Squamous Papilloma Research Articles

Squamous papilloma arising from within a branchial cleft cyst

PurposeTo report an unusual occurrence of HPV infection manifesting as a squamous papilloma within a branchial cleft cyst. Study design/MethodsCase report and review of literature. ResultsA 64-year-old male presented with a history of recurrent oropharyngeal papillomas concurrent with a cystic neck lesion. Initial FNA biopsy was suspicious for a cystic nodal metastasis of squamous cell carcinoma. Upon excision of the neck mass, histopathologic analysis revealed a squamous papilloma arising from within a branchial cleft cyst. HPV positivity was confirmed with in-situ hybridization. The patient remains disease free after 75 months of follow-up. ConclusionsHPV infections of the upper respiratory tract are potentially transmissible into the neck via a branchial anomaly. Oncologic considerations are discussed.

Immunohistochemical Expression Patterns of Inflammatory Cells Involved in Chronic Hyperplastic Candidosis

The profile of the inflammatory cell infiltrate in chronic hyperplastic candidosis (CHC) was determined in oral mucosal biopsies by immunohistochemistry. One tonsillar tissue section was included as an immunohistochemistry control, whilst squamous papilloma (n = 4) with secondary Candida infection was used as Candida controls. Oral lichen planus tissues (n = 10) provided negative controls for Candida presence, as well as positive controls for inflammation. Immunohistochemistry employed antibodies specific for CD3+ (T lymphocytes), CD4+ (T helper cells), CD8+ (cytotoxic T cells), and CD20+ (B lymphocytes). Manual counting of stained cells from digitised images determined the proportion of each cell type relative to the total number of cells, and these were assessed in the mucosa, the epithelium, and the lamina propria. The mean proportion of CD3+ cells was significantly higher than CD20+ cells in all tissue types. For CHC, the mean proportion of CD3+ cells in entire tissues was 15.6%, with the highest proportion in the lamina propria (32.6%) compared with the epithelium (3.9%). CD20+ cells were in much lower proportions (1.8%) in CHC, with the highest proportion (3.6%) in the lamina propria. T lymphocytes were predominately CD4+ cells (9.0%) compared with CD8+ cells (4.4%). CD4+ cells were most prevalent in the lamina propria (23.1%) compared with the epithelium (mean = 3.2%). From these results, it was concluded that the immune response invoked by Candida in CHC is primarily driven by the T helper cells.

A clinicopathological classification analysis of ocular mass lesions in 7 910 cases

Objective: To investigate the anatomical region, histopathological classification and histogensis distribution of ocular mass lesions in South China. Methods: Retrospective cases study. The clinical and pathological data of 7 910 samples with ocular (adnexal) tumors or proliferative lesions which were examined from January 2000 to May 2018 were retrospectively retrieved. The constituent ratios of ocular mass lesions in different anatomical regions and histogenesis have been analyzed. Results: There were 3 445 males and 4 465 females aged from 3 months to 106 years. Classification by anatomical region. Eyelid 4 976 cases (62.9%): benign-pigmented nevus (31.7%, 1 342/4 235), squamous cell papilloma (12.3%, 519/4 235), seborrheic keratosis (9.4%, 396/4 235); malignant-basal cell carcinoma (48.5%, 359/741), sebaceous gland carcinoma (34.4%, 255/741), squamous cell carcinoma (12.3%, 91/741). Ocular surface 1 449 cases (18.3%): benign-pigmented nevus (26.6%, 359/1 348), squamous cell papilloma (12.8%, 173/1 348); malignant-lymphoma (34.7%, 35/101), squamous cell carcinoma (30.7%, 31/101).Orbit 1 485 cases (18.8%): benign-hemangioma (28.5%, 332/1 167), lacrimal gland (duct) cyst(13.2%, 154/1 167); malignant-lymphoma (44.7%, 142/318), adenoid cystic carcinoma (10.1%, 32/318). Classification by histogenesis: epithelial 2 145 cases (27.1%), cutaneous appendages 378 cases (4.8%), cystoid 1 068 cases (13.5%), mesenchymal 748 cases (9.5%), lymph-hematopoietic 225 cases (2.8%), neurogenic 31 cases (0.4%), melanocytic 1 765 cases (22.3%), others 1 550 cases (19.6%). Conclusions: Over the past 18 years, the ocular tumors identified at the Second Affiliated Hospital, Zhejiang University School of Medicine most frequently occur in eyelid and originate from epithelium. The most common types are as followings. Benign lesions: pigmented nevus, squamous cell papilloma are the most common types for eyelid and ocular surface, whereas hemangioma, lacrimal gland (duct) cyst and epidermoid cyst are the most common types for orbit. Malignant cancers: basal cell carcinoma is the most prevalent disease in eyelid, whereas lymphoma occurs more frequently in ocular surface and orbit. (Chin J Ophthalmol, 2019, 55: 847-853).

