Focal epithelial hyperplasia in a group of South Africans: Its ultrastructural features

Molecular and serological evidence of the epidemiological association of HPV 13 with focal epithelial hyperplasia: A case-control study

BACKGROUND

Focal epithelial hyperplasia is a benign proliferative condition that is more frequently found in children of certain ethnic groups. Human papillomavirus 13 and 32 DNA has been consistently detected in these lesions.

OBJECTIVE

To demonstrate the epidemiological association of HPV 13 with FEH in the Emberá-Chamí community of Antioquia, Colombia.

METHODS

A population-based, case-control study was conducted. One hundred and thirty-eight children were screened and 17 clinical and histologically-confirmed cases were sex and age-matched with 27 controls. Biopsies from FEH lesions and mouth washes from controls were obtained for DNA analysis. HPV 13 DNA was identified using a previously described type-specific PCR test. HPV 13 VLPs were produced by cloning of L1 from the HPV 13 cloned genome and seroreactivity against HPV 13 VLPs of sera from cases and controls were evaluated by ELISA.

RESULTS

Among the whole population the prevalence of FEH was 13%. One-hundred-percent of the cases and 29.6% of the controls were HPV 13 positive. There was a significant difference in HPV DNA status between cases and controls (one-tailed Fisher exact test: P<0.0001). Antibodies against HPV 13 VLPs were found in 58.8% of cases and in 33.3% of controls, this difference was not statistically significant (P=0.089 Fisher exact test). However, the median of the ODs of the ELISA positive sera of the cases was 0.596 (interquartile range: 0.5075-0.8245) versus 0.452 (interquartile range: 0.337-0.479) in the controls and this was significantly different (P=0.0041 Man-Whitney test).

CONCLUSIONS

We demonstrated a risk for association of FEH with infection with HPV 13. The higher level of antibodies against HPV 13 VLPs in cases may suggest the requirement of higher viral load or viral persistence for disease development.

Heck's disease (focal epithelial hyperplasia): a longitudinal study

A 3-year longitudinal study on Heck's disease among school children was undertaken in 2 communities which are similar geographically, socioeconomically and ethnically. The variations in the annual prevalence rates (7% to 13%), the incidence rates per 1000 (38 to 68), the female to male ratios (1:0.4 to 1:1) and the average ages of the affected pupils did not differ between communities and from year to year. Lesions varied in number, size and duration. Some were seen only at one of the examinations, while others remained during the whole study. The majority were situated on the mucosae of the lower lips and cheeks. The prevalence of lesions amongst school children in these two communities was noticeably higher than that of another community of similar ethnicity studied earlier. The clinical behaviour of the lesions is in keeping with what is expected of some HPV infections. The relatively high prevalence rate and the anatomical distribution of the lesions indicate the infectious nature of the disease, which we believe is influenced to a large extent by the lifestyle in these communities.

In situ hybridization with digoxigenin-labelled DNA probes for the detection of human papillomavirus-induced focal epithelial hyperplasia among Venezuelans

An in situ hybridization assay with digoxigenin-labelled probes was used to detect the presence of human papillomavirus (HPV) sequences in ten related Venezuelan patients with the diagnosis of focal epithelial hyperplasia. The samples displayed HPV sequences in all cases. Further restriction analysis in four of the patients suggested the presence of HPV-13 in oral lesions.

Human papillomavirus (HPV) DNA in focal epithelial hyperplasia by in situ hybridization

Eighteen cases of focal epithelial hyperplasia (FEH) were investigated for the presence of human papillomavirus (HPV) group specific antigen by immunocytochemistry and HPV types 1, 6, 11, 13, 16, 18 and 32 by DNA in situ hybridization employing biotinylated probes. Seven (39%) specimens demonstrated the presence of HPV group specific antigen. Fifteen (83%) specimens were positive for HPV DNA: 9 (60%) showed HPV 32, of which 6 were on non-keratinized mucosa and 3 on border of keratinized and non-keratinized mucosa; 5 (33%) showed HPV 13, 4 lesions on keratinized mucosa and 1 on non-keratinized mucosa; 1 (7%) specimen on non-keratinized mucosa showed HPV-11 related. Two specimens on different sites from one patient showed the same HPV type and one patient had, in addition to FEH, a squamous papilloma also demonstrating the same HPV type. Results show a specific HPV distribution pattern in the epithelium indicating areas of high viral concentration adjacent to areas of low or no viral concentration. This study also indicates the possibility of tissue-site specificity or a latent infection and the possibility of a yet unidentified HPV type associated with FEH. It is suggested that future monitoring of patients be carried out with special reference to HPV type and anatomical distribution pattern for FEH lesions.

