Laryngeal papillomatosis: molecular, ultrastructural and clinical evaluation

Our study was designed to correlate the prevalence of human papilloma viruses [HPV] types 6 and 11 in laryngeal papillomatosis specimens using PCR to the clinical and pathological characteristics of these patients as a trial to evaluate the usefulness of HPV typing in identifying which patients are at a higher risk for more frequently recurring aggressive disease or future malignant. This study was conducted on 36 adult patients who were identified clinically and histopathologically as laryngeal papilloma. An index of the number of procedures [laryngoscopy and carbon dioxide laser ablation] needed per year for each patient was calculated to assess the frequency of recurrence and disease aggressiveness. They were subjected to the detection of HPV6 and 11 DNA by PCR and electon microscopic examination of biopsies that were taken from laryngeal papillomas and non diseased sites as controls. We found that all papillomas [100%] were positive for HPV, among them the positive rate of either HPV6 or HPV11 was 25% [9/36] and 41.7% [15/36] respectively, the positive rate of mixed types of HPV6 + 11 was 33.3% [12/36]. Percentage of Patients needed >3 Pr/y were significantly increased [p>0.05 and 0.01] in cases with mixed infection of both HPV6+11 in comparison to those infected with HPV11 orHPV6 respectively and in HPV 11 infected cases in comparison to those infected with HPV 6 [p<0.05]. Percentage of cases revealed dysplastic features [cellular atypia, invasion, keratinization and necrosis] were significantly increased [p<0.05 and 0.01] in mixed infection of both HPV6+11 in comparison to those infected with HPV11 or HPV6 respectively and in HPV11 infected cases in comparison to those infected with HPV6 [p<0.05]. Correlation study revealed direct correlation between percentage of patients needed >3 Pr/y and the appearance of dysplastic features. Our findings suggest that viral typing is one marker that may be useful to identify patients at a higher risk for aggressive disease and, possibly, to malignant potential but more studies with a larger number of cases are needed to assess their agnostic and prognostic value

Papilomatose laríngea: análise morfológica pela microscopia de luz e eletrônica do HPV-6 / Laryngeal papillomatosis: morphological study by light and electron microscopy of the HPV-6

Papilomatose laríngea é neoplasia benigna mais freqüente nas crianças, causada pelo HPV, principalmente subtipos 6 e 11 e caracteriza-se pela presença de lesões proliferativas exofíticas e recidivantes sobre a mucosa das vias aérea, em especial na laringe. Forma de Estudo: Clínico prospectivo. OBJETIVOS: Demonstrar alterações epiteliais morfológicas (pela microscopia de luz e eletrônica) em lesões papilíferas casadas pelo HPV-6. MATERIAL E MÉTODOS: Fragmentos de lesões de papilomatose laríngea, colhidos durante procedimento cirúrgico de quatro crianças (1 masculino, 3 femininas), foram submetidos à tipagem do HPV (por método de PCR), análise pela microscopia de luz e microscopia eletrônica (varredura e transmissão). RESULTADOS: Na tipagem, todos os papilomas eram do subtipo 6. A microscopia de varredura identificou projeções epiteliais de vários tamanhos, com células superficiais em descamação. A microscopia de luz demonstrou lesões exofíticas, revestidas por epitélio hiperplásico com coilócitos e binucleações, característicos do HPV. A membrana basal e o córion adjacente estavam íntegros. À microscopia eletrônica de transmissão identificou-se vacuolização perinuclear e alargamento das junções intercelulares. CONCLUSÕES: As alterações morfológicas apresentadas pelo HPV-6 demonstram o caráter não-invasivo da lesão, sendo necessário estudos morfológicos adicionais relacionando os outros tipos de HPV, considerados mais agressivos, com os achados ultra-estruturais.

Laryngeal papillomatosis is the most frequent benign neoplasia in children. It is caused by HPV 6 and 11. The lesions are exophytic and highly recurrent, compromising the airway mucosa, mainly the larynx. Study design - clinical prospective. AIMS: to show morphologic alterations of the epithelium (light and electron microscopy) in the HPV-6 lesions. METHODS: specimens of laryngeal lesions obtained during surgery of four children (1 male, 3 female) were submitted to HPV typing (PCR), light microscopy and electron microscopy. RESULTS: in all specimens, HPV type 6 was found. Epithelial projections were found by electron microscopy with superficial cells in desquamation. Light microscopy showed exophytic projections of the keratinized stratified squamous epithelium overlying a fibrovascular core. Koilocytes (vacuolated cells), suggesting the viral infection by HPV, were identified. No alterations were seen in the basement membrane and corion. Ultraestrutural analysis showed vacuolated cells with clear cytoplasmic inclusions, intercellular injuries and widening intercellular spaces. CONCLUSIONS: morphologic alterations of the epithelium in the HPV-6 lesions are superficial, and additional studies including the others HPV types are needed to show the more aggressive and extensive aspect of the disease.

Detección de infección por HPV en el hombre a través de la genitoscopia / Detection of HPV infection in men with genitoscopy

Se comunica los resultados del examen mediante genitoscopia de 64 varones sin lesiones clínicas, cuyas parejas sexuales tenían condilomas o CIN I, II o III. En 29 de ellos se observaron lesiones acetopositivas, que fueron confirmadas por histopatologías, como producidas por HPV. La citología, efectuada en 15 pacientes, no permitió confirmar lesiones por HPV. Se destaca la utilidad de la genitoscopia, técnica sencilla y de muy bajo costo, para el control y seguimiento de las parejas infectadas por HPV

Papilomatosis florida perianal / Perianal florid papillomatosis

Se presentan 2 casos de papilomatosis florida de localización perianal. Se detallan características de esta enfermedad, mencionando distintas formas clínicas, sus localizaciones, su clasificación histopatológica y sus distintos tratamientos. De estos 2 casos, uno recibió tratamiento quirúrgico, con buena evolución, presentándose al último control libre de recidivas. Dentro de la escasa frecuencia de esta entidad nosológica se destaca la rareza de la localización en estos 2 casos