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BRIEF COMMUNICATION
Year : 2013  |  Volume : 9  |  Issue : 3  |  Page : 541-542

Verruco-papillary lesions in relation to human papilloma virus


1 Department of Oral Pathology & Microbiology, Bhojia Dental College, Baddi, Himachal Pradesh, India
2 Department of Oral Pathology & Microbiology, I.T.S-CDSR, Muradnagar, Ghaziabad, Uttar Pradesh, India
3 Department of Prosthodontics & Implantology, Bhojia Dental College, Baddi, Himachal Pradesh, India

Date of Web Publication8-Oct-2013

Correspondence Address:
Charu Kapoor
Department of Oral Pathology and Microbiology, Bhojia Dental College, Budd, Baddi, District Solan, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.119362

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 > Abstract 

Plethora of pathologic conditions may affect the normal morphologic characteristics and intactness of the oral mucosa, presenting as surface alterations.The prevalence of the different types of HPV worldwide has implications for the effectiveness of HPV vaccinations against HPV-induced carcinogenesis. This article discusses HPV related lesions with emphasis on verrucopapillary lesions.

Keywords: Human papilloma virus, Papliiary lesions, Vaccine


How to cite this article:
Kapoor C, Dhanpal R, Shetty C, Vaidya S. Verruco-papillary lesions in relation to human papilloma virus. J Can Res Ther 2013;9:541-2

How to cite this URL:
Kapoor C, Dhanpal R, Shetty C, Vaidya S. Verruco-papillary lesions in relation to human papilloma virus. J Can Res Ther [serial online] 2013 [cited 2019 Nov 21];9:541-2. Available from: http://www.cancerjournal.net/text.asp?2013/9/3/541/119362


 > Introduction Top


Plethora of pathologic conditions may affect the normal morphologic characteristics and intactness of the oral mucosa, presenting as surface alterations. These changes on the surface of the oral mucosa can be divided into three major groups. [1]

  1. Ulcerative
  2. Vesiculobullous
  3. Papillary, papular or polypoid lesions [2] [Table 1].
Table 1: Classification of Verrucal-Papillary lesions: (Regezi)3

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These lesion encompasses many pathologic changes involving the mucosa that distort the normal appearance of the mucosal surface and assume an exophytic presentation, without significant extension to the deeper submucosal tissues. [2],[3] The vast majority of papillomas are associated with or indeed caused by members of the human papillomavirus (HPV) family [Table 2], yet there are a few papillary growths that have not been associated with HPV. One lesion in particular, molluscum contagiosum, is caused by a member of the poxvirus group or may be idiopathic in origin. [4],[5]

Although, these lesions are by definition morphologically different with papillary (or verrucous) lesions exhibiting pointed or blunt finger-like projections, papular lesions featuring small sessile elevations, and polypoid lesions consisting of larger, often pedunculated, exophytic growths, they are overall similar and can be confused with each other. Two common reactive conditions of the palate, inflammatory papillary hyperplasia and nicotine stomatitis, are included in the differential diagnosis of diffuse papillary/papular lesions. The former is almost always associated with chronic trauma induced by a maxillary denture and is occasionally complicated by a fungal infection (denture stomatitis), while the latter is a smoking-induced reactive condition which causes an almost pathognomonic combination of white papules with red depressed centers. [3],[4],[5]
Table 2: HPV and Oral Papillary or Verrucous Lesions[1,3,5-8]

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Microscopically the benign verrucae and papillomas show exophytic, finger-like projections of stratified squamous epithelium, showing wide variations in the thickness of the keratin layer, which is usually parakeratinized [Figure 1]. [1],[5]
Figure 1: Histological configuration in papillary and verrucous lesion

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HPV and other lesions: Infection with "high-risk" HPVs - types 16 and 18 and others - if persistent, can lead to cervical cancer and other genital cancers. [6]