Detection of human papillomavirus (HPV) DNA in focal epithelial hyperplasia

Five focal epithelial hyperplasia (FEH) specimens from four patients were examined by Southern blot hybridization analysis to determine the specific human papillomavirus (HPV) types present. The histomorphologic features of these specimens were also evaluated and a broad variety of changes including koilocytes, mitosoid cells, ballooning cells and cells showing individual cell keratinization were noted. FEH lesions from the three patients sharing a familial relationship demonstrated HPV DNA sequences that were either the prototype HPV-13 or a very closely related HPV-13 subtype. These patients also showed similar clinical features. Lesional tissue from the other patient was found to harbor HPV DNA sequences similar to HPV-32. In view of these findings it is suggested that these specific HPV types are associated with the characteristic FEH histomorphology described.

In situ DNA hybridization analysis of human papillomavirus (HPV) sequences in benign oral mucosal lesions

A series of 144 surgically treated benign oral mucosal lesions were analysed using an in situ DNA hybridization technique with 35S-labeled human papillomavirus (HPV) DNA probes to demonstrate the DNA of HPV types 6, 11, 13, and 16, in routinely processed, paraffin-embedded biopsy specimens. These lesions and an additional 62 benign oral mucosal biopsy specimens (total, 206 specimens) were also assessed by the indirect immunoperoxidase (IP-PAP) technique to detect the expression of HPV structural proteins (viral antigens). A total of 54/206 (26.2%) lesions were observed to express HPV antigens, being found in 45/92 (48.9%) of the squamous cell papillomas/condylomas, in 1/54 fibrous hyperplasias, in 1/8 true fibromas, and in 7/8 (87.5%) of the focal epithelial hyperplasia (FEH) lesions. Of the HPV DNA-positive lesions, 15/45 (33.3%) expressed HPV antigens, the expression not being related to any particular HPV type. HPV DNA sequences were found in 45/144 (31.3%) of the lesions. HPV DNA was present with the highest frequency in FEH (83.3%), followed by the papilloma/condyloma group (33.8%), papillary hyperplasia (28.6%), fibrous hyperplasia (24.4%), and true fibromas (14.3%). The most frequent HPV type was HPV 11, representing 37.8% of the DNA-positive lesions. HPV 13 DNA, previously regarded as specific to FEH, was disclosed as a single HPV type in seven cases, and as a double infection by HPV 11 and 13 in an additional three cases, including all five morphologically distinct entities. Noteworthy is the discovery of the high-risk HPV type 16 DNA in 17.8% of the DNA-positive lesions, four papilloma/condyloma lesions, three fibrous hyperplasias, and one FEH.(ABSTRACT TRUNCATED AT 250 WORDS)

Human papillomavirus type 13 DNA in focal epithelial hyperplasia among Mexicans. Brief report

Human papillomavirus (HPV) type 13 DNA was detected in focal epithelial hyperplasia lesions of the oral mucosa in seven half-caste mexicans. The lesions contained intracellular papillomavirus-like particles with a diameter of about 50 nm. DNA extracted from biopsies contained unintegrated HPV type 13 DNA genomes as revealed by Southern blot hybridization. The HPV 13 DNA that was isolated in the present study had the same restriction enzyme cleavage map as HPV 13 DNA, previously described by others. It was moreover confirmed that HPV type 13 genome is related to the genomes of HPV types 6 and 11.

Human papillomavirus type 13 and focal epithelial hyperplasia of the oral mucosa: DNA hybridization on paraffin-embedded specimens

16 cases of focal epithelial hyperplasia (Heck's disease) were studied for the presence of human papillomavirus DNA by means of nucleic acid hybridization. Hybridization was carried out in situ with biotin-labelled probes of HPV 1, 6, 11, 13, 16, and 18 DNA under stringent and non-stringent conditions. Under non-stringent conditions, 6 of 16 cases (38%) hybridized to a mixture of HPV 1, 6, 11, 16, and 18 DNA. When these probes were applied under stringent conditions, only one case could be shown to be weakly positive for HPV 6/11 DNA. Further stringent hybridizations, which were conducted with a HPV 13 probe on 12 of our 16 cases, revealed a positive result in 9 of 12 cases (75%). The results of our study strongly substantiate the concept that HPV 13 or a closely related HPV type is associated with lesions morphologically presenting as focal epithelial hyperplasia.

Focal epithelial hyperplasia. Report of three cases from Nigeria, West Africa

The first cases of focal epithelial hyperplasia from Nigeria and West Africa are presented. Although cases of this disease have been reported in Coloureds from South Africa, the three cases in this report represent the first in black Africans. The probability that the etiologic agent is a communicable agent, perhaps a virus, is reinforced by the clinical histories of the two related patients in this report.

Characterization of human papillomavirus type 13 from focal epithelial hyperplasia Heck lesions

Focal epithelial hyperplasia Heck lesions of a Turkish patient were shown to contain papillomavirus-specific DNA, which was molecularly cloned into bacteriophage lambda. It proved to be related to human papillomavirus (HPV) type 6 DNA and HPV type 11 DNA. Reassociation kinetics revealed a cross-hybridization of 4 and 3%, respectively. There was no cross-reactivity with HPV type 1, 2, 3, 4, 5, 8, or 10. This papillomavirus type will be referred to as HPV type 13. The DNA was characterized by cleavage with several restriction enzymes, and the cleavage sites were physically mapped. Papules from two additional cases of Morbus Heck contained HPV type 13 DNA as shown by Southern blot hybridization and by the characteristic cleavage patterns. This may indicate that HPV type 13 is more frequently associated with focal epithelial hyperplasia Heck than are other HPV types.