Squamous Cell Papilloma in a Student Aviator

BACKGROUND: Although oropharyngeal squamous cell papilloma (OSCP) is not uncommon in the general population, reports of OSCP in aviators are rare. This case report serves as a call for flight surgeons to consider all oropharyngeal pathology as a potential source of airway compromise during flight, and highlights regional risk factors for developing malignancies of the oropharynx.CASE REPORT: A 24-yr-old male foreign national student aviator from a central Asian country was at Fort Rucker for flight training. He presented to the clinic with a chief complaint of sore throat and cough for 2 d. He was afebrile but reported a history of a "throat" mass which was previously evaluated by a U.S. military otolaryngologist. Said mass was approximately 0.5 cm × 0.5 cm, irregular appearing, inflamed, and protruding from the inferior aspect of the right tonsil. Previous biopsy report revealed a squamous cell papilloma and, after consideration of the pilot's training program, active surveillance of the lesion was mutually agreed upon until the student's training had concluded and definitive excision was performed.DISCUSSION: A robust history and physical exam including an occupational, social, and environmental exposure history is crucial to diagnosis. Foreign national patients often have unique backgrounds that merit consideration when developing a differential diagnosis, assessment, and plan. In the field of Flight Medicine, a patient's occupational demands are essential to his or her care. In particular, any potential obstruction of the airway during flight must be considered, even if a pathology does not represent an immediate threat to the pilot's health.Swinson K, Burlile J, Pavelites J. Squamous cell papilloma in a student aviator. Aerosp Med Hum Perform. 2019; 90(11):978-981.

Molecular and pathological characterization of teat papillomatosis in dairy cows in southern Brazil.

Teat papillomatosis is caused by different bovine papillomavirus (BPV) types and is especially important for dairy cows, because it results in severe damage to the health and structure of the mammary gland. This work describes the molecular and pathological aspects of teat papillomatosis in dairy cows in southern Brazil. Samples of teat papillomas were collect from 73 slaughtered dairy cows. Fragments of the lesions were collected in individual pools per animal and subjected to PCR using the FAP primer pair and sequencing of the amplification products. Teats with the remaining lesions were fixed in 10% neutral buffered formalin, routinely processed for histopathology, and stained with hematoxylin and eosin (H&E). Papillomatous lesions were characterized by three macroscopic patterns, namely exophytic (5 [6.9%]), flat (29 [39.7%]), and mixed (39 [53.4%]). Histologically, all samples were identified as squamous papillomas. Partial sequencing of the L1 gene resulted in the detection of 8 classical BPV types (BPVs 4, 6, 7, 8, 9, 10, 11, and 12) in 27 samples, 6 previously reported putative BPV types in 17 samples, and 10 putative new BPV types in 15 samples. Four sequences could not be classified, and 10 were negative in the PCR. There was no correlation between the gross pattern and the BPV type identified, and all the samples were characterized by squamous papillomas under histological examination. However, 24 different BPV types were identified, demonstrating high genetic diversity among BPVs associated with teat papillomatosis in dairy cows in southern Brazil.

Implication and Management of Incidental Oropharyngeal Papillomas-A Retrospective Case Series Review.

