Distribution of HPV infection and tumour markers in cervical intraepithelial neoplasia from cone biopsies of Mozambican women

Abstract

Aims: To evaluate human papillomavirus (HPV) infection in whole cervical cone specimens with cervical intraepithelial neoplasia (CIN). In addition, to evaluate the relation between the presence of CIN lesions and HPV infection and the expression of Ki-67, p53, cytokeratins, Gp230 glycoprotein, and simple mucintype carbohydrates. Methods: Cervical cone specimens from five patients with CIN were studied. For each specimen, serial sections encompassing the whole cone were collected (52 samples). HPV infection and HPV types were detected by the polymerase chain reaction and enzyme immunoassay. The expression of Ki-67, p53, cytokeratins, Gp230, and simple mucin-type carbohydrates was examined immunohistochemically. Results: All cases showed high risk HPV types, namely types 16, 33, 35, and 58. Four of the five patients were infected by multiple viral types. HPV-58 was always seen in CIN III, whereas HPV-35 was more frequent in CIN I. The expression of Ki-67 and p53 was higher in CIN III lesions. The expression of cytokeratins 8 and 17 showed complete or almost complete overlap with CIN III. Altered expression of Gp230, Tn, and sialyl-T was often seen in all grades of CIN. Conclusions: When whole cervical cone specimens are evaluated the rate of multiple HPV infection is very high. The expression of cytokeratins 8 and 17 is a useful marker of CIN III. C ervical carcinoma is a major cause of cancer death in Africa. The strong causal association between cervical carcinoma and infection by human papillomavirus (HPV) is well established, and it was recently proposed that HPV infection is a necessary cause of cervical cancer development.1 Both our group, 2 and that of Castellsague et al, 3 have previously described the profile of HPV infection in Mozambican women.2 3 In both studies, the types of HPV identified coincided with those previously described in other sub-Saharan countries, with a high prevalence of HPV types 16, 31, 33, 35, and 58. 2-6 With the improvement of methods to detect HPV at the molecular level there is increasing evidence of the presence of HPV in cervical intraepithelial neoplasia (CIN) lesions.7 8 The detection of multiple infections has also increased, probably because of the higher sensitivity of the techniques that are currently used. 9-11''Cervical carcinoma is a major cause of cancer death in Africa'' Very few studies have explored the relation between the topographical distribution of HPV infection and HPV types and the different grades of CIN lesions in the uterine cervix.12 13 To the best of our knowledge, no studies relating the presence or absence of HPV infection and HPV types in CIN lesions, which have thoroughly evaluated the whole cervix, have been undertaken.CIN and HPV infection are accompanied by several alterations in molecular structures that are expressed de novo or are lost. The putative usefulness of these markers for diagnostic and prognostic purposes is still controversial, and the results so far obtained are frequently conflicting.In our present study, using serial sampl...

Vaccine‐related HPV genotypes in women with and without cervical cancer in Mozambique: Burden and potential for prevention

“…10 Our findings among cervical cancer cases are consistent with other smaller studies in Mozambique that also found that HPVs 16 and 18 were the most common types in tumor samples from these patients. [11][12][13][14] The results of these studies are consistent with the world-wide distribution of HPV types in cervical cancer. 7,15 Despite of the fact that HPVs 51 and 35 are the most frequently detected types in women without cervical abnormalities, HPV Types 16 and 18 are still the most frequently identified genotypes in cervical cancer specimens.…”

Prevalence and risk factors for cancer of the uterine cervix among women living in Kinshasa, the Democratic Republic of the Congo: a cross-sectional study

“…In other Sub-Saharan countries, the frequency of HPV16 and 18 varies. Some countries have reported patterns that resemble the situation in Europe and the United States [ 22 , 48 , 66 , 67 ], whereas in other countries, HPV types other than 16 and 18 appear to be more prominent [ 29 , 47 , 68 , 69 ].…”

Trends in Cancer Incidence in Maputo, Mozambique, 1991–2008

“…Increase in the awareness of the disease and improvements in the diagnostic capacity may have also played a role. Indeed, HPV infection, the cause of cancer of the uterine cervix has been shown to be highly prevalent in Mozambique with over 50% of the women being positive at 20 years of age and 20–30% of those over 30 years of age [ 20 – 22 ]. As in other low-income countries, the high prevalence of cancer of the uterine cervix may be explained by the difficulties in carrying out secondary prevention programs due to limited resources.…”