Diagnostic virology using electron microscopic techniques

This chapter illustrates the development of the use of electron microscopy in viral diagnosis. The field covered is confined to medical viral diagnosis, but parallel developments have taken place in both veterinary and botanical fields and techniques derived from both these sources are also included where relevant. It is reported that the scanning transmission mode of operation, which can induce image contrast changes electronically, may enhance studies with unstained sections and perhaps facilitate thin section immune electron microscopy (IEM). The application of negative stain IEM has been particularly useful for the study of the antigenic nature of some of the newly discovered noncultivable viruses. Viral antigens can also be detected in thin sections of infected cells by IEM with suitably labeled specific antibodies. Confirmation of viral infection by electron microscopy on tissues originally processed for light microscopy is also frequently useful.

Focal epithelial hyperplasia in Sweden

A prevalence of 0.11% of focal epithelial hyperplasia (FEH) was found among 20,333 adult Swedes. There was no sex difference, the lesion was most prevalent in age groups above 45 years and the lesion was most frequent on the tongue. The frequency of FEH in 15,132 consecutive routine biopsies was 0.26%. Four FEH-cells were ultrastructurally examined. They exhibited a clear cytoplasm with scattered ribosomes, a peripheral condensation of tonofilaments, a central aggregation of chromatin clumps with loss of nuclear membrane and an accumulation of desmosome fragments. No viral particles could be identified in these FEH-cells.

Heck's disease (focal epithelial hyperplasia)

A patient and his mother noted the insidious appearance of a distinctive benign papular eruption confined to the mucosa of the lips. The clinical pattern and histologic findings fulfill the criteria of a recently described entity, focal epithelial hyperplasia. An electron microscopic search for viral particles was negative. Arguments for both a viral and a hereditary pathogenesis have been put forth, but the etiology of the condition remains controversial. This disorder may be more frequently reported as dermatologists become increasingly aware of its existence.

Focal epithelial hyperplasia of the oral mucosa. A case report from the United Kingdom

A case of focal epithelial hyperplasia of the oral mucosa (Heck's disease) is presented, which appears to be the first to be described in the United Kingdom. Virus particles were found in tissue from the lesions studied by electron microscopy, and identified as belonging to the papilloma virus sub-group of the family of papovaviruses.

Focal epithelial hyperplasia in rabbit oral mucosa

Several papules on the floor of the mouth and the ventral surface of the tongue of a zinc-deficient rabbit were studied by light and electron microscopy. These papules appeared to be consistent with focal epithelial hyperplasia of man and chimpanzees. There was a concurrence of cytoplasmic vacuolization with the appearance of viral particles within the nucleus. Intranuclear crystalline viral aggregates were frequently observed in the upper spinous cells.

Florid focal epithelial hyperplasia in Fanconi's syndrome

Florid focal epithelial hyperplasia of at least 5 years' duration in a Cape Coloured boy aged 12 years and suffering from Fanconi's syndrome is reported.

Focal epithelial hyperplasia in a group of South Africans: Its ultrastructural features

Electron microscopic observation of samples of tissues from lesions diagnosed as focal epithelial hyperplasia revealed the presence of viral particles in six (possibly seven) of 13 cases examined. Viral particles were intranuclear and varied from sparsely scattered to densely packed. A crystalline arrangement was present in one case. The chromatin of affected cells was typically condensed into clumps and thick bands, and the nuclear membrane was usually absent in pronounced cases. The nuclei of the basal and prickle cells were frequently indented and the chromatin peripherally condensed. Numbers of lysosomal-like organelles were observed in many of these cells. The ballooning epithelial cells with their mitosis-like aberrations observed with light microscopy consisted of a rim of tonofilaments and organelles and a homogeneous granular center interspersed with dense areas. It is suggested that the nuclear characteristics and numerous lysosomes observed in basal and prickle cells are cellular changes induced by the viral infection and that the mitosis-like aberrations represent a bizarre and arrested form of mitosis.

Focal epithelial hyperplasia in a group of south africans: Its clinical and microscopic features

Thirty-seven cases of focal epithelial hyperplasia were discovered among pupils of reform schools and none among pupils of ordinary schools. This difference in occurrence was significant (P less than 0.01). Lesions were either discrete papules or clusters of papules; and the lining mucosa was the most affected part. Eighteen cases were examined microscopically revealing the typical features of the condition. The fact that these lesions occurred in a select group of pupils all of whom are classified as Cape Coloured points to either a selective distribution of the disease or a spread of the disease among people living in communal circumstances. This pattern of distribution coupled with the clinical and histological features would fit a disease of viral origin which is also communicable.