The association of condylomata acuminata and squamous carcinoma of the vulva

Vulvar and Anal Intraepithelial Neoplasia: Terminology, Diagnosis, and Ancillary Studies

Currently, it is recognized that there is an HPV-related and an HPV-independent pathway to developing squamous cell carcinomas (SCC) in the anus and vulva. The majority of precursor lesions and SCC in the anus and vulva are high-risk HPV-associated, with HPV16 the most common type. Given the morphologic overlap and biological equivalence of HPV-related preinvasive squamous lesions of the lower anogenital tract, a unified, 2-tiered histopathologic nomenclature is now recommended. In contrast, mutations in the TP53 gene have been associated with HPV-independent vulvar and anal SCC. A precursor lesion-differentiated or simplex vulvar intraepithelial neoplasia (dVIN)-has been identified for HPV-independent vulvar SCC but a similar lesion in the anus has not been described. Extramammary Paget disease is a nonsquamous intraepithelial lesion of the vulva and anus that may be a primary epidermotropic apocrine neoplasm or may represent secondary involvement by a synchronous/metachronous adenocarcinoma. This entity may be mimicked by squamous lesions and melanocytic lesions. Herein, we discuss the morphologic and immunohistochemical features of anal and vulvar intraepithelial neoplasia in the context of updated terminology and current understanding of disease biology.

HIV-1 infection, but not syphilis or HBV infection, is a strong risk factor for anorectal condyloma in Asian population: a prospective colonoscopy screening study

OBJECTIVE

To investigate the association between anorectal precancerous lesions, including condyloma, and sexually transmitted infections (STI) in Asian population.

METHODS

This prospective study enrolled 2677 patients who underwent high-resolution colonoscopy for anorectal cancer screening. Anorectal lesions were diagnosed based on endoscopic findings and confirmed by biopsy. The association of HIV-1 infection, syphilis, and HBV infection with anorectal lesion was estimated by multivariate logistic regression. In HIV-1-infected patients (n=244), anal canal HPV-DNA was screened and genotyped.

RESULTS

Although no malignancy was identified, anorectal condyloma was diagnosed in 32 (1.2%) male patients. 41% of anorectal condyloma cases had no specific lower GI symptoms. Multivariate analysis identified HIV-1 infection, but not syphilis or HBV infection, as an independent significant factor for condyloma (OR: 176.5, 95%CI 22.52-1383, p<0.001). In HIV-1 infected patients, positive type 16/18 HPV-DNA (OR: 4.766, 95%CI 1.838-12.36, p=0.001), lower CD4 cell count (per 100/μl decrement, OR: 1.056, 95%CI 1.056-1.587, p=0.013), and current smoking (OR: 3.828, 95%CI 1.486-9.857, p=0.005) were independently associated with anorectal condyloma.

CONCLUSIONS

HIV-1 infection, but not syphilis or HBV infection, was identified as a strong risk for anorectal condyloma. Anal HPV 16/18 was highly prevalent in patients with HIV-1 infection, especially in those with condyloma.

Genital warts and risk of cancer: a Danish study of nearly 50 000 patients with genital warts

BACKGROUND

We conducted a large national cohort study to examine the risk of cancer among men and women with genital warts (GW).

METHODS

By use of the Danish National Patient Register, we identified 16,155 men and 32,933 women who received a diagnosis of GW during 1978-2008. Standardized incidence ratios (SIRs) were computed as estimates of the relative risk of specific cancers or sites.

RESULTS

A diagnosis of GW was strongly related to anal (SIR for men, 21.5; SIR for women, 7.8), vulvar (SIR, 14.8), vaginal (SIR, 5.9), cervical (SIR, 1.5), penile (SIR, 8.2), and head and neck cancer (SIR, 2.8), including subsites of head and neck cancer with confirmed HPV association (SIR for men, 3.5; SIR for women, 4.8). The risks remained elevated for >10 years following GW diagnosis. In addition, we found moderately increased SIR estimates for nonmelanoma skin cancer, smoking-related cancers, and Hodgkin and non-Hodgkin lymphoma.

CONCLUSIONS

Individuals with GW have a long-term increased risk of anogenital cancers and head and neck cancers. The elevated risks of nonmelanoma skin cancers might indicate an association with HPV, while excess risks of other cancers could point to differences in other risk factors between individuals with GW and the general population.

Epidemiology of vulvar and vaginal cancer in Germany

OBJECTIVE

Vulvar and vaginal cancers are rare diseases with an incidence rate that increases with age. At present, epidemiological data are rather scarce. This review article provides an epidemiologic overview of these diseases, focussing on recent German data.

METHODS

This review article summarizes the information currently available in order to offer an epidemiologic overview.

RESULTS

The statistic incidence of vulvar carcinoma has been calculated between 2 and 7 cases per 100,000 women, and that of vaginal carcinoma 0.6-1.0 cases per 100,000 women. These incidence rates, especially concerning intraepithelial neoplasm, have increased heavily since the 1970s. The mean age of vulvar cancer affection is 72 years, and 74 years for vaginal carcinoma. In the case of women below the age of 50, cancer tends to be HPV-associated which implies a coincidence of about 20% for cervical and anal cancer. Various pathological mechanisms are the cause for women above the age of 50.

CONCLUSIONS

Due to a change in sexual behavior and an increased rate of HPV infection among younger women, increased incidence of both diseases has to be expected. The age-standardized mortality rate of vulvar carcinoma in Europe is stated at 0.7/100,000 women, and that of vaginal carcinoma at 0.4/100.000 women. To what extent the HPV-vaccination affects incidence and mortality rates is continually being observed.