Incidental papillomas of the pharynx can be found while examining the nasopharynx, oropharynx, and hypopharynx for other disorders of the head and neck. Purpose of the study is to explore the location, biopsy protocol, and decision to perform office-based versus operative management via potassium titanyl phosphate (KTP) laser when an oropharyngeal papilloma is discovered incidentally. A retrospective review of the senior author's patient population was performed using Current Procedural Terminology and/or International Classification of Diseases codes to identify patients who had KTP laser removal of incidental oropharyngeal papillomas. Patients were included based on the incidental nature of the papilloma and confirmed pathology report of squamous papilloma. Demographics, presenting complaint, lesion location, pathological analysis, type of intervention, and outcomes were recorded. When available, human papillomavirus (HPV) subtype was noted. A total of 26 cases were identified, 13 females and 13 males. The median age at time of surgery was 58 years (range: 21-77). The most common presenting symptoms were difficulty swallowing and throat pain. The most common locations were the base of tongue, uvula, tonsils, and the soft palate. Of the 26 patients, 23 patients received KTP laser ablation therapy as an office-based procedure, while the remaining 3 were performed under general anesthesia in the operating room. Only 5 patients had a recorded recurrence that required reoperation. There were no operative or postoperative complications. There were 16 biopsy samples tested for HPV, where 12 were negative for HPV and 4 were positive for HPV. Oropharyngeal papillomas, when present, can be found incidentally during examination of the oropharynx for other symptoms. Office-based biopsy and KTP laser is a safe and efficient means of identifying and removing most oropharyngeal papillomas.

Umbilical squamous papilloma: a case report

Umbilical squamous papilloma: a case report

3091 Squamous Papilloma of the Esophagus

INTRODUCTION: Squamous esophageal papillomas are rare epithelial lesions typically discovered incidentally during esophagoduodenoscopy (EGD). The occurrence in patients undergoing EGD is less than 0.45 percent and the prevalence in the general population inferred from autopsy is less than 0.04 percent. Most patients are asymptomatic unless the lesion is large. The most common symptom is dysphagia. A majority of these lesions are found in the distal one third of the esophagus. They have not been demonstrated to progress to esophageal carcinoma. CASE DESCRIPTION/METHODS: Our patient was a 53 year old male with history of alcohol abuse who presented with new-onset seizure/syncope, six painless maroon stools, and coffee-ground emesis. The patient admitted to frequent diclofenac use. He was found to be anemic with a hemoglobin of 7.9 G/dL and had an elevated INR of 1.2. He was transfused two units of packed red blood cells and was started on a pantoprazole drip. Initial endoscopy revealed an island of tissue growth in the mid-esophagus and a bleeding duodenal ulcer that was injected with epinephrine, cauterized with gold probe, and clipped. Biopsy of the esophageal lesion was deferred to outpatient follow-up given the severity of the patient's presenting condition. Following the procedure, he was continued on the pantoprazole drip with transition to oral pantoprazole 40 mg daily. He had no further signs of gastrointestinal bleeding. Two weeks later, an EGD was performed. Biopsies were taken of the stomach mucosa and mid-esophageal mass. Gastric biopsy demonstrated mild chronic gastritis without dysplastic changes or helicobacter pylori. Esophageal biopsy demonstrated findings consistent with squamous papilloma. DISCUSSION: Squamous papilloma of the esophagus is a rare but benign lesion. Its macroscopic appearance is similar to other, less benign growths (verrucous squamous cell carcinoma, granulation tissue, or papillary leukoplakia). The etiology is unclear. Chronic mucosal irritation from GERD or esophagitis is the prevailing theory of pathogenesis, but HPV – strongly associated with cervical, anal, and oropharyngeal cancers (depending on viral serotype) – has been detected in some lesions. Thus, the gold standard for evaluation is biopsy. There are various proposed therapies for squamous papillomas including resection, cautery and radiofrequency ablation. Future research is needed in regard to treatment and surveillance for these lesions.

