Buschke-Löwenstein tumor: verrucous carcinoma of the anogenitalia.
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Buschke-Löwenstein tumor is a rare type of anogenital squamous cell carcinoma with a distinctive clinical appearance. We present the case of a thirty-four-year-old man with this tumor, which was excised surgically. Human papillomavirus was detected in formalin-fixed, paraffin-embedded sections with a human papillomavirus 6/11 probe, but not with a human papillomavirus 16 or a human papillomavirus 18 probe.Keywords:
Verrucous carcinoma
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Buschke-Löwenstein tumor is a rare type of anogenital squamous cell carcinoma with a distinctive clinical appearance. We present the case of a thirty-four-year-old man with this tumor, which was excised surgically. Human papillomavirus was detected in formalin-fixed, paraffin-embedded sections with a human papillomavirus 6/11 probe, but not with a human papillomavirus 16 or a human papillomavirus 18 probe.
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Verrucous carcinoma oftheanusisadistinct and rare variantof well-differentia ted squamouscellcarcinoma. A caseofanal verrucous carcinoma ina35yearoldman was studied bylight microscopy andinsituDNA hybridization. Human papillomavirus (HPV) type16DNA sequences weredemonstrated in thetumourcells, aswellasincells showing koilocytotic and dyskeratotic changes. The possible viral(HPV)aetiology ofverrucous carcinoma isconsidered witha reviewofthe previous literature.
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We have recently observed the first case of invasive squamous cell carcinoma arising from a human papillomavirus genotype 16 (HPV16)-associated verrucous cyst. The lesion was found in the perineal area of an 86-year-old woman. Using in situ hybridization (ISH), we detected the presence of HPV16 in the cystic wall. HPV16 DNA sequences were detected in formalin-fixed, paraffin-embedded tissue sections using the DNA–DNA ISH method, as described previously.1Egawa K. Shibasaki Y. de Villiers E.M. Double infection with human papillomavirus 1 and human papillomavirus 63 in single cells of a lesion displaying only a human papillomavirus 63-induced cytopathogenic effect.Lab Invest. 1993; 69: 583-588PubMed Google Scholar For immunohistochemical analysis, a p16 monoclonal antibody (clone E6H4, CINtec p16INK4a Histology Kit; mtm laboratories AG, Heidelberg, Germany) was used. p16INK4a immunostaining showed diffuse and intense positivity throughout the dysplastic epithelium and in the areas of invasive carcinoma (Figure 1). In 1991 Meyer et al.2Meyer L.M. Tyring S.K. Little W.P. Verrucous cyst.Arch Dermatol. 1991; 127: 1828-1829Crossref PubMed Scopus (35) Google Scholar described five cases of verrucous cysts in which they detected HPV genomes by PCR, without specifying HPV type. Subsequently, numerous other reports have described HPV-specific DNA sequences in verrucous cysts, most prevalently in plantar and palmar regions. Specific HPV types were not identified until 1992, when Matsukura et al.3Matsukura T. Iwasaki T. Kawashima M. Molecular cloning of a novel human papillomavirus (type 60) from a plantar cyst with characteristic pathological changes.Virology. 1992; 190: 561-564Crossref PubMed Scopus (64) Google Scholar cloned the HPV type from a cyst that showed no homology with other known prototypes of HPV (from HPV1 through HPV59), so that it was named HPV60. Matsukura et al. found this HPV type in three cases of plantar cysts. In 1994 Egawa et al.4Egawa K. Honda Y. Inaba Y. Kojo Y. Ono T. de Villiers E.M. Multiple plantar epidermoid cysts harboring carcinoembryonic antigen and human papillomavirus DNA sequences.J Am Acad Dermatol. 1994; 30: 494-496Abstract Full Text PDF PubMed Scopus (17) Google Scholar described immunohistochemical staining positive signals indicating an HPV antigen in two cystic lesions of the left foot. The authors found that the DNA sequences were identical to HPV60. In 1994 Kawase et al.,5Kawase M. Honda M. Niimura M. Detection of human papillomavirus type 60 in plantar cysts and verruca plantaris by the in situ hybridization method using digoxigenin labeled probes.J Dermatol. 1994; 21: 709-715PubMed Google Scholar examined 10 cases of plantar cysts. Six of them were found to have cytopathic effects in the cyst wall and inner contents. HPV60 was detected in these cases by ISH. In 1995 Egawa et al.6Egawa K. Honda Y. Inaba Y. Ono T. De Villiers E.M. Detection of human papillomaviruses and eccrine ducts in palmoplantar epidermoid cysts.Br J Dermatol. 1995; 132: 533-542Crossref PubMed Scopus (50) Google Scholar examined 119 palmoplantar epidermoid cysts. Hybridization experiments to detect HPV DNA were performed in 47 cases, revealing the presence of HPV60 DNA sequences. In 1998, Egawa et al.7Egawa K. Kitasato H. Honda Y. Kawai S. Mizushima Y. Ono T. Human papillomavirus 57 identified in a plantar epidermoid cyst.Br J Dermatol. 1998; 138: 510-514Crossref PubMed Scopus (43) Google Scholar detected HPV57 DNA by PCR and ISH in the plantar cyst of a 23-year-old Japanese man. After routine histopathologic review, PCR of extracted DNA, sequencing of PCR products and, finally, a homology search were undertaken by Lee et al.8Lee S. Lee W. Chung S. Kim D. Sohn M. Kim M. et al.Detection of human papillomavirus 60 in epidermal cysts of nonpalmoplantar location.Am J Dermatopathol. 2003; 25: 243-247Crossref PubMed Scopus (24) Google Scholar in 63 epidermal cysts. As a result, nine of 63 (14.3%) cysts showed a positive reaction on PCR. By homology search after PCR, all were demonstrated to be HPV60. Our case demonstrates that HPV type 16 may be found in the HPV-associated verrucous cyst. Conflict of interest: No conflict of interest to declare.
