Human papillomavirus type 6 in grade I transitional cell carcinoma of the urethra

Human Papilloma Virus Infection and Overexpression of P53 Protein in Bilharzial Bladder Cancer

Aims and Background

An association between human papilloma virus (HPV) and bladder cancer has been reported. However, the role of HPV in bilharzial bladder cancer and its prevalence have not yet been clarified.

Study design

We investigated 50 cases for HPV types 16/18 by in situ hybridization. Also, p53 protein expression by immunohistochemistry was evaluated in 41 of the 50 cases, with correlation of these factors to clinicopathologic parameters and tumor relapse after primary treatment.

Results

HPV was detected in 46% of Egyptian bladder carcinomas (23/50 cases). Positivity was 47.8% for squamous cell carcinoma and 36.4% for transitional cell carcinoma. There was a possible viral-bilharzial association as 52.8% of Bilharzial cases, whereas only 12.5% of non-Bilharzial cases were HPV positive (P <0.05). P53 protein was found in 19/41 (46.3%) cases. There was a concordance between HPV and p53 in 58.5% of cases. Neither factor was related to tumor recurrence after primary treatment.

Conclusions

HPV may thus be implicated in the etiology of bilharzial bladder cancer, but a definite causal relationship remains to be demonstrated. HPV together with p53 alterations work in synergy to accelerate the carcinogenic process, as there was concordance in the results of both parameters in 24/41 (58.5%) cases.

Association of human herpes, papilloma and polyoma virus families with bladder cancer

The aim of the present study was to assess the possible etiologic role of human papillomavirus (HPV), human herpes virus (HHV) and the human polyoma virus families (BKV and JCV) in the tumourigenesis of bladder cancer. Thirty biopsy specimens from patients with different grades and stages of bladder cancer, who underwent transurethral bladder cancer resection, and 30 normal bladder mucosa specimens were analysed using polymerase chain reaction (PCR) for the detection of the above three virus family members. The presence of HPV was determined in all specimens with nested PCR and real-time quantitative PCR. All cancerous specimens, including the control group, were found to be negative both by PCR and real-time qPCR for the presence of HPV DNA, whilst all samples examined by PCR tested negative for the presence of HSV-1,2 Varicella zoster virus and HSV-7 DNA. Cytomegalovirus, HHV-6 and HHV-8 exhibited similar incidence in sample positivity in both cancerous and healthy tissues. EBV showed a higher prevalence in bladder cancer specimens compared to healthy tissue (p = 0.048), whilst BKV and JCV were detected only in tumour samples. The presence of EBV in a significant proportion of bladder tumours indicates the etiological role of this virus in cancer tumourigenesis.

High-grade urothelial carcinoma in a kidney transplant recipient with BK virus infection

Bladder malignancy in the kidney transplant recipient is rare and compared with the general population tends to be of high grade and have an aggressive clinical course. In this report, we describe a case of urothelial carcinoma developing in a kidney transplant recipient 6 years after the diagnosis of polyomavirus nephropathy (PVN). BK virus (BKV) DNA was identified in urine and serum by PCR. The diffuse strong staining of SV40 T-antigen and p53 within both the in situ and invasive carcinoma suggest that BKV may play a role in the oncogenic pathway in this clinical setting.

Primary urethral transitional cell carcinoma presenting as a urethral caruncle

Primary urethral neoplasm is an uncommon diagnosis, and carcinomas arising from urethral caruncle are rare. Optimal treatment guidelines are not available because of the limited number of diagnosed cases. However, an aggressive treatment approach is needed to provide the best chance of cure.

Transitional cell carcinoma of the navicular fossa detected human papillomavirus 16

We present a rare case of transitional cell carcinoma of the navicular fossa in an elderly man. We detected the expression of human papillomavirus type 16 specific DNA sequence in the tumor using polymerase chain reaction. Human papillomavirus dissemination into the urethra by urethral instrumentation might cause urethral tumors, such as squamous cell carcinoma or condyloma acuminatum, and also transitional cell carcinoma as seen in the present case.

