLINE databases were performed. Keywords included human papillomavirus, malignancy, cervical cancer, Pap smear, solid organ transplant, and immunosuppression. Manual searches were also conducted of other relevant journals and reference lists of primary articles. RESULTS Forty-one studies, articles, or clinical practice guidelines across 25 years of literature were included. Eligible literature was written in English or offered an English translation. CONCLUSION Human papillomavirus-related anogenital malignancies disproportionately affect transplant recipients compared to the general population. Evidence-based guidelines for cervical cancer screening and prevention in transplant patients are lacking. Current practice guidelines generally agree on increased Pap screening for transplant recipients compared to the general population. However, recommended screening frequency differs between organizations and amongst medical specialties. Vaccination against HPV remains the most effective strategy to prevent HPV-driven pre-malignant and malignant lesions.
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Affiliation(s)
| | - Mitchell Linder
- University of Rochester Medical Center, Obstetrics and Gynecology, Rochester, NY, USA
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Žulpaitė G, Žulpaitė R, Vėželis A. Scrotal squamous cell carcinoma: a case report. J Surg Case Rep 2023; 2023:rjad128. [PMID: 36974168 PMCID: PMC10039754 DOI: 10.1093/jscr/rjad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 03/27/2023] Open
Abstract
Scrotal squamous cell carcinoma (SCC) is a rare condition that typically manifests in the sixth decade of life and usually presents as a painless, solitary nodule that slowly increases in size, ulcerates, and gets infected. The diagnosis is often delayed, as the majority of patients tend to avoid seeking medical help due to embarrassment. We present a 62-year-old male with a massive 8 cm ulcerating painless tumor in the scrotum. A patient underwent scrotal extirpation with bilateral orchofuniculectomy and diagnostic bilateral inguinal lymphadenectomy. Histopathology revealed a well-differentiated SCC of the scrotal skin. Ignorance, lack of self-awareness, knowledge about risk factors and aggravated access to healthcare facilities remain important reasons for late diagnosis.
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Affiliation(s)
- Giedrė Žulpaitė
- Correspondence address. Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania. E-mail:
| | - Rūta Žulpaitė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
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5
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Hewavisenti RV, Arena J, Ahlenstiel CL, Sasson SC. Human papillomavirus in the setting of immunodeficiency: Pathogenesis and the emergence of next-generation therapies to reduce the high associated cancer risk. Front Immunol 2023; 14:1112513. [PMID: 36960048 PMCID: PMC10027931 DOI: 10.3389/fimmu.2023.1112513] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
Human papillomavirus (HPV), a common sexually transmitted virus infecting mucosal or cutaneous stratified epithelia, is implicated in the rising of associated cancers worldwide. While HPV infection can be cleared by an adequate immune response, immunocompromised individuals can develop persistent, treatment-refractory, and progressive disease. Primary immunodeficiencies (PIDs) associated with HPV-related disease include inborn errors of GATA, EVER1/2, and CXCR4 mutations, resulting in defective cellular function. People living with secondary immunodeficiency (e.g. solid-organ transplants recipients of immunosuppression) and acquired immunodeficiency (e.g. concurrent human immunodeficiency virus (HIV) infection) are also at significant risk of HPV-related disease. Immunocompromised people are highly susceptible to the development of cutaneous and mucosal warts, and cervical, anogenital and oropharyngeal carcinomas. The specific mechanisms underlying high-risk HPV-driven cancer development in immunocompromised hosts are not well understood. Current treatments for HPV-related cancers include surgery with adjuvant chemotherapy and/or radiotherapy, with clinical trials underway to investigate the use of anti-PD-1 therapy. In the setting of HIV co-infection, persistent high-grade anal intraepithelial neoplasia can occur despite suppressive antiretroviral therapy, resulting in an ongoing risk for transformation to overt malignancy. Although therapeutic vaccines against HPV are under development, the efficacy of these in the setting of PID, secondary- or acquired- immunodeficiencies remains unclear. RNA-based therapeutic targeting of the HPV genome or mRNA transcript has become a promising next-generation therapeutic avenue. In this review, we summarise the current understanding of HPV pathogenesis, immune evasion, and malignant transformation, with a focus on key PIDs, secondary immunodeficiencies, and HIV infection. Current management and vaccine regimes are outlined in relation to HPV-driven cancer, and specifically, the need for more effective therapeutic strategies for immunocompromised hosts. The recent advances in RNA-based gene targeting including CRISPR and short interfering RNA (siRNA), and the potential application to HPV infection are of great interest. An increased understanding of both the dysregulated immune responses in immunocompromised hosts and of viral persistence is essential for the design of next-generation therapies to eliminate HPV persistence and cancer development in the most at-risk populations.
