Prevalence of human papillomavirus in sinonasal squamous cell carcinoma with and without association of inverted papilloma in Eastern China

Interferon alpha-2b treatment for exophytic nasal papillomas and human papillomavirus infection

OBJECTIVES

Exophytic Sinonasal Papilloma (ESP) is a benign tumor of the sinonasal tract. Complete surgical excision by endoscopic surgery is the treatment of choice. However, a high recurrence rate (36% at 5-year follow-up) is associated with this method, which may indicate the presence of microorganisms such as Human Papillomavirus (HPV). It is important to note that the standard treatment for ESP does not include antiviral drugs. In our study, we are testing the effectiveness of an interferon-containing drug in reducing recurrence and postoperative reactions in patients with ESP.

METHODS

We included 78 patients aged 23-83 years with a confirmed diagnosis of ESP by rhinoscopy and nasal endoscopy and a positive PCR test for HPV in nasal scrapings. To compare the results, we divided the patients into main and control groups. The main group received recombinant human interferon after surgery, while the control group did not receive the drug. We performed a statistical analysis to compare the proportion of patients without reactive manifestations at different stages of the postoperative period, as well as to compare the proportion of patients with recurrent ESP at certain stages of observation.

RESULTS

The introduction of recombinant human interferon accelerated the resolution of postoperative reactions and promoted the healing of the nasal mucosa after surgical removal of the ESP. We also found a statistically significant association between treatment with recombinant interferon and a reduction in the recurrence rate of ESP.

CONCLUSION

According to the results of the study, it was found that in the main group of patients who received rhIFN-α2b (recombinant human Interferon alpha 2b) in the postoperative period, the frequency of relapses of ESP and the time of postoperative recovery were significantly lower than in patients in the control group who did not take the drug.

LEVEL OF EVIDENCE

Cohort Study.

Epithelial Tight Junction Anomalies in Nasal Inverted Papilloma

OBJECTIVES

As a critical component of the epithelial barrier, tight junctions (TJs) are essential in nasal mucosa against pathogen invasion. However, the function of TJs has rarely been reported in nasal inverted papilloma (NIP). This study aims to investigate the potential factors of TJs' abnormality in NIP.

METHODS

We assessed the expression of ZO-1, occludin, claudin-1, claudin-3, and claudin-7 in healthy controls and NIP by real-time quantitative polymerase chain reaction and immunofluorescent staining. The correlation between TJs expression and neutrophil count, TH 1/TH 2/TH 17 and regulatory T cell biomarkers, and the proportion of nasal epithelial cells was investigated.

RESULTS

Upregulation of ZO-1, occludin, claudin-1, and claudin-7, along with downregulation of claudin-3, was found in NIP compared to control (all p < 0.05). An abnormal proportion with a lower number of ciliated cells (control vs. NIP: 37.60 vs. 8.67) and goblet cells (12.52 vs. 0.33) together with a higher number of basal cells (45.58 vs. 124.00) in NIP. Meanwhile, claudin-3 was positively correlated with ciliated and goblet cells (all p < 0.01). Additionally, neutrophils were excessively infiltrated in NIP, negatively correlated with ZO-1, but positively with claudin-3 (all p < 0.05). Furthermore, FOXP3, IL-10, TGF-β1, IL-5, IL-13, and IL-22 levels were induced in NIP (all p < 0.01). Occludin level was negatively correlated with IL-10, IL-5, IL-13, and IL-22, whereas ZO-1 was positively with TGF-β1 (all p < 0.05).

CONCLUSION

Nasal epithelial barrier dysfunction with TJs anomalies is commonly associated with abnormal proliferation and differentiation of epithelial cells and imbalance of immune and inflammatory patterns in NIP.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:552-561, 2024.