Transitional cell carcinoma of the fossa navicularis in a man with preexisting adenocarcinoma of the prostate

In this report we present a patient with a history of prostatic adenocarcinoma who was found to have a low-grade/low-stage transitional cell carcinoma of the fossa navicularis. The patient underwent transurethral resection and at approximately 2 years of follow-up he has no evidence of tumor recurrence. Very limited follow-up data exist on which to base management decisions, and this report lends support to the use of transurethral resection alone as a means to treat low-grade/low-stage lesions.

Detection of human papillomavirus DNA and p53 codon 72 polymorphism in prostate carcinomas of patients from Argentina

Background

Infections with high-risk human papillomaviruses (HPVs), causatively linked to cervical cancer, might also play a role in the development of prostate cancer. Furthermore, the polymorphism at codon 72 (encoding either arginine or proline) of the p53 tumor-suppressor gene is discussed as a possible determinant for cancer risk. The HPV E6 oncoprotein induces degradation of the p53 protein. The aim of this study was to analyse prostate carcinomas and hyperplasias of patients from Argentina for the presence of HPV DNA and the p53 codon 72 polymorphism genotype.

Methods

HPV DNA detection and typing were done by consensus L1 and type-specific PCR assays, respectively, and Southern blot hybridizations. Genotyping of p53 codon 72 polymorphism was performed both by allele specific primer PCRs and PCR-RFLP (Bsh1236I). Fischer's test with Woolf's approximation was used for statistical analysis.

Results

HPV DNA was detected in 17 out of 41 (41.5 %) carcinoma samples, whereas all 30 hyperplasia samples were HPV-negative. Differences in p53 codon 72 allelic frequencies were not observed, neither between carcinomas and hyperplasias nor between HPV-positive and HPV-negative carcinomas.

Conclusion

These results indicate that the p53 genotype is probably not a risk factor for prostate cancer, and that HPV infections could be associated with at least a subset of prostate carcinomas.

Transitional cell papilloma of the penis associated with human papilloma virus infection. Report of two cases

Condylomas are one of the most common human papilloma virus (HPV)-related benign lesions of the male genitourinary tract. Although rarely, HPV has also been detected along the urinary tract, using molecular techniques, in transitional cell neoplasms without microscopic signs of koilocytic atypia. When affecting the urethra, condylomas are usually limited to its third distal portion. However, transitional cell neoplasms of the urethra are exceptional and in most of the cases remain limited to its proximal portion. To the best of our knowledge, 12 cases of transitional cell carcinomas and only one case of typical transitional cell papilloma have been described in the anterior urethra. We report two exceptional cases of typical transitional cell papilloma of the glans of the penis near the fossa navicularis which showed microscopic signs of HPV infection.

Transitional cell carcinoma of the fossa navicularis

We report a case of transitional cell carcinoma of the fossa navicularis in an elderly white male. The patient presented in urinary retention, with a large exophytic mass at the external urethral meatus. Both the pathogenesis and natural history of this highly unusual tumor are unclear. Treatment depends on grade and stage of disease. Transurethral resection and fulguration have been successfully used to treat superficial lesions. Segmental resection and partial penectomy, with or without inguinal lymph node dissection, form the mainstay of treatment for invasive disease. The role of chemotherapy for advanced disease is unknown.

Cell-type-specific separate regulation of the E6 and E7 promoters of human papillomavirus type 6a by the viral transcription factor E2