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Affiliation(s)
- Rehana V. Hewavisenti
- Immunovirology and Pathogenesis Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Joshua Arena
- Immunovirology and Pathogenesis Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- UNSW RNA Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Chantelle L. Ahlenstiel
- Immunovirology and Pathogenesis Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- UNSW RNA Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Sarah C. Sasson
- Immunovirology and Pathogenesis Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- *Correspondence: Sarah C. Sasson,
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6
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Nemirovsky DR, Singh R, Jalalian A, Malik RD. Urologic dermatology: a comprehensive foray into the noninfectious etiologies of balanitis. Int J Dermatol 2021; 61:1467-1478. [PMID: 34826136 DOI: 10.1111/ijd.15985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/06/2021] [Accepted: 11/06/2021] [Indexed: 11/26/2022]
Abstract
Balanitis is classically defined as inflammation of the glans penis, often also encompassing the prepuce (balanoposthitis). Several investigations have found that a sizable proportion of urology clinic visits are due to balanitis or related complaints. Balanitis can have numerous complications, including severe pain, urethral stenosis, phimosis, sexual dysfunction, and if untreated, malignancy. Unfortunately, there is no recent or comprehensive review that describes the various etiologies, clinical workup, and treatments for balanitis. Herein this review, we attempt to provide the reader with a complete and updated guide to balanitis in an attempt to improve clinical outcomes.
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Affiliation(s)
- Daniel R Nemirovsky
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Rohan Singh
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Aria Jalalian
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Rena D Malik
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Abstract
Cigarette and electronic cigarette use are significant public health concerns across the United States. Tobacco use remains the single most preventable cause of morbidity and mortality in the world. Electronic cigarettes initially emerged as a better alternative to conventional cigarettes and for promoting smoking cessation; however, current evidence reveals similar deleterious health implications caused by both products on almost all organ systems, including the skin. Recognition of the cutaneous manifestations associated with cigarette and electronic cigarette use is essential for dermatologists in current clinical practice. Dermatologists play a vital role in educating and counseling patients on smoking cessation. We specifically highlight the cutaneous consequences of conventional cigarette smoking and electronic cigarettes on dermatologic disease.
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Affiliation(s)
- Andia Mitri
- Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Gloria Lin
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Reid A Waldman
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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8
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Ribeiro CS, Azulay DR, Quintella DC, Cuzzi T, Ramos-e-Silva M. Cutaneous Horn of the Glans. Case Rep Dermatol 2021; 13:304-309. [PMID: 34248537 PMCID: PMC8255720 DOI: 10.1159/000516980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 11/19/2022] Open
Abstract
Cutaneous horn is a protuberance constituted by compact keratinous material, with a hard consistence similar to a horn, which occurs more frequently in photoexposed areas. The authors describe a case of cutaneous horn on the glans considered a rare location. Verrucous carcinoma was the histopathological diagnosis of the base of the horn and lichen sclerosis, the precursor lesion.
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Affiliation(s)
- Camilla Santos Ribeiro
- Sector of Dermatology and Post Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - David Rubem Azulay
- Sector of Dermatology and Post Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Danielle Carvalho Quintella
- Department of Pathology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tullia Cuzzi
- Department of Pathology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ramos-e-Silva
- Sector of Dermatology and Post Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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9
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Ürün YG, Ürün M, Fıçıcıoğlu S. A case of perianal bowenoid papulosis: dermoscopic features and a review of previous cases. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2021. [DOI: 10.15570/actaapa.2021.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Does smoking affect your skin? Postepy Dermatol Alergol 2021; 38:371-376. [PMID: 34377115 PMCID: PMC8330869 DOI: 10.5114/ada.2021.103000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022] Open
Abstract
Smoking has a negative influence on human beings. Carcinogens detected in smoke can increase the risk of developing chronic disorders, cancer and premature death. Nicotine can also affect dermatological diseases such as psoriasis, hidradenitis suppurativa, chronic dermatoses, alopecia, lupus erythematosus, polymorphous light eruption, skin cancer and tobacco-associated oral lesions. Advanced education at a doctor's surgery in various medical occupations can change the bad habits and protect people from the consequences.