High-risk HPV Does not Appear to be an Important Risk Factor for Sinonasal Carcinomas in Turkish Population: A Tertiary Center Experience

Background. The sinonasal tract is the second most common site of human papillomavirus (HPV)-related carcinomas in the head and neck. Published data on the association between sinonasal tumors and HPV are quite inconsistent among different regions. Material and methods. We performed high-risk HPV DNA in situ hybridization (ISH) and p16 immunohistochemistry on sinonasal carcinomas diagnosed between 2006 and 2016. Results. Of 105 sinonasal carcinomas, we found only two (2%) HPV-positive cases; both had non-keratinizing morphology and were diffusely positive for p16. By histologic type, HPV DNA positivity rate was 14% in non-keratinizing squamous cell carcinomas, and we did not detect HPV DNA in any other type of sinonasal carcinomas. Thirteen HPV-negative tumors (7 salivary gland carcinomas, 3 sinonasal undifferentiated carcinomas, 2 keratinizing squamous cell carcinomas, and 1 non-keratinizing squamous cell carcinoma) were positive for p16. In nine carcinomas arising from an underlying sinonasal papilloma, p16 and HPV DNA ISH were evaluated in both carcinoma and papilloma areas and all were negative. Follow-up information was available for 104 patients; 46 (44%) were alive and 58 (55%) died of disease. One of the two HPV-positive patients died of the disease; the other was alive at 100 months of follow-up. Conclusions. We detected a much lower percentage of HPV positivity in sinonasal carcinomas when compared to the literature. We believe that our results support various rates of HPV-related carcinomas depending on the geographic and ethnic characteristics.

Association between human papillomavirus infection and malignant transformation of sinonasal inverted papilloma: A systematic review and meta-analysis

PURPOSE

Although sinonasal inverted papilloma malignant transformation has not been entirely understood, some studies have suggested that human papillomavirus acts as a potential oncogenic agent in the progression of sinonasal inverted papilloma to squamous cell carcinoma. The purpose of this study was to assess the association between human papillomavirus infection and sinonasal inverted papilloma transformation, taking also into account human papillomavirus types and their distribution in different geographic areas.

MATERIALS AND METHODS

The literature from the last 25 years was examined. The systematic review and meta-analysis were performed according to the PRISMA guidelines.

RESULTS

A total of 163 malignant sinonasal inverted papilloma and 961 non-malignant sinonasal inverted papilloma were included in the overall analysis. From this sample it was possible to recognize a statistically significant increase in risk of malignancy of sinonasal inverted papilloma for human papillomavirus infection (OR = 2.43, 95 % CI: 1.45-4.08, I2 = 14.0 %). A positive association for patients with high-risk human papillomavirus types was noted (OR = 10.20, 95 % CI: 3.66-28.42, I2 = 15.9 %). In all the 3 geographical areas analyzed the presence of high-risk human papillomavirus significantly increased the probability of malignant transformation.

CONCLUSIONS

High-risk human papillomavirus infection plays a key role in the malignant transformation of sinonasal inverted papilloma and its research during histological examination can be of paramount importance. More prospective studies are needed to help further tease out this association.

Positive Rate of Human Papillomavirus and Its Trend in Head and Neck Cancer in South Korea

Introduction

This study aimed to investigate the positive rate of human papillomavirus (HPV) and its trend in head and neck squamous cell carcinoma (HNSCC) in South Korea and to evaluate the clinical differences between HPV-positive and -negative tumors.

Methods

We studied 300 patients with HNSCC arising in the oropharynx (n = 77), oral cavity (n = 65), larynx (n = 106), hypopharynx (n = 40), and sinonasal cavity (n = 12), treated in a tertiary university hospital in South Korea from January 2008 to July 2020. HPV status was determined using p16 immunohistochemical staining of formalin-fixed paraffin-embedded tissues.

Results

Of the 300 patients with HNSCC, the positive rate of p16 was 30.3% (91/300). The p16 positive rate was 70.1, 13.9, 20.8, 15, and 0% in the oropharynx, oral cavity, larynx, hypopharynx, and sinonasal cavity, respectively. HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) patients were significantly younger than HPV-negative OPSCC patients. The positive rate of HPV in OPSCC has increased over time from 2008 to 2020, but has not changed significantly in the other primary sites. The disease-free survival curve of HPV-positive OPSCC was significantly better than that of HPV-negative tumors.

Conclusion

The positive rate of HPV in Korean patients with OPSCC is significantly high (70.1%), similar to that in North America and Europe, and has increased abruptly in the past 12 years.