1781 Esophageal Squamous Cell Carcinoma Masquerading as Neuropathic Pain

INTRODUCTION: The most common symptoms for esophageal carcinoma are dysphagia and odynophagia, though most are asymptomatic. We describe a case of upper esophageal squamous cell carcinoma masquerading as subphrenic neuropathic pain, not previously described in the literature. CASE DESCRIPTION/METHODS: A 67 year-old male with a past medical history of cholecystitis status post cholecystectomy, hepatic steatosis, acid reflux, hyperlipidemia, and 5-pack year tobacco history presented with 2 years of neuropathic subphrenic pain that radiated below the subcostal margins. The ingestion of solids and liquids triggered the pain, lasting for 1-2 seconds. The pain did not respond to viscous lidocaine or proton pump inhibitors. EGD two years prior revealed a nodular area of mucosa suspicious for esophageal squamous papilloma. His BMI was 29.6 and physical examination was otherwise unremarkable. He had normal peristalsis on esophageal manometry. EGD revealed a nodular mucosal patch in the upper third of the esophagus. Biopsies reproduced the patient’s sharp neuropathic pain. Pathology revealed ulcerated high-grade squamous dysplasia with a focus suspicious for stromal invasion. The stomach demonstrated segmental moderate mucosal changes characterized by atrophy, discoloration, and altered texture along the greater curvature of the gastric body with chronic inactive gastritis with extensive intestinal metaplasia on biopsy. H. pylori testing was negative.Endoscopic ultrasound demonstrated a confirmed a 4cm superficial lesion involving 1/3rd of the lumen. Endoscopic submucosal dissection was performed and pathology demonstrated a T1a squamous cell carcinoma with infiltration into the lamina propria and a focal tongue of tumor in the superficial muscularis mucosa. His pain resolved following resection. DISCUSSION: Esophageal squamous cell carcinoma masquerading as neuropathic pain is highly unusual. The mechanism behind this presentation remains unclear. The squamous papilloma visualized on prior EGD was a risk factor for the development of carcinoma. This case illustrates that squamous cell carcinoma can present with neuropathic pain, a symptom with swallowing that warrants further investigation.

1903 Esophageal Squamous Papilloma: A Rare Epithelial Tumor of Undetermined Significance

INTRODUCTION: Esophageal squamous papilloma (ESP) is an uncommon lesion with less than 200 cases described. Although typically a benign lesion, the etiology remains uncertain. Currently, no guidelines exist for the management of esophageal squamous papilloma. CASE DESCRIPTION/METHODS: A 59-year-old woman presented with dysphagia; she reported symptoms of acid reflux and globus sensation. One year prior, esophagogastroduodenoscopy (EGD) was performed for these symptoms and revealed atrophic changes consistent with gastritis. Biopsy at that time was negative for H. Pylori infection. She was treated with PPI therapy, however her symptoms persisted. She endorsed intermittent dysphagia but denied weight loss or poor appetite. Physical exam revealed no palpable thyromegaly or epigastric tenderness. Repeat upper EGD revealed a white, 7 mm frond-like pedunculated polyp located 20 cm from the incisors (Figure 1). Endoscopic ultrasound (EUS) was performed, the origin of the lesion appeared to be within the superficial mucosa. The endosonographic borders were well defined, intact interfaces between the mass and adjacent structures suggested a lack of submucosal invasion (Figure 2). No was lymphadenopathy seen. The polyp was excised endoscopically (Figure 3), pathological review identified the specimen as an esophageal squamous papilloma, positive for Ki67 and HPV marker P16. The patient tolerated the procedure well and had no recurrence of symptoms after polypectomy. DISCUSSION: Often an incidental finding on endoscopy, ESP are most commonly found in adults over age 50 and typically involve the middle and distal thirds of the esophagus. ESP may be associated with dyspepsia but rarely cause obstruction. Purported etiologies include mechanical, chemical and viral insult to mucosa but is likely multifactorial. The malignant potential of ESP remains uncertain; although rare, several reported cases have been complicated by carcinoma. Studies to detect HPV DNA in ESP show variable percentage of HPV positivity. If HPV infection predisposes to ESP, this may explain cases of malignant conversion as HPV is a known cause of squamous cell cancer. ESP should be considered in patients over 50 years old presenting with dysphagia or GERD resistant to medical therapy. We recommend early recognition and removal of esophageal squamous papilloma due to ambiguity regarding malignant potential.