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Synchronous verrucous carcinoma and squamous cell carcinoma of the penis is a rare condition. We report on a case of penile carcinoma with a well demarcated and ulcerated endophytic squamous carcinoma lesion by human papillomavirus 16 and 61 types, and a whitish exophytic verrucous carcinoma lesion by an unknown lower risk human papillomavirus type.
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Verrucous carcinoma of the anus is a distinct and rare variant of well-differentiated squamous cell carcinoma. A case of anal verrucous carcinoma in a 35 year old man was studied by light microscopy and in situ DNA hybridization. Human papillomavirus (HPV) type 16 DNA sequences were demonstrated in the tumour cells, as well as in cells showing koilocytotic and dyskeratotic changes. The possible viral (HPV) aetiology of verrucous carcinoma is considered with a review of the previous literature.
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Verrucous carcinoma
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Verrucous carcinoma
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Aims Verrucous carcinoma ( VC ) is a variant of well‐differentiated squamous cell carcinoma and in the anal region is regarded as synonymous with giant condyloma (Buschke–Löwenstein tumour) ( BLT ). Aetiology, diagnostic criteria and clinical behaviour of both lesions are controversial. Recent studies suggest that VC at other sites is not associated with human papillomaviruses ( HPV ). We hypothesized that anal VC is also not related to HPV , while BLT is a HPV ‐induced lesion. Methods and results Ten cases of VC and four cases of BLT were included. Several techniques were used for HPV detection: in‐situ hybridization for HPV 6, 11, 16 and 18, six different polymerase chain reaction ( PCR ) protocols for detection of at least 89 HPV types from alpha‐ , beta‐ , gamma‐ and mu‐ PV genera and in‐situ hybridization for high‐risk HPV E6/E7 mRNA ; p16 immunohistochemistry and morphometric analysis were also performed. Alpha‐ , gamma‐ and mu‐ PV s were not found in any case of VC , while HPV 6 was detected in all cases of BLT . p16 overexpression was not present in any of the lesions. Among microscopic features, only the absence of koilocytosis and enlarged spinous cells seem to be useful to distinguish VC from BLT . Conclusions Our results suggest that anal VC , similarly to VC at other sites, is not associated with HPV infection, and must be distinguished from BLT , which is associated with low‐risk HPV . Only with well‐set diagnostic criteria will it be possible to ascertain clinical behaviour and optimal treatment for both lesions.
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The association between uterine cervix and anogenital carcinomas and human papillomavirus, HPV, is well established, however the involvement of this virus in the development of oral squamous cell carcinomas remains controversial.To evaluate the relationship between HPV infection and oral squamous cell carcinomas, and to estimate the incidence of this infection in these patients.Four electronic databases were searched to find studies that met the following inclusion criteria: i) performed in humans; ii) were cohort, case-control or cross-sectional; iii) assessed the HPV oncogenic activity by the E6 and E7 mRNA; iv) included primary oral squamous cell carcinomas which; v) diagnosis had been confirmed by biopsy. Information about the country; study period; sample obtainment; sites of oral squamous cell carcinomas; number, gender and age range of the population; the prevalence of HPV infection and subtypes detected; use of tobacco or alcohol and oral sex practice were extracted. The methodological quality of included articles was assessed using 14 criteria.The search strategy retrieved 2129 articles. Assessment of the full text was done for 626 articles, but five were included. The total of participants included was 383, most of them male with mean age between 51.0 and 63.5 years old. Seventeen patients were HPV/mRNA-positive, being the subtypes 16 and 18 detected more frequently. Nine of the HPV/mRNA-positive oral squamous cell carcinomas occurred on the tongue. The quality score average of included articles was five points.Among the 383 oral squamous cell carcinoma patients included, 17 (4.4%) were HPV/mRNA-positive, nevertheless it was not possible to assess if HPV infection was associated with oral squamous cell carcinomas because none of the studies included was longitudinal and cross-sectional investigations do not have control group.
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