The Association of Oncogenic Human Papillomaviruses with Urologic Malignancy

Carcinoma epidermóide da uretra feminina associado ao vírus do papiloma humano: relato de um caso

O carcinoma da uretra feminina é uma doença rara. Os autores relatam o caso de uma paciente de cor preta, com 32 anos de idade, que procurou o serviço com quadro de retenção urinária em nível vesical. A investigação pré-operatória demonstrou tratar-se de um carcinoma epidermóide de uretra a causa da obstrução. O tratamento consistiu da cisto-uretrectomia combinada com linfadenectomia pélvica, histerectomia , salpingo-ooforectomia e ressecção da parede vaginal anterior. A reestruturação do trato urinário foi realizada com a confecção de um reservatório urinário pela técnica de Indiana Pouch. Ao estudo imuno-histoquimico da peça operatória, demonstrou-se reação positiva para o antígeno do vírus do papiloma humano (HPV, sigla em Inglês). Atualmente, após 12 meses de seguimento, a paciente não apresenta sinais de recidiva da neoplasia e desfruta de boa qualidade de vida.

Penile cancer: clinical presentation, diagnosis, and staging

Penile cancer is an uncommon malignancy in developed countries, with an estimated 1290 new cases of invasive penile cancer and 290 deaths among men in the United States in 2009, but is much more common in the developing countries of Asia, Africa, and South America. This disease can result in loss of function, disfigurement, and death. Thus, recognizing penile cancer early in the clinical setting and accurately diagnosing the patients is critical. Because the management and prognosis varies by the extent of local disease, lymph node status, and other factors, accurate staging of penile cancer is of utmost importance. This article focuses on the presentation, diagnosis, and staging of invasive squamous cell carcinoma of the penis. The authors highlight the recent changes to the American Joint Committee on Cancer's staging system for penile carcinoma and discuss other prognostic factors and predictive models.

Prevalence of genital human papillomavirus infections established using different diagnostic techniques among males attending a urological clinic

OBJECTIVE

To compare the accuracy of different diagnostic methods and their use in estimating the prevalence of genital human papillomavirus (HPV) infections in males attending a urological clinic.

MATERIAL AND METHODS

The study population was derived from a series of 1,153 consecutive males attending a urological clinic in São Paulo between January 1996 and November 1998. Of these 1,153 males, 334 had clinically suspected genital HPV infection and comprised the study cohort. The diagnostic methods used included peniscopy, directed biopsy and HPV detection by means of the Hybrid Capture 2 (HC) assay for both oncogenic and non-oncogenic HPV types.

RESULTS

Peniscopy was performed for 297 males, positive results being reported in 237 cases (79.8%). Directed biopsy was performed in 188 males, and histology suggested HPV in 140 of these cases (74.5%). HC confirmed the presence of HPV in only 35.2% of the histologically HPV-suggestive cases. Peniscopy has good sensitivity for identifying male carriers of genital HPV. However, the technique has an inherent low specificity, limiting its usefulness to the correct identification of those who never present with HPV infection. Characteristic histological alterations are useful in suggesting HPV infection, but their correlation with HPV detection using HC is not particularly good.

CONCLUSIONS

These data suggest that both histology and peniscopy have low specificity in detecting male genital HPV. Accurate diagnosis of HPV infection can be confirmed by molecular detection methods only. Histology, however, plays an important role in the differential diagnosis. An appropriate diagnostic protocol for male genital HPV infections in a urological clinic should include peniscopy, histology and molecular diagnostic tools (HC or polymerase chain reaction).

[Advanced urethral carcinoma. Which is the best management of a infrequent disease?]

Urethral cancer is an uncommon tumor (<0.1% of all genitourinary neoplasms). Most of them are squamous carcinoma, adenocarcinomas are about 5% of all urethral cancer. Surgery is the only curative treatment. Surgical technics depend of tumoral location and extension. Conservative surgery is elective if survival is not compromised. Extensive surgery is needed in large lesions. Chemotherapy (CT) and radiotherapy (RT) must be used in patients in which surgery is not possible. Due to the low incidence of this neoplasm is not well established the best therapeutic approach. We present the case of a female (35 years old) with a diagnosis of urethral adenocarcinoma. The initial stage was IV due to non-regional lymph nodes metastases. Surgery was impossible and the patient received chemotherapy and radiotherapy. The patient achieved complete response with CT but a progression was observed in course of RT. The patient died due to systemic progression.

Human papillomavirus infection of the epididymis and ductus deferens: an evaluation by nested polymerase chain reaction

CONTEXT

Human papillomaviruses (HPVs) play an important role in the etiology of squamous cell carcinoma of the uterine cervix. The possible role of the male urogenital tract as a reservoir of HPV infection is not fully understood. We inferred from our previous observation of HPV-31 in epididymal tissue in a case of chronic epididymitis that HPV might be commonly present in cases of epididymitis caused by sexually transmitted pathogens.

OBJECTIVE

To assess the presence of HPV in the epididymis and ductus deferens in nontuberculous epididymitis.

DESIGN

Epididymal samples obtained from 17 patients and epididymal and ductus deferens samples from 5 patients surgically treated for nontuberculous epididymitis were analyzed by nested polymerase chain reaction for the presence of HPV DNA. In positive samples, the HPV type was determined by DNA sequencing.

SETTING

Tertiary-care academic hospital and national reference laboratory for papillomaviruses.

RESULTS

Low-risk HPV type 6 and high-risk HPV types 16, 33, 35, 55, and 73 were detected in 7 patients (31%). Neither koilocytes nor dysplastic changes were found in the epididymis and ductus deferens.

CONCLUSION

Low-risk and high-risk HPV types were detected in the epididymis and ductus deferens of patients with nontuberculous epididymitis. The infection was not accompanied by koilocytic atypia or dysplasia. Our findings support the hypothesis that the male urogenital tract serves as a reservoir of HPV infection.