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# | [[Image:High grade squamous intraepithelial lesion - 2 - p16 -- high mag.jpg|thumb|Micrograph showing block positive [[p16]] immunostaining in [[high-grade squamous intraepithelial lesion]] of the cervix. ''p16'' is commonly used as a surrogate marker for human papillomavirus (HPV). (WC)]] | ||
'''Human papillomavirus''', abbreviated '''HPV''', is virus implicated in a large number of [[cancer]]s. | |||
==General== | |||
*Sexually transmitted. | |||
Note: | |||
*Some tests can be done on formalin-fixed, paraffin-embedded tissue.<ref name=pmid21128780>{{Cite journal | last1 = Black | first1 = CC. | last2 = Bentley | first2 = HA. | last3 = Davis | first3 = TH. | last4 = Tsongalis | first4 = GJ. | title = Use of a linear array for the detection of human papillomavirus genotypes in head and neck cancer. | journal = Arch Pathol Lab Med | volume = 134 | issue = 12 | pages = 1813-7 | month = Dec | year = 2010 | doi = 10.1043/2009-0592-OAR.1 | PMID = 21128780 }}</ref> | |||
===Associated pathology=== | |||
*Benign: | |||
**[[Verruca vulgaris]]. | |||
**[[Condyloma acuminatum]]. | |||
**[[Esophagus#Human_papilloma_virus_esophagitis|HPV esophagitis]]. | |||
*Malignant: | |||
*#[[Uterine cervix|Cervical cancer]] and precursors ([[LSIL]], [[HSIL]]). | |||
*#Anal cancer and precursors ([[Anus#Anal_intraepithelial_neoplasia|AIN]]).<ref name=pmid21616117>{{Cite journal | last1 = Borget | first1 = I. | last2 = Abramowitz | first2 = L. | last3 = Mathevet | first3 = P. | title = Economic burden of HPV-related cancers in France. | journal = Vaccine | volume = 29 | issue = 32 | pages = 5245-9 | month = Jul | year = 2011 | doi = 10.1016/j.vaccine.2011.05.018 | PMID = 21616117 }}</ref> | |||
*#[[Vulva|Vulvar cancer]].<ref name=pmid21616117/> | |||
*#[[Vagina|Vaginal cancer]].<ref name=pmid21616117/> | |||
*#[[Penis|Penile cancer]].<ref name=pmid21616117/> | |||
*#[[HPV-associated head and neck squamous cell carcinoma]] - oropharynx (specifically - tonsils, base of tongue). | |||
*#[[Human papillomavirus-related multiphenotypic sinonasal carcinoma]] (previously known as ''HPV-related carcinoma with adenoid cystic-like features''). | |||
**Possibly esophageal carcinoma<ref name=pmid21130683>{{Cite journal | last1 = Zhang | first1 = QY. | last2 = Zhang | first2 = DH. | last3 = Shen | first3 = ZY. | last4 = Xu | first4 = LY. | last5 = Li | first5 = EM. | last6 = Au | first6 = WW. | title = Infection and integration of human papillomavirus in esophageal carcinoma. | journal = Int J Hyg Environ Health | volume = 214 | issue = 2 | pages = 156-61 | month = Mar | year = 2011 | doi = 10.1016/j.ijheh.2010.11.001 | PMID = 21130683 }}</ref> - disputed.<ref name=pmid21169053>{{Cite journal | last1 = Iyer | first1 = A. | last2 = Rajendran | first2 = V. | last3 = Adamson | first3 = CS. | last4 = Peng | first4 = Z. | last5 = Cooper | first5 = K. | last6 = Evans | first6 = MF. | title = Human papillomavirus is detectable in Barrett's esophagus and esophageal carcinoma but is unlikely to be of any etiologic significance. | journal = J Clin Virol | volume = 50 | issue = 3 | pages = 205-8 | month = Mar | year = 2011 | doi = 10.1016/j.jcv.2010.11.015 | PMID = 21169053 }}</ref> | |||
===Oncocytic types=== | |||
Known as "high risk" types; this grouping includes:<ref name=pmid22312235>{{Cite journal | last1 = Ntova | first1 = CK. | last2 = Kottaridi | first2 = C. | last3 = Chranioti | first3 = A. | last4 = Spathis | first4 = A. | last5 = Kassanos | first5 = D. | last6 = Paraskevaidis | first6 = E. | last7 = Karakitsos | first7 = P. | title = Genetic Variability and Phylogeny of High Risk HPV Type 16, 18, 31, 33 and 45 L1 Gene in Greek Women. | journal = Int J Mol Sci | volume = 13 | issue = 1 | pages = 1-17 | month = | year = 2012 | doi = 10.3390/ijms13010001 | PMID = 22312235 }}</ref> | |||
