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Sanchez DF, Fernández-Nestosa MJ, Alemany L, Cañete-Portillo S, Lloveras B, Clavero O, Rodríguez I, Quint W, Muñoz N, de Sanjosé S, Bosch FX, Cubilla AL. Detection of variable genotypes in common human papillomavirus-associated invasive penile squamous cell carcinomas: a study of 177 human papillomavirus-positive cases. Hum Pathol 2023; 139:65-72. [PMID: 37429448 DOI: 10.1016/j.humpath.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
Human papillomavirus (HPV) is detected in 30-50% of invasive penile carcinomas, and it is frequently associated with basaloid and warty morphological features. Based on this heterogeneity and different clinical behaviors, we hypothesized a variation in their HPV genotypic composition. To test this, we evaluated 177 HPV-positive cases: basaloid (114), warty-basaloid (28), and warty (condylomatous) (35) invasive carcinomas. HPV DNA detection and genotyping was performed using the SPF-10/DEIA/LiPA25 system. Nineteen HPV genotypes were detected. High-risk HPVs predominated (96%), and low-risk HPVs were rarely present. Most common genotype was HPV16 followed by HPVs 33 and 35. According to the genotypes identified, 93% of the cases would be covered with current vaccination programs. There was a significant variation in the distribution of HPV16 and non-HPV16 genotypes according to histological subtype. HPV16 was significantly frequent in basaloid (87%) and was less frequent in warty carcinomas (61%). This molecular difference, along with their distinctive macro-microscopic and prognostic features, makes basaloid and warty carcinomas unique. The gradual decreasing frequency of HPV16 demonstrated in basaloid, warty-basaloid, and warty carcinomas suggest that the basaloid cell, present in those types in decreasing proportions, may be responsible for the differences.
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Affiliation(s)
- Diego F Sanchez
- Instituto de Patología e Investigación, Asunción 1228, Paraguay; Translational Oncogenomics Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester Cancer Research Centre, Manchester M20 4GJ, UK
| | | | - Laia Alemany
- Institut Català D'Oncologia, Barcelona 08908, Spain
| | | | | | - Omar Clavero
- Institut Català D'Oncologia, Barcelona 08908, Spain
| | - Ingrid Rodríguez
- Instituto de Patología e Investigación, Asunción 1228, Paraguay; Universidad Nacional de Asunción, San Lorenzo 2111, Paraguay
| | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk 2288, Netherlands
| | - Nubia Muñoz
- National Cancer Institute of Colombia, Bogotá 111511-110411001, Colombia
| | - Silvia de Sanjosé
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08036, Spain
| | | | - Antonio L Cubilla
- Instituto de Patología e Investigación, Asunción 1228, Paraguay; Universidad Nacional de Asunción, San Lorenzo 2111, Paraguay.
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2
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Penile intraepithelial neoplasia: Distribution of subtypes, HPV genotypes and p16 INK4a in 84 international cases. Hum Pathol 2023; 131:1-8. [PMID: 36427594 DOI: 10.1016/j.humpath.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
There are few pathologic or molecular studies of penile precancerous lesions, and the majority refers to lesions associated with invasive carcinomas. Penile Intraepithelial Neoplasia (PeIN) is classified in two morphologically and distinctive molecular groups, non-HPV and HPV-related with special subtypes. The primary purpose of this international series was to classify PeIN morphologically, detect HPV genotypes and determine their distribution according to PeIN subtypes. A secondary aim was to evaluate the p16INK4a immunostaining as a possible HPV surrogate for high-risk HPV infection in penile precancerous lesions. Samples consisted of 84 PeIN cases, part of a retrospective cross-sectional analysis of 1095 penile carcinomas designed to estimate the HPV DNA prevalence in penile cancers using PCR and p16INK4a immunostaining. Penile Intraepithelial Neoplasia (PeIN) was classified in HPV-related (basaloid, warty-basaloid, warty, hybrid, and mixed subtypes) and non-HPV-related (differentiated), the former being the most frequent. PeIN subtypes were differentiated (non-HPV-related) and basaloid, warty-basaloid, warty, hybrid and mixed (HPV-related). Basaloid PeIN was the most commonly diagnosed subtype, and HPV16 was the most frequent HPV genotype detected. Warty-basaloid and warty PeIN showed a more heterogeneous genotypic composition. Most HPV genotypes were high-risk but low-risk HPV genotypes were also present in a few cases (4%). A single HPV genotype was detected in 82% of HPV positive cases. In contrast, multiple genotypes were detected in the remaining 18% of cases. The findings in this study support the paradigm that penile in situ neoplasia, like its invasive counterparts, is HPV dependent or independent and has distinctive morphological subtypes readily identified in routine practice. Considering that HPV16 is clearly the predominant type, and that the three available vaccines have HPV16, all of them will be suitable for vaccination programs; the price of the vaccines will be probably the main determinant to choose the vaccine.