Complicated tracheo-bronchial papillomatosis

Respiratory papillomas are rare benign lesions. They are characterized by the appearance of papillomatous lesions anywhere in the tracheobronchial tree. It affects children and young adults. Although the disease affects mainly the upper airways, it may be aggressive and extends distally to the lower respiratory tract and pulmonary parenchyma. The course of the disease is unpredictable. It may regress spontaneously, but in other instances, it may lead to serious complications ranging from airway obstruction up to malignant transformation. Surgical excision is the mainstay of definitive treatment to prevent recurrence and to exclude malignancy. We have reviewed the literature for this rare type of respiratory disease and present a thirty-five years old; male patient who had chronic cough and was referred to our unit with a CT-chest that revealed left main endo-bronchial lesion. Bronchoscopy and biopsy of the lesion were performed and revealed squamous papilloma. Final treatment introduced to the patient was endoscopic thermal ablation. However, the final pathology revealed complicated squamous bronchial papilloma with infection by aspergillosis and actinomycosis. Key words: HPV; Tracheo-bronchial papilmomatosis; endo-broncial lesion; bronchoscopy

Esophageal squamous cell papilloma on the background of gastroesophageal reflux disease: a clinical case in a 23-year-old obese man.

Background. A number of weighting factors, primarily obesity and manifestations of duodenogastroesophageal reflux (DGER), are correlated with the presence of inflammation and an increased risk of progression of negative changes in the esophagus with gastroesophageal reflux disease (GERD). This should be considered when screening for GERD using esophagogastroduodenoscopy (EGDS). Objective: to draw the attention of doctors to the need for early screening of morphological changes in the mucous membrane of the esophagus among young people with obesity, as an example of a clinical case. Methods. 23-year-old man with overweight, heartburn, bloating. Heartburn has been troubling for more than two years. Smokes. Has a family history of cancer of the upper gastrointestinal tract. On endoscopy: 38 cm from the upper incisors, a single, 3 mm in diameter, polypoid whitish formation was found, it rises on a broad basis. In the stomach – a significant amount of bile. Pylorus – open. Biopsy samples of the gastric mucosa (antrum, body) were taken. A quick urease test is negative. The removal of the formation of the esophagus. In a histological examination of the formation of the esophagus, we revealed squamous papilloma with low-grade epithelial dysplasia, chronic esophagitis, and reflux gastritis. Final diagnosis: GERD with chronic esophagitis. Squamous cell papilloma of the esophagus with mild epithelial dysplasia. Reflux gastritis, inactive. Obesity of 1 degree. Results. According to the literature, obesity, smoking, a family history of cancer are risk factors for GERD and the most common events among patients with squamous esophageal papilloma. DHER promotes the formation of GERD, esophagitis, metaplasia and neoplasia of the surface epithelium of the mucous membrane of the esophagus. But there is no scientific evidence for the benefits of endoscopic screening for GERD among obese young adults. Conclusion. A clinical case demonstrates that screening endoscopy in a young man against the background of factors aggravating the course of GERD revealed lesions of the esophagus in the form of squamous papilloma with epithelial dysplasia. Further studies are needed to confirm the benefits of endoscopic screening for GERD in obese young adults.

Microwave Ablation for the Removal of Benign Lesion of Nasal Cavity: "How I Do It".

