Condylomata acuminata, giant condyloma acuminatum (Buschke‐Loewenstein tumour) and verrucous squamous carcinoma of the perianal and anorectal region: a continuous precancerous spectrum?

Bogomoletz, W. V.; Potet, F; Molas, G

doi:10.1111/j.1365-2559.1985.tb02796.x

Cited by 96 publications

(44 citation statements)

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“…51 Given the overlapping histologic features, some authorities regard giant condyloma of Buschke-Lowenstein and verrucous carcinoma as a spectrum of the same process. 52 Since condylomata accuminata do not regress spontaneously and, unless excised, will persist for years or even decades, showing decreasing koilocytosis and proliferation while developing increasing superficial keratinization (unpublished observations 51 ), it is not inconceivable that verrucous carcinoma may evolve from a persistent, irritated condyloma. Low oncogenic risk HPVs may initiate the growth process, while subsequent chronic epithelial irritation may contribute to a gradual evolution of malignant phenotype.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of mucosal and cutaneous human papillomaviruses in different histologic subtypes of vulvar carcinoma

2008

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Two independent pathways of vulvar carcinogenesis have currently been identified, one related to infection with mucosal human papillomaviruses (HPVs) and a second related to chronic inflammatory or autoimmune processes. The goal of the study was to examine a possible role of cutaneous HPVs from the beta genus in vulvar carcinogenesis and to evaluate the distribution of intratypic variants of HPV 16 in HPV 16-positive vulvar cancer. Consecutive cases of vulvar carcinoma were retrieved from the files and included the following histologic subtypes: keratinizing (n ¼ 21), basaloid (n ¼ 7), warty (n ¼ 1), mixed basaloid-warty (n ¼ 4), verrucous (n ¼ 4), keratoacanthoma (n ¼ 1), basal cell carcinoma (n ¼ 1). All tumors were microdissected and tested for 25 beta HPV types and 25 mucosal HPV types. Cases identified as positive for HPV 16 were further tested for intratypic variants. All cases were immunostained for p16 INK4a . Beta HPVs were not detected in any of the tumor cases. Mucosal HPVs were detected in all but one basaloid/warty carcinomas; of these, nine cases (82%) were positive for HPV 16, including five European subtypes, one African subtype, one North American subtype and two indeterminate subtypes. Two of four verrucous carcinomas were positive for HPV 6. Mucosal HPVs were not detected in keratinizing carcinomas, keratoacanthoma and basal cell carcinoma. All cases of basaloid/warty carcinomas, but none of the remaining tumors, overexpressed p16 The pathogenesis of vulvar carcinoma is not entirely understood. Results of epidemiologic, clinicopathologic and virologic studies are in support of two independent pathways of vulvar carcinogenesis, one related to infection with oncogenic mucosal human papillomaviruses (HPVs) and a second related to a chronic inflammatory and/or autoimmune process involving vulvar mucosa and skin. [1][2][3][4][5][6] Vulvar cancers associated with oncogenic mucosal HPVs tend to occur in young women with past history of genital warts, cervical dysplasia and/or immunosuppression. These carcinomas typically belong to basaloid or warty histologic subtypes and develop from a well-characterized in situ lesion, namely, classic vulvar intraepithelial neoplasia grade 3 (VIN3).7 Approximately 80-90% of HPVpositive vulvar cancers are associated with HPV16 and nearly all remaining tumors are positive for HPV18 and HPV33. [4][5][6][8][9][10][11][12][13] Vulvar carcinomas not associated with mucosal HPVs occur in older women. These well-differentiated keratinizing squamous cell carcinomas histologically resemble conventional squamous cell carcinomas occurring in non-genital skin. 4 However, unlike the usual squamous cell carcinomas, vulvar cancers are not arising in the setting of actinic keratosis. In the vulva, these tumors develop in a background of squamous cell hyperplasia, a chronic inflammatory condition, or long-lasting lichen sclerosus, a lesion with strong links to autoimmune diseases. Although patients with lichen sclerosus

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Section: Discussionmentioning

confidence: 99%

Prevalence of mucosal and cutaneous human papillomaviruses in different histologic subtypes of vulvar carcinoma

2008

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“…And, evidence of exposure to many sexually transmitted organisms has been observed in women with cervical cancer, including syphilis, genital herpes, human papilloma virus, and Chlamydia (Levin et al, 1942;Rojel, 1952;Melnick et al, 1974;Kauffman & Adam, 1986;Durst et al, 1983;Syrjanen et al, 1985;Schachter et al, 1982;Cardillo, 1985). These same diseases also have been found more often in women with vulvar cancer than would be expected in a similar group of women without this disease (Franklin & Rutledge, 1974;Mabuchi et al, 1985;Schwartz & Naftolin, 1981;Rueda-Leverone et al, 1987) and have been found in patients with anal cancer more often than in controls (Gal et al, 1987;Bogomoletz et al, 1985;Daling et al, 1987).…”