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3
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Straub Hogan MM, Spieker AJ, Orejudos M, Gheit T, Herfs M, Tommasino M, Sanchez DF, Fernandez-Nestosa MJ, Pena MDCR, Gordetsky JB, Epstein JI, Canete-Portillo S, Gellert LL, Prieto Granada CN, Magi-Galluzzi C, Cubilla AL, Giannico GA. Pathological characterization and clinical outcome of penile intraepithelial neoplasia variants: a North American series. Mod Pathol 2022; 35:1101-1109. [PMID: 35190664 DOI: 10.1038/s41379-022-01020-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/08/2022]
Abstract
Penile intraepithelial neoplasia (PeIN) is classified as human papillomavirus (HPV)- and non-HPV-related. This classification is associated with distinct morphologic subtypes. The natural history and prognosis of PeIN subtypes are not well known. This study aims to evaluate clinicopathological features, HPV status, and outcome of PeIN subtypes. Eighty-two lesions from 64 patients with isolated PeIN were retrospectively reviewed. Mean age was 59 years. Lesions were multicentric in 34% of patients and affected glans (33%), shaft (26%), and foreskin (20%). Histologically, 22% of patients had coexisting lesions, classified as hybrid and mixed. HPV-related PeIN (97%) included basaloid (59%), warty (8%), warty-basaloid (8%), hybrid (19%) and mixed (3%) types. P16 and HPV positivity occurred in 99% and 82% of lesions, respectively. HPV 16 was more common in basaloid PeIN. Multiple genotypes were detected in 35%, more commonly in hybrid PeIN (P = 0.051). Positive margins occurred in 63% of excisions. PeIN recurred in 48% of excisions and 30% of overall repeated procedures, and progression to invasive carcinoma occurred in 2%. At follow-up, 86% of patients had no evidence of disease and 12% were alive with disease. Lichen sclerosus occurred in non-HPV and HPV-related PeIN (100% and 47%).In conclusion, HPV-related and, more specifically basaloid PeIN were the predominant types and preferentially associated with HPV 16. While PeIN had a high recurrence rate, there was a slow and infrequent progression to invasive or metastatic carcinoma with multimodal treatments. Additional studies are needed to understand biology and natural history of PeIN.
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Affiliation(s)
- Melissa M Straub Hogan
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Orejudos
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Michael Herfs
- Laboratory of Experimental Pathology, University of Liège, Liège, Belgium
| | - Massimo Tommasino
- Instituto de Patología e Investigación, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Diego F Sanchez
- Instituto de Patología e Investigación, Universidad Nacional de Asunción, Asunción, Paraguay
- School of Medicine, National University of Asunción, San Lorenzo, Paraguay
| | | | | | - Jennifer B Gordetsky
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan I Epstein
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | | | | | | | - Antonio L Cubilla
- Instituto de Patología e Investigación, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Giovanna A Giannico
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
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8
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Medeiros-Fonseca B, Mestre VF, Estêvão D, Sánchez DF, Cañete-Portillo S, Fernández-Nestosa MJ, Casaca F, Silva S, Brito H, Félix A, Medeiros R, Colaço B, Oliveira PA, Bastos MM, Nelson PS, Vakar-Lopez F, Gaivão I, Brito L, Lopes C, Cubilla AL, Gil da Costa RM. HPV16 induces penile intraepithelial neoplasia and squamous cell carcinoma in transgenic mice: first mouse model for HPV-related penile cancer. J Pathol 2020; 251:411-419. [PMID: 32488868 DOI: 10.1002/path.5475] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/09/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Abstract