Background Isolated benign lesions of the nasal cavity are commonly seen in the rhinology clinic; their treatment using various therapies has been explored in several studies. Methods In this retrospective study, isolated lesions of the nasal cavity were removed from 47 patients using microwave ablation (MWA) with a 2450-MHz cooled MWA antenna and sent for histological examination. Results The most commonly involved site was the nasal septum (n = 21, 44.7%), followed by the inferior turbinate (n = 12, 25.5%), bulla ethmoidalis (n = 9, 19.1%), and uncinate process (n = 5, 10.6%). The most common pathology was hemangioma (n = 36, 76.6%), followed by nasal polyp (n = 9, 19.1%) and squamous papilloma (n = 2, 4.3%). All lesions were removed endoscopically using MWA in patients administered local anesthesia. The total duration of ablation was 5 to 10 minutes, with an average duration of 7.3 ± 2.6 minutes. Follow-up at 6 months revealed no severe complications, including no cases of recurrent epistaxis, septal perforation, or synechiae of the nasal cavity. Conclusions The advantages of MWA are its short ablation time and minimal complications. This was demonstrated in our study in which a single session of MWA was sufficient to excise the isolated lesion while providing hemostasis. Most of the patients well tolerated the procedure, which could be performed using local anesthesia in the outpatient setting.

The Prevalence, Anatomic Distribution and Significance of HPV Genotypes in Head and Neck Squamous Papillomas as Detected by Real-Time PCR and Sanger Sequencing

Squamous papillomas (SPs) of the head and neck are generally regarded as a human papillomavirus (HPV)-driven process, but reported rates of HPV detection vary dramatically. Moreover, they are generally considered a benign condition, but the detection of high risk HPV types is commonly reported. This latter finding is particularly disturbing to clinicians and their patients given the alarming rise of HPV-associated head and neck cancer. The capriciousness of HPV detection reflects in large part differences in methodologies. The purpose of this study was to review an institutional experience using a state of the art detection method to determine the presence, type and anatomic distribution of HPV in head and neck SPs. The surgical pathology files of the Mount Sinai Hospital were reviewed for all SPs that had undergone HPV testing between 2012 and 2018. HPV screening was performed on tissue blocks with real-time PCR using primers designed to target the L1 region of low and high-risk HPV types. Genotyping was performed on HPV positive cases. HPV detection was repeated for cases that were originally reported to be positive for high risk HPV. 134 cases had undergone HPV analysis. Of the 131 with sufficient cellular material, 2 were excluded because the HPV testing yielded inconclusive results. The remaining 129 cases were the basis of this study. Thirty-eight cases (29%) were HPV positive and 91 (71%) were negative. The most common genotype was HPV 6 (n = 27, 71%), followed by HPV 11 (n = 10, 26%). One case (1%) was HPV positive but the genotype could not be determined. Of the HPV negative cases, 3 were originally reported as HPV 16 positive but found to be HPV negative on re-review and repeat testing. SPs arising in the larynx were more likely to harbor HPV than those arising in the oral cavity and oropharynx (64% vs. 10%, p < 0.00001). Similarly, recurrent respiratory papillomatosis (RRP) were much more likely to be HPV positive than solitary SPs (71% vs. 10%, p < 0.00001). Almost a third of head and neck SPs harbor HPV, but incidence is highly dependent on anatomic site. Those arising in the larynx are more prone to be HPV-driven than those arising in the oral cavity and oropharynx, particularly when occurring in the setting of RRP. High risk HPV could not be confirmed in any of the cases. Routine HPV testing as a strategy to unmask potentially malignant lesions harboring high risk HPV is not likely to be useful.

HPV RNA in-situ hybridization as a diagnostic aid in papillary laryngeal lesions.