Abnormalities in the PRAD1 (CYCLIN D1/BCL-1) oncogene are frequent in cervical and vulvar squamous cell carcinoma cell lines

BACKGROUND

CYCLIN D1, a cell-cycle control gene, recently has been shown to be identical to an oncogene alternatively known as BCL-1 and PRAD1 and implicated in centrocytic lymphomas and parathyroid adenomas, respectively. PRAD1 complexes to the product of the retinoblastoma (Rb) tumor suppressor gene, an event followed by Rb inactivation. Squamous cell carcinomas of the cervix and vulva are gynecologic tumors in which human papillomaviruses have been implicated as an initiating event, and proteins derived from these viruses also complex with an inactivate Rb. Because of the overlap in some of the molecular processes mediated by human papillomaviruses and by the PRAD1 oncogene, the authors analyzed the PRAD1 (CYCLIN D1/BCL-1) genomic structure and expression in vulvar and cervical squamous cell carcinoma cell lines.

METHODS

PRAD1 DNA and PRAD1 mRNA expression were assessed by Southern and Northern blotting, respectively, in 13 squamous cell carcinoma cell lines of gynecologic origin (10, cervical cancer; 3, vulvar cancer).

RESULTS

We found low baseline levels of a 4.5-kb PRAD1 transcript in a series of control cell lines, which were derived from normal fibroblasts, various hematologic malignancies, and a choriocarcinoma. PRAD1 mRNA overexpression (> or = 10-fold greater than that in control lines) was seen in all three vulvar carcinoma cell lines, two of which also showed amplification (5-fold and > 10-fold) of PRAD1 genomic sequences. Abnormalities of PRAD1 also were seen in 4 of the 10 cervical cancer cell lines and included overexpression of PRAD1 transcripts (3-9-fold) in 3 lines and rearrangement of PRAD1 DNA in an additional line that, however, did not shown any aberration in PRAD1 mRNA as discernible by Northern blotting. PRAD1 abnormalities were observed in three of the four cervical cell lines derived from metastatic sites and in one of the six cervical lines derived from primary tissue.

CONCLUSIONS

Seven of 13 squamous cell lines of gynecologic origin showed abnormalities of PRAD1. These abnormalities included amplification and rearrangement of DNA and overexpression of mRNA. The role of PRAD1 as a cell-cycle regulatory gene and its interactions with the Rb tumor suppressor gene suggests that PRAD1 deregulation may be a significant molecular event in the evolution of these tumors.

HPV changes and their significance in patients with invasive squamous cell carcinoma of the vulva: a clinicopathologic study

Records of 28 patients with invasive squamous cell carcinoma of the vulva were analyzed with regard to age-specific incidence rate, associated human papillomavirus (HPV) changes, multifocal and unifocal distribution of the lesions, and incidence of nodal metastasis. The presence of HPV changes (koilocytosis and condyloma) around the neoplastic epithelium correlated with a mean age group younger than that of those without HPV changes (47 vs 77 years). All multifocal cancers were associated with HPV changes while only 35% of unifocal lesions were so associated. Patients with multifocal disease were found to have a mean age younger than that of those with unifocal disease (44 vs. 67). When patients with microinvasion were excluded, no patients with multifocal invasive cancer and HPV changes were found to have nodal metastases. In contrast, nodal metastases were present in 59% of patients with unifocal invasive cancer.

Cervical intraepithelial neoplasia among women with papillomavirus infection compared to women with Trichomonas infection

This study was undertaken to determine if women with papillomavirus infection were more likely to develop cervical intraepithelial neoplasia (CIN) than women with other sexually transmitted infections. Women with cytologic evidence of papillomavirus infection and a comparison group of women with cytologic evidence of Trichomonas infection were identified from a reexamination of cervicovaginal smears initially evaluated between 1973 and 1981 in a private pathology laboratory. To identify subsequent CIN among these women the authors reviewed records of private obstetric and gynecology practices and public clinics through 1983. After accounting for possible confounding variables, including age, marital status, frequency of cervical cytologic examination, and selected characteristics of pregnancy history, a 2.7-fold increase in the rate of CIN was found among the 613 women with prior papillomavirus infection compared to the 410 women with previous Trichomomas infection. The rate ratio was higher among women with more severe cervical neoplasia than for those with less severe neoplasia and for those followed for greater than 12 months than for those followed 7 to 12 months. The results of this study provide further evidence of the role of papillomavirus in the etiology of cervical cancer.

Condyloma acuminatum: epidemiological, clinical and therapeutic aspects

Condyloma acuminatum, CA or genital warts, are benign fibro-epithelial tumors with a predilection for moist environments, especially mucosal surfaces. This sexually transmitted disease (STD) is increasing rapidly in incidence. The lesions are associated with a number of human papillomavirus (HPV) types. Some HPV types are closely linked with genital (especially cervical) dysplasia and neoplasia. Treatment consists of such traditional modalities as podophyllin, cryotherapy or surgical excision and, more recently, administration of interferon (IFN).

Buschke-Loewenstein tumour. A histologic and ultrastructural study of six cases

Results on the light- and electron microscopic studies of six cases of Buschke-Loewenstein tumour are presented. The role of chronic irritation is emphasized in the aetiology of the tumour. Fistulas and abscesses arising in the tumour are dangerous as they give rise to chronic sepsis. In two perianal tumours, in situ or invasive carcinoma developed. Electron microscopy revealed varying degrees of differentiation of keratinocytes. As a result of the defective desmosomes, the tumour cell underwent segregation, with widened intercellular spaces containing oedema, erythrocytes and leucocytes. This phenomenon is probably responsible for frequent bleeding and fistula formation. The investigations disclosed that the Buschke-Loewenstein tumour is a special form of squamous carcinoma and therefore, radical surgical excision must be attempted even in case of a benign histological picture.