Section: Discussionmentioning

confidence: 66%

Multiple primary tumours in women with vulvar neoplasms: a case-control study

Sherman

Daling²,

Chu³

et al. 1988

Br J Cancer

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Summary We sought to determine whether women with in situ or invasive squamous cell vulvar cancer were more likely than other women to have had a previous or concurrent tumour at other anogenital sites. One hundred and fifty-eight women with vulvar cancer were identified who were first diagnosed during 1980-1985, were ages 18-79 years at that time, and were residents of one of three counties in western Washington. Two control groups were selected: (1) from records of hospital pathology departments, a sample of 113 women with certain benign conditions of the vulva; (2) through random digit dialing, a sample of 212 women from the general population of these counties. Information on a history of other cancers, and on sexual, reproductive, medical, and demographic characteristics was collected from cases and controls in at-home interviews. Cases were more likely to report a history of other anogenital cancers than were controls, with relative risks of 3.5-29.8, depending on the type of case group and type of control. These associations were not explained by case-control differences in demographic characteristics or frequency of cervical screening. On the other hand, prior or concurrent non-anogenital cancers were equally common in cases and controls. These results support the hypothesis that the different anogenital cancers have at least one aetiology in common.Recent research suggests that cancers of the cervix, vulva, and anus may share one or more risk factors (Peters et al., 1984;Okagaki, 1984). If this is true, women with cancer at one anogenital site would be at increased risk of developing another anogenital tumour. One way to examine this possibility is to see if women with cancer at a specific anogenital site were more likely than other women to have had a previous or concurrent tumour at another anogenital site.There have been numerous reports of women with squamous cell cancer of the vulva who have had one or more second primary malignancies of the anogenital tract (Taussig, 1940;Cromer, 1963;Day, 1958;Caberra et al., 1966), especially the cervix (Franklin & Rutledge, 1974;Friedrich et al., 1980), that were detected before (McPherson et al., 1963), simultaneous with (Eichner, 1956), or after the vulvar tumour (Diehl et al., 1951). While these reports are intriguing, they were not derived from a defined population, nor were the cases compared to a control group. Using data on cancer incidence rates from the Connecticut Tumor Registry, Schoenberg (1977) showed that women who had cervical cancer were at greater risk for other anogenital malignancies compared with other women. In a hospitalbased, case-control study of vulvar cancer, Mabuchi et al. (1985) found that six of 149 women with vulvar cancer but none of 149 controls had a history of prior urogenital cancer.As part of a case-control study of women with in situ and invasive vulvar cancer, we had the opportunity to examine the hypothesis that multiple anogenital malignancies occur more commonly that would be predicted by chance. (2) a random sampl...

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“…26 Moreover, it has also been suggested that malignant transformation may be more related to the host response to the HPV infections than to the virus itself. 11 Giant condylomas have been considered as a different spectrum of the same entity as verrucous carcinoma, 27,45 suggesting that a chronic irritated condylomata caused by a low-risk HPV could evolve to a more aggressive lesion as a verrucous carcinoma. 38,46 RT-PCR analysis of the verrucous carcinoma testing positive for low-risk HPV revealed E6 mRNA expression in all of them, indicating that the virus is actively present.…”

Section: Human Papillomavirus In Verrucous Carcinomamentioning

confidence: 99%

“…18,24,25 However, a causal relationship between HPV and verrucous carcinoma remains to be proven, specifically in those cases in which a low-risk HPV has been suggested to be involved in the genesis of the tumours. 5,26 Some authors have considered verrucous carcinoma and giant condyloma as a spectrum of the same process mainly due to the overlapping histological features, 27 suggesting that verrucous carcinoma may evolve from a persistent irritated condyloma. In those cases, low-risk HPV types may initiate the growth process and the chronic epithelial irritation could subsequently contribute to the development of a malignant phenotype.…”

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confidence: 99%

Comprehensive analysis of human papillomavirus prevalence and the potential role of low-risk types in verrucous carcinoma

et al. 2012

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The role of human papillomavirus (HPV) infections in the development of verrucous carcinoma, a welldifferentiated variant of squamous cell carcinoma with difficult differential diagnosis, is controversial in the literature. In this study, we analysed verrucous carcinoma from different origins for the presence and activity of a broad spectrum of HPV types, and carefully reviewed the histopathological features. A random series of 27 formalin-fixed, paraffin-embedded specimens of verrucous carcinoma was taken, representing the head and neck region (n ¼ 6), anogenital area (n ¼ 16) and extragenital skin region (n ¼ 5). After review of the histological slides, all samples were subjected to different polymerase chain reaction-based HPV detection techniques, together detecting a total of 83 HPV types, including both mucosal and cutaneous types. Histological revision was carefully performed. Lesions with keratinised papillae, blunt stromal invaginations and minimal cytological atypia were considered verrucous carcinoma. Condylomatous lesions with viral changes were defined as giant condyloma. Verrucous lesions that did not meet those criteria were classified as verrucous hyperplasia. Tumours with stromal infiltration were considered as invasive squamous cell carcinoma. Histological revision revealed that 13 out of 27 cases were verrucous carcinoma (one showing a double infection with HPV 35 and 45), 5 invasive squamous cell carcinomas, 5 verrucous hyperplasia (one with a double infection with HPV 4 and 8), 1 pseudoepitheliomatous hyperplasia and 3 giant condylomas. All three giant condylomas were low-risk HPV positive (HPV 6 and 11) and showed active mRNA transcription. None of the HPV-positive samples tested positive for diffuse p16 INK4A staining. In conclusion, our results do not support a causal role of HPV in the development of verrucous carcinoma. Testing for LR-HPV, particularly HPV 6 and 11, may help in the differential diagnosis of lesions suspicious of verrucous carcinoma as those testing positive for LR-HPV most likely represent giant condylomas.

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Condylomata acuminata, giant condyloma acuminatum (Buschke‐Loewenstein tumour) and verrucous squamous carcinoma of the perianal and anorectal region: a continuous precancerous spectrum?

Cited by 96 publications

References 32 publications

Prevalence of mucosal and cutaneous human papillomaviruses in different histologic subtypes of vulvar carcinoma

Prevalence of mucosal and cutaneous human papillomaviruses in different histologic subtypes of vulvar carcinoma

Multiple primary tumours in women with vulvar neoplasms: a case-control study

Comprehensive analysis of human papillomavirus prevalence and the potential role of low-risk types in verrucous carcinoma

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