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11
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Hagstrom EL, Haynes D, Ortega-Loayza AG. A Treatment-Refractory, Perianal Tumor Arising in an Otherwise Healthy Older Adult Woman. JAMA Dermatol 2020; 156:453-454. [PMID: 32049309 DOI: 10.1001/jamadermatol.2019.4823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Erika L Hagstrom
- Department of Dermatology, Oregon Health and Science University, Portland
| | - Dylan Haynes
- Department of Dermatology, Oregon Health and Science University, Portland
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12
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Kolekar KK, Tambe SA, Nayak CS. In situ squamous cell carcinoma of male and female external genitalia. Indian J Sex Transm Dis AIDS 2020; 40:168-171. [PMID: 31922109 PMCID: PMC6896379 DOI: 10.4103/ijstd.ijstd_108_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In situ squamous cell carcinoma (SCC) of male and female genitalia can present as Bowen's disease (BD), erythroplasia of Queyrat, Bowenoid papulosis, Paget's disease, pseudoepitheliomatous keratotic, and micaceous balanitis. BD is SCC in situ. It affects both skin and mucous membranes and has the potential to progress to invasive SCC. BD can be found on any body site, including both sun-exposed and non-sun-exposed regions of the body. However, BD presenting on the genitalia is rare. Here, we present a report of three cases of in situ genital malignancies. Two females had BD, and one male had erythroplasia of Queyrat.
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Affiliation(s)
- Ketan Kallappa Kolekar
- Department of Dermatology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Swagata Arvind Tambe
- Department of Dermatology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Chitra Shivanand Nayak
- Department of Dermatology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
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13
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Proietti I, Michelini S, Skroza N, Bernardini N, Tolino E, Anzalone A, Colapietra D, Mambrin A, DI Fraia M, Marchesiello A, Balduzzi V, Porta N, Petrozza V, Potenza C. Ingenol mebutate therapy in erythroplasia of Queyrat: a new approach. Ital J Dermatol Venerol 2019; 156:388-391. [PMID: 31804047 DOI: 10.23736/s2784-8671.19.06371-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Erythroplasia of Queyrat (EQ) is a rare squamous cell carcinoma in situ, usually occurring on the glans penis, the prepuce, or the urethral meatus. Therapy is mandatory because it can progress to invasive carcinoma in up to 30% of cases. Treatment options include 5-fluorouracil, curettage, cryotherapy, radiotherapy, laser, partial or total penectomy, and microsurgery, as also with imiquimod and photodynamic therapies. METHODS Between 2015 to 2018 we treated five patients, with histologically confirmed EQ, with ingenol mebutate (IM) 0.015% gel applied for 3 days consecutively. RESULTS Three patients showed complete response at one year follow up. Two patients showed partial response after two months, so they received a second course of therapy with IM. At one-year follow-up, one of them showed complete response, the other partial response. CONCLUSIONS Our experience demonstrated that IM may be considered as an effective and safe treatment option in EQ. IM offers various advantages such as easy and fast application, rapid complete remission, better compliance, few side effects and excellent cosmetical results. The authors call for further exploitation in bigger trials.