In the larynx, differentiating squamous papillomas from de-novo papillary squamous dysplasias or squamous cell carcinomas (SCC) has significant consequences for management. Overlapping clinical presentations and cytologic changes across the spectrum of papillary lesions presents diagnostic challenges for otolaryngologists and pathologists. In this study, we evaluate whether ribonucleic acid (RNA) in-situ hybridization (ISH) for low-risk and high-risk human papillomavirus (HPV) can help distinguish these lesions. We constructed tissue microarrays from 97 papillary laryngeal lesions, including 61 squamous papillomas, two papillomas with dysplasia, two SCCs-ex papilloma, 14 papillary squamous dysplasias, and 18 papillary SCCs identified at the Johns Hopkins Hospital between 2000 and 2017. We performed RNA ISH using probes for low-risk and high-risk HPV types. Low-risk HPV RNA was identified in 55 benign papillomas (90%), two papillomas with dysplasia (100%), and two SCCs-ex papilloma (100%) but was absent in de-novo papillary dysplasias and SCCs (0%). High-risk HPV RNA ISH was positive only in four papillary SCC (22%). Overall, low-risk HPV RNA ISH was 90% sensitive and 89% specific for benign papillomas with a positive predictive value of 93% and negative predictive value of 84%. In contrast, high-risk HPV was 20% sensitive for SCC. Low-risk HPV RNA ISH is a useful diagnostic adjunct for distinguishing laryngeal squamous papillomas from papillary squamous dysplasia and SCC. However, it is not entirely specific for benign processes as it is also retained in papillomas with dysplasia and SCCs-ex papilloma. Because high-risk HPV is rare in papillary laryngeal lesions, high-risk HPV RNA ISH has limited utility. Level 4 Laryngoscope, 130:955-960, 2020.

Abstract 1401: Sensitive detection of integrated HPV in carcinoma cells

Abstract It is estimated that 79 million people in the US are currently infected with human papillomavirus (HPV). There are more than 200 different HPV types that are common worldwide. HPV types are categorized as either high risk (HR) or low risk (LR). LR types, such as HPV 6 and HPV 11, can cause genital warts or squamous papillomas of the oral cavity, while persistent infection with HR HPV types can induce cervical, anal, or head and neck cancers. Episomal HPV DNA can be detected in advanced stages of cancer. HPV integration in the host genome drives oncogenesis by the expression of the two major viral oncogenes, E6 and E7, which abrogate cell cycle checkpoints, promote cellular proliferation, and cause progressive genetic instability. Hence, screening for the presence of E6/E7 RNA transcripts expression is considered the gold standard for confirming active HPV infection. Early detection of active HPV is critical for better understanding of prognosis and therapeutics. So far, detection of integrated HPV DNA in tissue specimens has been challenging. A novel, cost-effective, in situ hybridization (ISH) detection assay has been developed using two sets of HPV probes with enhanced signaling, termed hyper probes. The Hyper HPV D probe detects HR HPV DNA and the Hyper HPV DR probe can simultaneously detect DNA and E6/E7 RNA of HR HPV subtypes in cancer cell lines and formalin fixed paraffin embedded (FFPE) biopsy specimens. The probes were tested on cervical carcinoma SiHa cells containing 1-3 copies of integrated DNA of HPV 16 and HPV negative cervical cancer C33A cell line. The Hyper HPV DR probe resulted in 1-3 puncta in more than 90% of SiHa cell nuclei, indicating integrated copies of HPV DNA into the host genome. There was also the additional presence of a diffuse signal which was abolished by pretreating SiHa cells with RNase. These data suggest the diffuse signal corresponds to E6/E7 mRNA expression. No signals were detected in HPV negative C33A cells. When cells were stained with Hyper HPV D probes, only punctate signals in nuclei of SiHa cells was present and no signal was evident in C33A control cells. Additionally, human cervical and anal FFPE biopsies were analyzed. Simultaneous presence of both punctate signals and diffuse signals were detected when using Hyper HPV DR probes in HR HPV infected tissues, while only punctate signal was detected when using HPV D hyper probes. The signal from the hyper probes was significantly stronger when compared to other commercially available HPV detection kits. Moreover, other commercially available kits failed to detect low copy of integrated HPV. In conclusion, these data demonstrate the Hyper HPV probes can reliably detect low copies of HPV DNA integrated in the host genome and the presence of HPV mRNA using ISH in HPV infected cells. Citation Format: Maurizio Mauro, Richard Delle Bovi, Jack Coleman. Sensitive detection of integrated HPV in carcinoma cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1401.