Gene expression of human papillomaviruses (HPV) is tightly controlled by cellular factors and by the virally encoded E2 protein through binding to distinct sites within the regulatory noncoding region. While for the high-risk genital papillomaviruses a single promoter drives the expression of all early genes, a second promoter present in the E6 open reading frame of the low-risk HPV type 6 (HPV6) would allow an independent regulation of E6 and E7 oncogene expression. In this report, we provide the first evidence that E2 regulates both early promoters of HPV6 separately and we show that promoter usage as well as E2 regulation is cell type dependent. Among the different epithelial cell lines tested, only RTS3b cells allowed an expression pattern similar to that observed in naturally infected benign condylomas. While the E6 promoter was repressed by E2 to 50% of its basal activity, the E7 promoter was simultaneously stimulated up to fivefold. Activation of the E7 promoter was mediated predominantly by the binding of E2 to the most promoter-distal E2 binding site. Repression of the E6 promoter depended on the presence of two intact promoter-proximal binding sites. Mutation of both of these repressor binding sites reversed the effect of E2 on the E6 promoter from repression to activation. In contrast, in HT3 cells we observed an E2-mediated activation of the E6 promoter in the context of the wild-type noncoding region. This indicated that repression of the E6 promoter by binding of E2 to both promoter-proximal binding sites did not function in the cellular environment provided by HT3 cells. These data suggest that the separate regulation of the E6 and E7 promoters of HPV6 is mediated through successive occupation of binding sites with different affinities for E2 depending on the intracellular concentration of E2 and on the cellular environment provided by the infected cell.

Papillomavirus infections--a major cause of human cancers

The papillomavirus family represents a remarkably heterogeneous group of viruses. At present, 77 distinct genotypes have been identified in humans and partial sequences have been obtained from more than 30 putative novel genotypes. Geographic differences in base composition of individual genotypes are generally small and suggest a low mutation rate and thus an ancient origin of today's prototypes. The relatively small size of the genome permitted an analysis of individual gene functions and of interactions of viral proteins with host cell components. Proliferating cells contain the viral genome in a latent form, large scale viral DNA replication, as well as translation and functional activity of late viral proteins, and viral particle assembly are restricted to differentiating layers of skin and mucosa. In humans papillomavirus infections cause a variety of benign proliferations: warts, epithelial cysts, intraepithelial neoplasias, anogenital, oro-laryngeal and -pharyngeal papillomas, keratoacanthomas and other types of hyperkeratoses. Their involvement in the etiology of some major human cancers is of particular interest: specific types (HPV 16, 18 and several others) have been identified as causative agents of at least 90% of cancers of the cervix and are also linked to more than 50% of other anogenital cancers. These HPV types are considered as 'high risk' infections. Their E6/E7 oncoproteins stimulate cell proliferation by activating cyclins E and A, and interfere with the functions of the cellular proteins RB and p53. The latter interaction appears to be responsible for their mutagenic and aneuploidizing activity as an underlying principle for the progression of these HPV-containing lesions and the role of high risk HPV types as solitary carcinogens. In non-transformed human keratinocytes transcription and function of viral oncoproteins is controlled by intercellular and intracellular signalling cascades, their interruption emerges as a precondition for immortalization and malignant growth. Recently, novel and known HPV types have also been identified in a high percentage of non-melanoma skin cancers (basal and squamous cell carcinomas). Similar to observations in patients with a rare hereditary condition, epidermodysplasia verruciformis, characterized by an extensive verrucosis and development of skin cancer, basal and squamous cell carcinomas develop preferentially in light-exposed sites. This could suggest an interaction between a physical carcinogen (UV-part of the sunlight) and a 'low risk' (non-mutagenic) papillomavirus infection. Reports on the presence of HPV infections in cancers of the oral cavity, the larynx, and the esophagus further emphasize the importance of this virus group as proven and suspected human carcinogens.

Human papillomavirus infection and transitional cell carcinoma of the bladder. Immunohistochemistry and in situ hybridization

The aim of the present research was to investigate human papillomavirus (HPV) infection by means of immunohistochemistry and in situ hybridization in 76 bladder cancer specimens. A biotinylated DNA probe that recognizes HPV 6/11, HPV 16/18 and HPV 31/33/35 was used for in situ hybridization. A polyclonal antibody recognizing HPV capsid antigen (HPVcAg) was used for immunohistochemistry. In situ hybridization and immunohistochemistry were developed by alkaline phosphatase and immunogold-silver techniques respectively. Our results showed that 25 (32.8%) out of 76 bladder carcinoma specimens reacted with HPVcAg. Twelve (15.7%) out of 76 cases were positive for HPV 16/18-DNA using non-isotopic in situ hybridization. Sixteen cases had koilocytosis. No positive signals were found for HPV 6/11 or 31/33/35-DNA probes.