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Affiliation(s)
- Ilaria Proietti
- Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy -
| | - Simone Michelini
- Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy
| | - Nevena Skroza
- Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy
| | - Nicoletta Bernardini
- Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy
| | - Ersilia Tolino
- Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy
| | - Alessia Anzalone
- Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy
| | - Daniela Colapietra
- Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy
| | - Alessandra Mambrin
- Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy
| | - Marco DI Fraia
- Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy
| | - Anna Marchesiello
- Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy
| | - Veronica Balduzzi
- Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy
| | - Natale Porta
- Unit of Pathology, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, I.C.O.T. Hospital, Latina, Italy
| | - Vincenzo Petrozza
- Unit of Pathology, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, I.C.O.T. Hospital, Latina, Italy
| | - Concetta Potenza
- Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy
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Santos JMO, Peixoto da Silva S, Costa NR, Gil da Costa RM, Medeiros R. The Role of MicroRNAs in the Metastatic Process of High-Risk HPV-Induced Cancers. Cancers (Basel) 2018; 10:cancers10120493. [PMID: 30563114 PMCID: PMC6316057 DOI: 10.3390/cancers10120493] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 02/08/2023] Open
Abstract
High-risk human papillomavirus (HPV)-driven cancers represent a major health concern worldwide. Despite the constant effort to develop and promote vaccination against HPVs, there is still a high percentage of non-vaccinated population. Furthermore, secondary prevention programs are not ubiquitous worldwide and not widely followed. Metastatic disease is the cause of the great majority of cancer-associated deaths, making it essential to determine its underlying mechanisms and to identify actionable anti-metastatic targets. Within certain types of cancer (e.g., head and neck), HPV-positive tumors show different dissemination patterns when compared with their HPV-negative counterparts, implicating HPV-related factors in the metastatic process. Among the many groups of biomolecules dysregulated by HPV, microRNAs have recently emerged as key regulators of carcinogenesis, able to control complex processes like cancer metastization. In this review, we present recent data on the role of microRNAs in the metastization of HPV-related cancers and on their possible clinical relevance as biomarkers of metastatic disease and/or as therapeutic targets.
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Affiliation(s)
- Joana M O Santos
- Molecular Oncology and Viral Pathology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), 4200-072 Porto, Portugal.
- Faculty of Medicine of the University of Porto (FMUP), 4200-319 Porto, Portugal.
- Research Department of the Portuguese League Against Cancer⁻Regional Nucleus of the North (Liga Portuguesa Contra o Cancro⁻Núcleo Regional do Norte), 4200-177 Porto, Portugal.
| | - Sara Peixoto da Silva
- Molecular Oncology and Viral Pathology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), 4200-072 Porto, Portugal.
- Faculty of Medicine of the University of Porto (FMUP), 4200-319 Porto, Portugal.
| | - Natália R Costa
- Molecular Oncology and Viral Pathology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), 4200-072 Porto, Portugal.
| | - Rui M Gil da Costa
- Molecular Oncology and Viral Pathology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), 4200-072 Porto, Portugal.
- Center for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro (UTAD), 5001-911 Vila Real, Portugal.
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), 4200-072 Porto, Portugal.
- Faculty of Medicine of the University of Porto (FMUP), 4200-319 Porto, Portugal.
- Research Department of the Portuguese League Against Cancer⁻Regional Nucleus of the North (Liga Portuguesa Contra o Cancro⁻Núcleo Regional do Norte), 4200-177 Porto, Portugal.
- Virology Service, Portuguese Oncology Institute of Porto (IPO Porto), 4200-072 Porto, Portugal.
- Biomedical Research Center (CEBIMED), Faculty of Health Sciences of the Fernando Pessoa University, 4249-004 Porto, Portugal.
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15
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Hami LT, Lampe B, Mallmann P, Forner DM. The Impact of Age on the Prognosis of Vulvar Cancer. Oncol Res Treat 2018; 41:520-524. [DOI: 10.1159/000488800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/27/2018] [Indexed: 11/19/2022]
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16
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Abstract
Individuals with cutaneous diseases of the external genitalia often initially present to their primary care provider. When present, these conditions may be associated with considerable physical symptoms and psychological distress. Dermatoses affecting the genitals may be of infectious, inflammatory, or neoplastic cause, and can be processes confined to the genitalia or a manifestation of a more widespread dermatologic condition. This article provides a guide to recognizing and managing common genital dermatoses and when to refer for specialist opinion.
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Affiliation(s)
- Emily Yura
- Department of Urology, Northwestern University, Tarry Building Room 16-703, 300 East Superior Street, Chicago, IL 60611, USA
| | - Sarah Flury
- Department of Urology, Northwestern University, Tarry Building Room 16-703, 300 East Superior Street, Chicago, IL 60611, USA.