Penile cancer is an under-studied disease that occurs more commonly in developing countries and 30-50% of cases show high-risk human papillomavirus (HPV) infection. Therapeutic advances are slow, largely due to the absence of animal models for translational research. Here, we report the first mouse model for HPV-related penile cancer. Ten-week-old mice expressing all the HPV16 early genes under control of the cytokeratin 14 (Krt14) gene promoter and matched wild-type controls were exposed topically to dimethylbenz(a)anthracene (DMBA) or vehicle for 16 weeks. At 30 weeks of age, mice were sacrificed for histological analysis. Expression of Ki67, cytokeratin 14, and of the HPV16 oncogenes E6 and E7 was confirmed using immunohistochemistry and quantitative PCR, respectively. HPV16-transgenic mice developed intraepithelial lesions including condylomas and penile intraepithelial neoplasia (PeIN). Lesions expressed cytokeratin 14 and the HPV16 oncogenes E6 and E7 and showed deregulated cell proliferation, demonstrated by Ki67-positive supra-basal cells. HPV16-transgenic mice exposed to DMBA showed increased PeIN incidence and squamous cell carcinoma. Malignant lesions showed varied histological features closely resembling those of HPV-associated human penile cancers. Wild-type mice showed no malignant or pre-malignant lesions even when exposed to DMBA. These observations provide the first experimental evidence to support the etiological role of HPV16 in penile carcinogenesis. Importantly, this is the first mouse model to recapitulate key steps of HPV-related penile carcinogenesis and to reproduce morphological and molecular features of human penile cancer, providing a unique in vivo tool for studying its biology and advancing basic and translational research. © 2020 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Verónica F Mestre
- CITAB, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | - Diogo Estêvão
- Grupo de Oncologia Molecular e Patologia Viral, CI-IPOP, IPO-Porto, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Diego F Sánchez
- Instituto de Patología e Investigación and Universidad Nacional de Asunción, Asunción, Paraguay
| | - Sofía Cañete-Portillo
- Instituto de Patología e Investigación and Universidad Nacional de Asunción, Asunción, Paraguay
| | | | - Fátima Casaca
- Botelho Moniz Análises Clínicas (BMAC), Porto, Portugal
| | - Sandra Silva
- Botelho Moniz Análises Clínicas (BMAC), Porto, Portugal
| | - Haissa Brito
- Biobanco de Tumores e DNA do Maranhão, PPGSAD, Universidade Federal do Maranhão (UFMA), São Luís, Brazil
| | - Ana Félix
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.,Serviço de Anatomia Patológica, IPO-Lisboa, Lisbon, Portugal
| | - Rui Medeiros
- Grupo de Oncologia Molecular e Patologia Viral, CI-IPOP, IPO-Porto, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Serviço de Virologia, IPO-Porto, Porto, Portugal.,Liga Portuguesa Contra o Cancro - Núcleo Regional do Norte, Porto, Portugal.,CEBIMED, Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal
| | - Bruno Colaço
- CITAB, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal.,Departamento de Zootecnia, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | - Paula A Oliveira
- CITAB, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal.,Departamento de Ciências Veterinárias, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | | | - Peter S Nelson
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - Funda Vakar-Lopez
- LEPABE, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - Isabel Gaivão
- CECAV and Department of Genetics and Biotechnology, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal
| | - Luciane Brito
- Biobanco de Tumores e DNA do Maranhão, PPGSAD, Universidade Federal do Maranhão (UFMA), São Luís, Brazil
| | - Carlos Lopes
- Botelho Moniz Análises Clínicas (BMAC), Porto, Portugal.,Grupo de Patologia Experimental, Ci-IPOP, IPO-Porto, Porto, Portugal.,Departamento de Patologia e Imunologia Molecular, ICBAS, Universidade do Porto, Porto, Portugal
| | - Antonio L Cubilla
- Instituto de Patología e Investigación and Universidad Nacional de Asunción, Asunción, Paraguay
| | - Rui M Gil da Costa
- CITAB, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal.,Grupo de Oncologia Molecular e Patologia Viral, CI-IPOP, IPO-Porto, Porto, Portugal.,Biobanco de Tumores e DNA do Maranhão, PPGSAD, Universidade Federal do Maranhão (UFMA), São Luís, Brazil.,LEPABE, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal.,Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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