p53 and human papillomavirus DNA in renal pelvic and ureteral carcinoma including dysplastic lesions

Ninety-eight cases of transitional-cell carcinoma (TCC) of the renal pelvis and ureter, including dysplastic lesions, were studied for tumor incorporation of human papillomavirus (HPV) type-16 and type-18 DNA by in situ hybridization (ISH) with DNA probes for each HPV viral type. Immunohistochemical analysis of p53 expression was also performed. Fresh tumor tissues from 26 patients were also studied for p53 mutations in exons 4 through 9 by direct sequencing and for HPV infection by polymerase chain reaction (PCR). Thirty-two tumors were positive for HPV DNAs, including 6 double-positive cases. Among these tumors, adjacent dysplastic lesions in 21 cases (66%) also revealed identical reactivity. Overexpressed p53 was detected in 26 cases. Expression of p53 was also detected in dysplastic lesions in 19 out of these 26 cases (73%). Three cases were positive for both HPV DNA and p53 antibody. p53 point mutation was detected in 7 of 26 cases, 6 of which were also positive for p53. HPV type-16 DNA was detected in 6 cases by PCR, 4 of which were also ISH-positive. Overexpressed p53 was frequently detected in invasive and non-papillary tumors (p < 0.01) and in high-grade tumors (p < 0.05). HPV infection was more common in non-invasive and papillary tumors (p < 0.05). These findings suggest that HPV infection or overexpression (mutation) of p53 may be an early event and be related to phenotypes of tumor-cell growth patterns and progression.

Detection of human papillomavirus DNA sequences in cancer of the urinary bladder by in situ hybridisation and polymerase chain reaction

OBJECTIVE

To evaluate the prevalence of "high risk" human papillomavirus type 16 (HPV 16) in transitional cell carcinoma of the urinary bladder.

MATERIALS AND METHODS

The study included 10 biopsy specimens from male patients of transitional cell carcinoma of the urinary bladder for the detection of HPV DNA sequences. Specimens were collected from the Urology Clinic of the K.G. Medical College Hospital, Lucknow, India. Detection of HPV DNA was carried out by tissue in situ hybridisation (a single copy gene localisation method) using 3H-labelled HPV DNA probe and also by polymerase chain reaction (PCR) techniques using primers to HPV 16 upstream regulatory region (URR).

RESULTS

Out of 10 cases of transitional cell carcinoma of the urinary bladder, "high risk" HPV 16 DNA was detected only in one (10%) by using in situ hybridisation whereas two cases (20%) were found to be positive by polymerase chain reaction.

CONCLUSION

Our results suggest that the rare occurrence of HPV in bladder carcinoma may not have a causal relation with the viral infection.

Transitional cell carcinoma of the bladder: failure to demonstrate human papillomavirus deoxyribonucleic acid by in situ hybridization and polymerase chain reaction

Human papillomaviruses have been implicated in the pathogenesis of a variety of malignancies, particularly those of the anogenital tract. Some recent reports on the presence of human papillomavirus in bladder cancer have raised the possibility that it might be involved in the development of this malignancy as well. To study this concept, a series of 108 transitional cell carcinomas of the bladder were screened for the presence of human papillomavirus deoxyribonucleic acid (DNA) by in situ hybridization with biotin-labeled human papillomavirus cocktail probe and polymerase chain reaction with human papillomavirus L1 consensus primers. Although the positive controls showed strong hybridization signals, no evidence for human papillomavirus DNA was found in any of the bladder carcinomas by in situ hybridization. Similarly, despite the amplification of a 450 bp product in cervical human papillomavirus lesions (used as positive controls), no signals were obtained in any of the bladder tumors studied. beta-globin gene sequences (110 bp), serving as internal controls, were consistently amplified from all tumor samples, suggesting that cellular DNAs from the carcinoma specimens were sufficient for the amplification reaction. These data indicate that human papillomavirus infection is rare in transitional cell carcinoma of the bladder. The significance of these findings is discussed in relation to previous reports on human papillomavirus involvement in bladder carcinomas.