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17
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Human Papillomavirus Genotyping of Incidental Malignant and Premalignant Lesions on Hemorrhoidectomy Specimens. Am J Surg Pathol 2017; 41:382-388. [DOI: 10.1097/pas.0000000000000809] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Chiriac A, Brzezinski P, Podoleanu C, Stolnicu S. Erythroplasia of Queyrat Treated with 5% Imiquimod Cream — Case Report Emphasizing the Role of Human Papilloma Virus Testing in a Clinical Setting. JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBackground:Anogenital premalignancies and malignancies often affect females and males, and human papillomavirus infection plays a crucial role in their etiopathogenesis. These lesions are very important and represent an immense public health burden.Case presentation:A 78-year-old Caucasian male presented to the Dermatology Unit for persistent, slowly progressing, well-demarcated, erythematous plaques on the glans penis, observed by the patient 18 months prior to the consultation. Variable topical treatments were applied, with no improvement and with the denial of a punch biopsy. A clinical diagnosis of erythroplasia of Queyrat was established and the test for HPV revealed an association with subtype 16 (which excluded other benign inflammatory conditions). Positive results were obtained after 4 weeks of topical application of 5% imiquimod cream, once daily, 5 times a week.Conclusion:Erythroplasia of Queyrat should be diagnosed in a non-compliant patient based on the clinical picture and HPV testing even in the absence of a biopsy, and a non-surgical treatment should be initiated immediately.
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Schnürch HG, Ackermann S, Alt CD, Barinoff J, Böing C, Dannecker C, Gieseking F, Günthert A, Hantschmann P, Horn LC, Kürzl R, Mallmann P, Marnitz S, Mehlhorn G, Hack CC, Koch MC, Torsten U, Weikel W, Wölber L, Hampl M. Diagnosis, Therapy and Follow-up Care of Vulvar Cancer and its Precursors. Guideline of the DGGG and DKG (S2k-Level, AWMF Registry Number 015/059, November 2015. Geburtshilfe Frauenheilkd 2016; 76:1035-1049. [PMID: 27765958 DOI: 10.1055/s-0042-103728] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: This is an official guideline, published and coordinated by the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO, Study Group for Gynecologic Oncology) of the Deutsche Krebsgesellschaft (DKG, German Cancer Society) and the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG, German Society for Gynecology and Obstetrics). The number of cases with vulvar cancer is on the rise, but because of the former rarity of this condition and the resulting lack of literature with a high level of evidence, in many areas knowledge of the optimal clinical management still lags behind what would be required. This updated guideline aims to disseminate the most recent recommendations, which are much clearer and more individualized, and is intended to create a basis for the assessment and improvement of quality care in hospitals. Methods: This S2k guideline was drafted by members of the AGO Committee on Vulvar and Vaginal Tumors; it was developed and formally completed in accordance with the structured consensus process of the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). Recommendations: 1. The incidence of disease must be taken into consideration. 2. The diagnostic pathway, which is determined by the initial findings, must be followed. 3. The clinical and therapeutic management of vulvar cancer must be done on an individual basis and depends on the stage of disease. 4. The indications for sentinel lymph node biopsy must be evaluated very carefully. 5. Follow-up and treatment for recurrence must be adapted to the individual case.
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Affiliation(s)
| | | | - C D Alt
- Institut für Diagnostische und Interventionelle Radiologie, Universität Düsseldorf, Düsseldorf
| | - J Barinoff
- Klinik für Gynäkologie und Geburtshilfe, Markus Krankenhaus, Frankfurt am Main
| | - C Böing
- Katholisches Klinikum Oberhausen, Frauenklinik St. Clemens-Hospital, Oberhausen
| | - C Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität München, Campus Großhadern, München, Munich
| | - F Gieseking
- Dysplasiezentrum in der Frauenarztpraxis Heussweg, Hamburg
| | - A Günthert
- Frauenklinik Luzerner Kantonsspital, Lucerne, Switzerland
| | - P Hantschmann
- Abteilung Gynäkologie und Geburtshilfe, Kreiskliniken Altötting - Burghausen, Altötting
| | - L C Horn
- Institut für Pathologie des Universitätsklinikums Leipzig, Leipzig
| | - R Kürzl
- ehem. Universitätsfrauenklinik Maistraße, Munich
| | - P Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität Köln, Cologne
| | - S Marnitz
- Klinik und Poliklinik für Radioonkologie und Strahlentherapie der Universität Köln, Cologne