*HPV 18 - predominantly adenocarcinoma.<ref name=pmid15551313>{{Cite journal | last1 = De Boer | first1 = MA. | last2 = Peters | first2 = LA. | last3 = Aziz | first3 = MF. | last4 = Siregar | first4 = B. | last5 = Cornain | first5 = S. | last6 = Vrede | first6 = MA. | last7 = Jordanova | first7 = ES. | last8 = Fleuren | first8 = GJ. | title = Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries. | journal = Int J Cancer | volume = 114 | issue = 3 | pages = 422-5 | month = Apr | year = 2005 | doi = 10.1002/ijc.20727 | PMID = 15551313 }}</ref> | |||
**'''Eigh'''teen = '''a'''denocarcinoma. | |||
*HPV 16 - predominantly squamous cell carcinoma.<ref name=pmid15551313/> | |||
**'''S'''ixteen = '''s'''quamous. | |||
*HPV 31. | |||
*HPV 33. | |||
*HPV 45. | |||
===Oncogenesis=== | |||
Quick & dirty explanation of pathogenesis:<ref name=pmid12445661>{{Cite journal | last1 = Münger | first1 = K. | last2 = Howley | first2 = PM. | title = Human papillomavirus immortalization and transformation functions. | journal = Virus Res | volume = 89 | issue = 2 | pages = 213-28 | month = Nov | year = 2002 | doi = | PMID = 12445661 }}</ref><ref name=Ref_PCPBoD8_169>{{Ref PCPBoD8|169}}</ref> | |||
*Virus integrates into host genome. | |||
**This is accompanied by loss of ''viral gene E2'' (which suppresses function of E6 & E7). | |||
*''Viral gene E6'' dysregulates ''p53''. | |||
*''Viral gene E7'' dysregulates ''RB''. | |||
===Vaccine=== | |||
Recombinant vaccine (Gardasil, Silgard) - covers:<ref name=pmid21942919>{{Cite journal | last1 = McCormack | first1 = PL. | last2 = Joura | first2 = EA. | title = Spotlight on Quadrivalent Human Papillomavirus(Types 6, 11, 16, 18) Recombinant Vaccine(Gardasil®) in the Prevention of PremalignantGenital Lesions, Genital Cancer, and Genital Warts in Women†. | journal = BioDrugs | volume = 25 | issue = 5 | pages = 339-43 | month = Oct | year = 2011 | doi = 10.2165/11205060-000000000-00000 | PMID = 21942919 }}</ref> | |||
*HPV 6. | |||
*HPV 11. | |||
*HPV 16. | |||
*HPV 18. | |||
==Microscopic== | |||
Features: | |||
*Koilocytes: | |||
** Perinuclear clearing. | |||
** Nuclear changes. | |||
*** Size similar (or larger) to those in the basal layer of the epithelium. | |||
*** Nuclear enlargement should be evident on low power, i.e. 25x. | |||
*** Central location - nucleus should be smack in the middle of the cell. | |||
===Images=== | |||
<gallery> | |||
Image:Low-grade_squamous_intraepithelial_lesion.jpg | LSIL (WC). | |||
Image:Low-grade_sil_and_endocx.jpg | LSIL & endocervix (WC). | |||
</gallery> | |||
==IHC== | |||
*[[p16]] +ve -- stains most cells infected by HPV. | |||
===Images=== | |||
<gallery> | |||
Image: High grade squamous intraepithelial lesion - 2 - p16 -- high mag.jpg | Block positive p16 staining in [[HSIL]]. (WC) | |||
Image:Consistent with HPV-associated SCC - p16 -- intermed mag.jpg | c/w [[Human papillomavirus-associated head and neck squamous cell carcinoma|HPV-assoc. SCC]] - p16 - intermed. mag. (WC/Nephron) | |||
Image:Consistent with HPV-associated SCC - p16 -- high mag.jpg | c/w HPV-assoc. SCC - p16 - high mag. (WC/Nephron) | |||
</gallery> | |||
==See also== | |||
*[[Virus]]. | |||
*[[Viruses and cancer]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Viruses]] | [[Category:Viruses]] | ||