Transitional cell carcinoma of the bladder: evaluation of the role of human papillomaviruses

OBJECTIVES

The study evaluated the conflicting results of the role of human papillomavirus (HPV) in the development of bladder carcinoma.

METHODS

We analyzed the frequency of HPV types 6, 11, 16, 18, and 33 by using polymerase chain reaction on formalin-fixed, paraffin-embedded specimens, from 75 cases of transitional cell carcinoma (TCC) of the bladder. Fifteen samples of normal urothelium adjacent to TCC (10) or from normal bladder obtained at autopsy (5) served as negative controls.

RESULTS

HPV type 16 deoxyribonucleic acid (DNA) was detected in 2 (2.7%) of the 75 cases of TCC and in none of the normal urinary bladder cases. The 2 patients with HPV type 16 were immunosuppressed after undergoing renal and cardiac transplantation.

CONCLUSIONS

These results strongly suggest that HPVs play a minor role in the development of TCC of the bladder in the general population, although they can act as oncogenic agents in predisposed patients, such as those who are immunosuppressed.

Human papillomavirus type 16 associated with multifocal transitional cell carcinomas of the bladder in two transplanted patients

This report describes two cases of rapidly progressive, multifocal transitional cell carcinomas of the bladder that developed in two patients after renal and cardiac transplantation, respectively. In both cases human papillomavirus (HPV) type 16 DNA was detected using the polymerase chain reaction DNA amplification method. To our knowledge, this HPV type has not been previously described in multifocal bladder transitional cell carcinoma in transplanted patients. Our findings suggest that HPV may play a major role in the development of rapidly progressive, multifocal transitional cell carcinoma in immunosuppressed patients.

Transitional cell carcinoma of fossa navicularis in a man with three other synchronous malignancies

Transitional cell carcinoma arising from the anterior portion of the male urethra is rare, with less than 10 cases reported in the literature. Our patient had a high-grade, highly invasive transitional cell carcinoma originating in the fossa navicularis and extending proximally along the corpus spongiosum, the corpora cavernosa, and blood and lymphatic vessels. In addition, the patient had a concurrent low-grade prostatic adenocarcinoma, a large basal cell carcinoma of the nose, and a squamous cell carcinoma of the penile skin. The previously reported cases are reviewed, with particular reference to the possible association of these tumors with human papillomavirus infection.

Expression of the different viral mRNAs of human papilloma virus 6 in a squamous-cell carcinoma of the bladder and the cervix

The prevalence of HPV6 and HPV11 in benign condylomata or mild dysplasias has led to the view of HPV6/11 as rather harmless viruses in relation to carcinogenesis. However, the detection of HPV6/11 DNA in a number of individual cases of squamous-cell carcinomas of the anogenital/urinary tract could also point to a possible contribution of these viruses in the development of certain malignancies. Recently we have shown that the transcription of the E6 and E7 genes of HPV6 in benign anogenital condylomata is strictly confined to the basal cell layers of the epithelium, which express c-fos mRNA. This report describes the in situ hybridization analysis of individual mRNA species of HPV6 in 2 malignant tumours. A consistent feature of both carcinomas was the lack of detectable amounts of E6 mRNA, while the E7 mRNA was the major transcript observed. In situ hybridization with a riboprobe for c-fos revealed an expression pattern similar to that detected with the E7 probe. Hybridization with a probe specific for mRNA with a coding potential for a full-length E2 protein yielded weak signals in both carcinomas. Using restriction-enzyme analysis, we compared the long control region of HPV6 amplified by polymerase chain reaction from both tumours with already known HPV6 subtypes. In contrast to previous reports suggesting a correlation between genetic alterations in the long control region of HPV6 and increased malignant behaviour, our data do not support this hypothesis.