| | - G Mehlhorn
- Universitätsfrauenklinik Erlangen, Erlangen
| | - C C Hack
- Universitätsfrauenklinik Erlangen, Erlangen
| | - M C Koch
- Universitätsfrauenklinik Erlangen, Erlangen
| | - U Torsten
- Klinik für Gynäkologie und Zentrum für Beckenbodenerkrankungen, Vivantes Klinikum Neukölln, Berlin
| | - W Weikel
- Klinik für Gynäkologie und gynäkologische Onkologie, Universitätsfrauenklinik Mainz, Mainz
| | - L Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - M Hampl
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf, Düsseldorf
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Erythroplasia of Queyrat treated by laser and light modalities: a systematic review. Lasers Med Sci 2016; 31:1971-1976. [DOI: 10.1007/s10103-016-2005-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
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Xue R, Elbendary A, Valdebran M, Chaudhari S, Elston D. Pathologic features of anogenital precancerous high-grade squamous intraepithelial lesion (squamous cell carcinoma in situ). J Cutan Pathol 2016; 43:735-9. [PMID: 27152742 DOI: 10.1111/cup.12732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 01/27/2016] [Accepted: 05/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Precancerous high-grade squamous intraepithelial lesion (HSIL), the current consensus terminology for anogenital squamous cell carcinoma in situ (SCCIS), often presents with distinctive histopathologic findings that may be a function of anatomic site or associated human papillomavirus infection. METHODS Fifty-six specimens of anogenital HSIL were compared with an equal number of specimens of SCCIS from non-anogenital sites in regard to the presence of parakeratosis, flag sign in the stratum corneum, compact stratum corneum, hypergranulosis, koilocytes, small blue cells, clonal populations of keratinocytes, pagetoid scatter of atypical keratinocytes, clear cell change, glassy red cytoplasm, pigmentation, nuclear/cytoplasmic(N/C) ratio >2/1, nuclear hyperchromasia, pleomorphic nuclei, mitotic figures, abnormal mitotic figures, dyskeratotic keratinocytes, involvement of skin appendages, acantholysis and amyloid deposition. RESULTS Hypergranulosis, koilocytes, small blue cells, pigmentation, nuclear hyperchromasia, dyskeratotic keratinocytes and amyloid deposition were more frequently noted in anogenital HSIL. Parakeratosis, clear cell change, pleomorphic nuclei, skin appendages involvement and acantholysis were strongly associated with non-anogenital location. There was no significant difference in the incidence of the remaining features. CONCLUSION The strongest predicators of an anogenital location included hypergranulosis, koilocytes, small blue cells and nuclear hyperchromasia. Pigmentation and amyloid deposition were also strongly associated with an anogenital location.
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Affiliation(s)
- Ruzeng Xue
- Department of Dermatology, Guangdong Provincial Dermatology Hospital, Guangzhou, China.,Medical University of South Carolina, Charleston, SC, USA
| | - Amira Elbendary
- Medical University of South Carolina, Charleston, SC, USA.,Dermatology Department, Kasr Al Ainy University Hospital, Cairo University, Giza City, Egypt
| | | | - Soham Chaudhari
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV, USA
| | - Dirk Elston
- Medical University of South Carolina, Charleston, SC, USA
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Hidalgo-Tenorio C, Rivero-Rodriguez M, Gil-Anguita C, Esquivias J, López-Castro R, Ramírez-Taboada J, de Hierro ML, López-Ruiz MA, Martínez RJ, Llaño JP. The role of polymerase chain reaction of high-risk human papilloma virus in the screening of high-grade squamous intraepithelial lesions in the anal mucosa of human immunodeficiency virus-positive males having sex with males. PLoS One 2015; 10:e0123590. [PMID: 25849412 PMCID: PMC4388587 DOI: 10.1371/journal.pone.0123590] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/19/2015] [Indexed: 01/15/2023] Open
Abstract
Objectives To evaluate the advantages of cytology and PCR of high-risk human papilloma virus (PCR HR-HPV) infection in biopsy-derived diagnosis of high-grade squamous intraepithelial lesions (HSIL = AIN2/AIN3) in HIV-positive men having sex with men (MSM). Methods This is a single-centered study conducted between May 2010 and May 2014 in patients (n = 201, mean age 37 years) recruited from our outpatient clinic. Samples of anal canal mucosa were taken into liquid medium for PCR HPV analysis and for cytology. Anoscopy was performed for histology evaluation. Results Anoscopy showed 33.8% were normal, 47.8% low-grade squamous intraepithelial lesions (LSIL), and 18.4% HSIL; 80.2% had HR-HPV. PCR of HR-HPV had greater sensitivity than did cytology (88.8% vs. 75.7%) in HSIL screening, with similar positive (PPV) and negative predictive value (NPV) of 20.3 vs. 