  • HPV 16 and 18 account for an estimated 70% of all cervical cancers. [6]
  • HPV 16 and 18 account for an estimated 25% of all low grade precancerous lesions.
  • HPV 16 and 18 account for an estimated 50% of all high grade precancerous lesions.
  • Infection with "low-risk" HPVs-types 6 and 11 and others - can cause the development of low-grade pre-cancerous lesions and genital warts.
  • HPV types 6 and 11 are responsible for approximately 10% of low-grade precancerous lesions.
  • HPV types 6 and 11 are responsible for approximately 90% of all genital warts. [6]
  • Both high and low-risk HPV types can cause cervical lesions and abnormal smear (Pap) tests [7] (used to detect cancer and cellular changes in the cervix). [8]
  • The high-risk types (mainly HPV 16, 18, 31, 33, 35, 45, 52 and 56) are implicated in cervical cancer. Among these, HPV 16 and 18 cause approximately 70% of cervical cancers worldwide.
  • The next most prevalent oncogenic type is HPV 45. It should be noted that HPV 45 is more frequent in adenocarcinoma (12% of cases) than squamous cancer (5% of cases).
  • Together, HPV 16, 18 and 45 cause 75% of squamous cell carcinoma and 94% of adenocarcinoma. The next five most common oncogenic HPV types (HPV 31, 33, 35, 52 and 58) together cause another 15% of all cervical cancers. [9]
  • In addition, HPV types 16 and 18 together account for about 90% of anal cancers and approximately half of all vulval and vaginal cancers.
  • In men, as well as anal disease, HPV causes penile intraepithelial neoplasia and about 50% of penile cancers. [9],[10]
  • HPV can also cause non-genital disease; it can cause disease on the skin, and the mucous membranes of the head and neck, where it is increasingly being found in oropharyngeal cancers. [11],[12]
  • HPV has a global distribution. The prevalence of the different types of HPV worldwide has implications for the effectiveness of HPV vaccinations against HPV-induced carcinogenesis. The use of the in situ deoxyribonucleic acid (DNA) hybridization as a powerful tool in detecting the specific HPV DNA sequences in routinely processed oral biopsy specimens is strongly recommended. [9],[10],[11]


In conclusion, a vaccine containing the seven most common HPV types would prevent about 87% of cancers worldwide, with little regional variation. Generating a vaccine with seven HPV types could be technically feasible; however, the production cost may be high, and the protection conferred by the less common HPV types may be difficult to demonstrate clearly.

 
 > References Top

1.Carlos R, Sedano HO. Multifocal papilloma virus epithelial hyperplasia. Oral Surg Oral Med Oral Pathol 1994;77:631-5.  Back to cited text no. 1
[PUBMED]    
2.Eversole LR, Laipis PJ. Oral squamous papillomas: Detection of HPV DNA by in situ hybridization. Oral Surg Oral Med Oral Pathol 1988;65:545-50.  Back to cited text no. 2
[PUBMED]    
3.Regezi JA, Sciubba JJ. Verruco-papillarylesions Oral Pathology: Clinico-Pathologic Correlation. 5 th ed. London: W.B. Saunders Company Ltd.; 2008. p. 105-10.  Back to cited text no. 3
    
4.Flaitz CM, Hicks MJ. Molecular piracy: The viral link to carcinogenesis. Oral Oncol 1998;34:448-53.  Back to cited text no. 4
[PUBMED]    
5.Garlick JA, Taichman LB. Human papillomavirus infection of the oral mucosa. Am J Dermatopathol 1991;13:386-95.  Back to cited text no. 5
[PUBMED]    
6.Muñoz N, Bosch FX, de Sanjosé S, Herrero R, Castellsagué X, Shah KV, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003;348:518-27.  Back to cited text no. 6
    
7.Krogh GV, Lacey C, Gross C, Barrasso R, Schneider A. European Course on HPV Associated Pathology: Guideline for the diagnosis and management of anogenital warts. Sex Transm Inf 2000;76:162-8.  Back to cited text no. 7
    
8.Centers for Disease Control & Prevention. Prevention of Genital HPV Infection: . Available from: http://www.cdc.gov/std/HPV/2004HPV%20report.pdf.   Back to cited text no. 8
    
9.De Sanjose S, Quint WG, Alemany L, Geraets DT, Klaustermeier JE, Lloveras B et al. Human papillomavirus genotype attribution in invasive cervical cancer: A retrospective cross-sectional worldwide study. Lancet Oncol 2010;11:1048-56.  Back to cited text no. 9
    
10.Miralles-G C, Bruni L, Cubilla AL, Castellsagué X, Bosch FX, de Sanjosé S. Human papillomavirus prevalence and type distribution in penile carcinoma. J Clin Pathol 2009;62:870-8.  Back to cited text no. 10
    
11.Mehanna H, Jones TM, Gregoire V, Ang KK. Oropharyngeal carcinoma related to human papillomavirus. BMJ 2010;340:c1439.  Back to cited text no. 11
[PUBMED]    
12.Lacey CJ, Lowndes CM, Shah KV. Chapter 4: Burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease. Vaccine 2006;2:35-41.  Back to cited text no. 12
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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