LARGE SQUAMOUS PAPILLOMA IN UNUSUAL SITE: A CASE REPORT AND REVIEW OF THE LITERATURE

Squamous papilloma is a benign proliferation of the stratified squamous epithelium, resulting in a papillary mass, which appears as sessile or pedunculated growth with cauliflower-like projection. The most common sites are palate, uvula followed by tongue and lip. Most of the time it usually presents as a solitary, exophytic growth with an average size of less than 1 cm.Here, we report the case of a 28-years-old male patient presented with a solitary sessile, white growth with multiple papillary projections on the right buccal mucosa measuring approximately 4 x 3 cm. An incisional biopsy followed by surgical excision of the lesion was performed confirming the diagnosis of squamous papilloma. This paper highlights a case of unusually large-sized papilloma in an uncommon site.

Maxillary Sinus Squamous Cell Carcinoma in a Tertiary Hospital in the Philippines

Objective: To establish preliminary demographic and clinicopathologic data on Maxillary Sinus Squamous Cell Carcinoma (SCC) in the Philippine General Hospital&#x0D; Methods: &#x0D; Design: Retrospective Case Series&#x0D; Setting: Tertiary National University Hospital&#x0D; Participants: Socio-demographic and clinical data from records of 22 patients admitted at the Department of Otorhinolaryngology of the Philippine General Hospital from 2013-2016 and histopathologically confirmed to have Maxillary Sinus SCC, were collected and described using means and proportions.&#x0D; Results: There were 15 males and 7 females with a mean age of 50-years-old (range 24 to 77-years-old). Maxillary mass/swelling was the most common chief complaint. The mean gap between initial symptoms and consult was 6.77 months. Initial biopsies were obtained from the maxillary sinus in 16 patients, with 1 patient noted to have undergone malignant transformation from a prior intranasal squamous papilloma. Staging was advanced (Stage IVA in 16, IVB in 4, and III in 2), with no patients with Stage I or II disease. Sixteen (16) patients underwent surgery and radiotherapy, while 6 patients received radiotherapy (RT) with or without chemotherapy. Regional and distant metastases were uncommon.&#x0D; Conclusion: In this series, maxillary sinus SCC occurs more in males, with a maxillary mass as the most common chief complaint. Delay in treatment is common, with a mean gap of 6 months between initial symptoms and consult. Neck node metastasis is uncommon, and most patients undergo surgery with radiotherapy as treatment.&#x0D; &#x0D; Keywords: maxillary sinus cancer; paranasal sinus cancer; squamous cell carcinoma&#x0D;

Canine papillomavirus types 1 and 2 in classical papillomas: High abundance, different morphological associations and frequent co-infections

Canine papillomatosis is mainly attributed to papillomavirus infections. Papillomavirus DNA is also frequently identified in healthy skin, and evidence of high papillomavirus diversity complicates this simplistic view of causality. The aim of this study was to determine how frequently canine papillomas contain papillomavirus DNA and express viral protein, and how these factors correlate to the histology and anatomic location. Fifty-three archived, formalin-fixed samples of canine papillomas and eight samples of other proliferative skin lesions from dogs were included. Samples were re-evaluated histologically, tested for papillomavirus L1-antigen using immunohistochemistry, and for papillomavirus DNA with PCR assays and molecular sequencing.Most papillomas from haired skin contained papillomavirus DNA (96%) and antigen (92%). Of oral papillomas, 88% were positive for both papillomavirus DNA and antigen. Approximately 50% of non-papilloma proliferations and papillomas from eyelid/conjunctiva specimens contained viral DNA, but antigen was present in only 12% of eyelid/conjunctiva papillomas and in none of the non-papilloma proliferations. The presence of viral antigen was highly correlated with histological indicators of viral infection, including intranuclear inclusions, koilocytes, cytoplasmatic vacuolation and dysplasia. The viruses found were mainly CPV1 and CPV2. CPV1 dominated in oral infections, while CPV2 dominated in cutaneous endophytic papillomas. Co-infections with CPV1 and CPV2 accounted for about 20% of all detected infections. These results support a role for papillomaviruses in canine cutaneous and oral, exophytic and endophytic papillomas and support previously raised doubts about their role in squamous papillomas from eyelid/conjunctiva specimens.

Oral Squamous Papilloma Management with Diode Laser: A Case Report

Oral Squamous Papilloma Management with Diode Laser: A Case Report