22.9 and 89.7 vs. 88.1, respectively. Combining both tests increased the sensitivity and NPV of HSIL diagnosis to 100%. Correlation of cytology vs. histology was, generally, very low and PCR of HR-HPV vs. histology was non-existent (<0.2) or low (<0.4). Area under the receiver operating characteristics (AUROC) curve analysis of cytology and PCR HR-HPV for the diagnosis of HSIL was poor (<0.6). Multivariate regression analysis showed protective factors against HSIL were: viral suppression (OR: 0.312; 95%CI: 0.099-0.984), and/or syphilis infection (OR: 0.193; 95%CI: 0.045-0.827). HSIL risk was associated with HPV-68 genotype (OR: 20.1; 95%CI: 2.04-197.82). Conclusions When cytology and PCR HR-HPV findings are normal, the diagnosis of pre-malignant HSIL can be reliably ruled-out in HIV-positive patients. HPV suppression with treatment protects against the appearance of HSIL.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain
- * E-mail:
| | - Mar Rivero-Rodriguez
- Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Javier Esquivias
- Pathology Service, University Hospital Virgen de las Nieves, Granada, Spain
| | | | | | | | - Miguel A. López-Ruiz
- Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain
| | - R. Javier Martínez
- Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain
| | - Juan P. Llaño
- Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain
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Raptis D, Schneider I, Matzel KE, Ott O, Fietkau R, Hohenberger W. The differential diagnosis and interdisciplinary treatment of anal carcinoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:243-9. [PMID: 25891807 DOI: 10.3238/arztebl.2015.0243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Anal carcinoma accounts for 2-4% of all cases of colorectal and anorectal carcinoma. Its peak incidence is from age 58 to age 64; women are affected somewhat more commonly than men. Its incidence has risen markedly in the past three decades. METHODS This article is based on a selective review of the literature, including the guidelines of the National Comprehensive Cancer Network and the European Society of Medical Oncology. RESULTS Anal carcinoma is often an incidental finding. About 85% of newly diagnosed cases are associated with an HPV infection with strain 16, 18, or 33. Radiochemotherapy with 5-fluorouracil and mitomycin C is the treatment of choice. The 5-year survival rate is 80-90%. Primary surgery with curative intent is indicated only for well-differentiated carcinoma of the anal margin (T1, N0). 10-30% of patients now undergo radical resection. The utility of endosonography and positron emission tomography for staging is debated and needs further study. CONCLUSION The treatment of patients with anal carcinoma requires a specialized multidisciplinary approach in accordance with the current evidence-based guidelines. The potential role of prophylactic vaccination against oncogenic types of HPV in the prevention of anal carcinoma merits further investigation.
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Affiliation(s)
- Dimitrios Raptis
- Department of Surgery, Universitätsklinikum Erlangen, Department of Radiation Oncology, Universitätsklinikum Erlangen
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Reusser NM, Downing C, Guidry J, Tyring SK. HPV Carcinomas in Immunocompromised Patients. J Clin Med 2015; 4:260-81. [PMID: 26239127 PMCID: PMC4470124 DOI: 10.3390/jcm4020260] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/13/2014] [Accepted: 12/19/2014] [Indexed: 12/20/2022] Open
Abstract
Human papillomavirus (HPV) infection is the most common sexually transmitted disease worldwide and can result in pre-malignancies or overt malignancies of the skin and mucosal surfaces. HPV-related illnesses are an important personal and public health problem causing physical, mental, sexual and financial detriments. Moreover, this set of malignancies severely affects the immunosuppressed population, particularly HIV-positive patients and organ-transplant recipients. There is growing incidence of HPV-associated anogenital malignancies as well as a decrease in the average age of affected patients, likely related to the rising number of high-risk individuals. Squamous cell carcinoma is the most common type of HPV-related malignancy. Current treatment options for HPV infection and subsequent disease manifestations include imiquimod, retinoids, intralesional bleomycin, and cidofovir; however, primary prevention with HPV vaccination remains the most effective strategy. This review will discuss anogenital lesions in immunocompromised patients, cutaneous warts at nongenital sites, the association of HPV with skin cancer in immunocompromised patients, warts and carcinomas in organ-transplant patients, HIV-positive patients with HPV infections, and the management of cutaneous disease in the immunocompromised patient.