Human papillomavirus type 6 in squamous cell carcinoma of the bladder and cervix

Human papillomavirus (HPV) types 16 and 18 are the most frequent genotypes identified in genital malignancies, while HPV types 6 and 11 are found predominantly in condylomas and low-grade dysplasias. It is thought that HPV types 16 and 18 represent high-risk genotypes, while HPV types 6 and 11 rarely, if ever, participate in the development of malignant tumors. In a series of over 300 invasive tumors of the lower genital tract analyzed for the presence of HPV three have been found to contain HPV type 6 DNA: two invasive squamous cell carcinomas of the cervix and one squamous cell carcinoma of the bladder. Human papillomavirus type 6 was the only HPV type detected in these tumor DNAs by Southern blot hybridization and by the polymerase chain reaction using both consensus and type-specific primers. In situ hybridization using whole genomic RNA probes localized viral DNA to tumor cells. Although extensive virologic and epidemiologic studies conducted in the last decade indicate that HPV types 16 and 18 are more likely to be associated with high-grade dysplasias and invasive cancer, HPV type 6 may not be as innocuous as previously supposed.

High frequency of human papillomavirus infection in carcinoma of the urinary bladder

BACKGROUND AND METHODS

The prevalence of type 6, 11, 16, 18, and 33 human papillomavirus (HPV) was investigated with the polymerase chain reaction (PCR) on formalin-fixed, paraffin wax-embedded material, including 48 neoplastic and 21 normal urinary bladder specimens. The PCR-amplified DNA were analyzed by gel electrophoresis and dot blot and Southern blot hybridization. Some tissues were tested further by nonisotopic in situ hybridization.

RESULTS

HPV DNA was detected in 39 (81%) of 48 carcinomas and 7 (33%) of 21 normal urinary bladder specimens. The presence of high-risk HPV (types 16, 18, and 33) was increased significantly in carcinoma cases (62%) as compared with normal specimens (14%) (P less than 0.01). Similarly, multiple HPV infections were significantly higher in carcinoma (60%) than in the normal tissues (5%) (P less than 0.01). The overall and high-risk HPV infections in both neoplastic and normal specimens were distributed almost equally in male and female patients. There was no significant correlation between positive results for HPV and histologic grades of the carcinoma.

CONCLUSIONS

These results demonstrate that the urinary bladder in both sexes is another site where infection with the common genital tract HPV may carry a risk of malignant transformation.

Detection of human papillomavirus DNA in cancer of the urinary bladder by in situ hybridisation

The association of the human papillomavirus (HPV) with cancer of the urinary bladder was assessed by in situ hybridisation using probes selective for HPV types 6/11 and 16/18 DNA. No hybridisation signal was detected with the type 6/11 probe on 100 formalin-fixed, paraffin-embedded bladder tumours sampled. However, when the same samples were hybridised with the HPV type 16/18 DNA probe, 11 of 66 (16.6%) papillary and 1 of 10 (10%) solid transitional cell carcinomas gave positive signals. These results suggest the involvement of HPV in cancer of the bladder, although the frequency of multiple HPV types in these tumours is uncertain.

Primary transitional cell carcinoma of the anterior urethra: a rare presentation

A 72 year old Caucasian male presented with symptoms and signs of littritis. There was no response to a two week course of doxycycline. Cysto-urethroscopy revealed a transitional cell carcinoma of the anterior urethra. As there was no response to deep x-ray therapy, radical amputation of the penis was carried out. The literature pertaining to this rare entity is reviewed.

De novo carcinoma of the lower urinary tract in renal allograft recipients

Immunocompetence has been postulated as an important defense against the progression of urothelial carcinoma. Three cases of de novo lower urinary tract carcinoma in renal transplant recipients demonstrated the potential for unusually rapid urothelial extension and invasion in chronically immunosuppressed patients. Two patients had a history of perineal condyloma acuminata; tumors from 1 of these harbored the genetic sequences of human papillomavirus type 6. One patient had multiple manifestations of cyclophosphamide-related urothelial injury, including bladder carcinoma. Treatment of 2 patients culminated in a radical operation during which the remaining native urinary system was resected completely, with sacrifice of the allograft kidney in 1 and diversion into an ileal conduit in 1. The remaining patient underwent urethrectomy and partial cystectomy with a sigmoid conduit.