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Affiliation(s)
- Nicole M Reusser
- Medical School, the University of Texas Health Science Center at Houston, 6431 Fannin, Houston, TX 77030, USA.
| | | | - Jacqueline Guidry
- Center for Clinical Studies, 1401 Binz, Suite 200, Houston, TX 77004, USA.
| | - Stephen K Tyring
- Medical School, the University of Texas Health Science Center at Houston, 1401 Binz, Suite 200, Houston, TX 77004, USA.
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Marcucci C, Sabban EC, Friedman P, Peralta R, Calb I, Cabo H. Dermoscopic findings in bowenoid papulosis: report of two cases. Dermatol Pract Concept 2014; 4:61-3. [PMID: 25396088 PMCID: PMC4230261 DOI: 10.5826/dpc.0404a11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/18/2014] [Indexed: 10/31/2022] Open
Abstract
Bowenoid papulosis (BP) corresponds to an in situ squamous cell carcinoma (SCC) located in the anogenital region. It is related to HPV, and presents with gray-brown elevated papules or plaques. A biopsy is needed to confirm the diagnosis; however, dermoscopy may be useful to differentiate this disease from other conditions, such as genital warts, seborrheic keratosis and lichen planus. In this paper we describe the dermoscopic findings in two patients with this disease.
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Affiliation(s)
| | - Emilia Cohen Sabban
- Dermatology Section, Instituto de Investigaciones Médicas "A. Lanari", University of Buenos Aires, Argentina
| | | | | | | | - Horacio Cabo
- Dermatology Section, Instituto de Investigaciones Médicas "A. Lanari", University of Buenos Aires, Argentina
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Musquer N, Bossard C, Coron E. An uncommon combination of polyps. Gastroenterology 2014; 147:e1-2. [PMID: 25064549 DOI: 10.1053/j.gastro.2014.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 02/27/2014] [Accepted: 03/03/2014] [Indexed: 12/02/2022]
Affiliation(s)
- Nicolas Musquer
- Institut des Maladies de l'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Céline Bossard
- Service d'Anatomo-pathologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Emmanuel Coron
- Institut des Maladies de l'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, Nantes, France
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Antiretroviral therapy as a factor protective against anal dysplasia in HIV-infected males who have sex with males. PLoS One 2014; 9:e92376. [PMID: 24676139 PMCID: PMC3967991 DOI: 10.1371/journal.pone.0092376] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 02/20/2014] [Indexed: 02/03/2023] Open
Abstract
Objectives Chronic infection with oncogenic HPV genotype is associated with the development of anal dysplasia. Antiretroviral therapy (ART) has been shown to decrease the incidence of cervical carcinoma in women with HIV. We sought to: 1) describe the prevalence and grade of anal dysplasia and HPV infection in our study subjects; 2) analyze the grade of correlation between anal cytology, PCR of high-risk HPV, and histology; 3) identify the factors associated with the appearance of ≥AIN2 lesions. Design Cross-sectional, prospective study. Methods A cohort of HIV-positive males (n = 140, mean age = 37 years) who have sex with males (MSM) had epidemiological, clinical and analytical data collected. Anal mucosa samples were taken for cytology, HPV PCR genotyping, and anoscopy for histological analysis. Results Within the cohort, 77.1% were being treated with ART, 8.5% anoscopy findings were AIN2, and 11.4% carcinoma in situ; 74.2% had high-risk (HR), 59.7% low-risk (LR) HPV genotypes and 46.8% had both. The combination of cytology with PCR identifying HR-HPV better predicts the histology findings than either of these factors alone. Logistic regression highlighted ART as a protective factor against ≥AIN2 lesions (OR: 0.214; 95%CI: 0.054–0.84). Anal/genital condylomas (OR: 4.26; 95%CI: 1.27–14.3), and HPV68 genotype (OR: 10.6; 95%CI: 1.23–91.47) were identified as risk factors. Conclusions In our cohort, ART has a protective effect against dysplastic anal lesions. Anal/genital warts and HPV68 genotype are predictors of ≥AIN2 lesions. Introducing PCR HPV genotype evaluation improves screening success over that of cytology alone.
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