HPV.pdf

Oral Pathology September 10th , 2020 Epithelial Lesions Associated with Human Papillomavirus (HPV) Amr Bugshan, BDS, PhD What is (HPV ) ❓ ❓ • A large group of double-stranded DNA viruses. • Infect SQUAMOUS EPITHELIUM (skin or mucosa) Host • > 130 HPV types have been identified to infect both...

Oral Pathology September 10th , 2020 Epithelial Lesions Associated with Human Papillomavirus (HPV) Amr Bugshan, BDS, PhD What is (HPV ) ❓ ❓ • A large group of double-stranded DNA viruses. • Infect SQUAMOUS EPITHELIUM (skin or mucosa) Host • > 130 HPV types have been identified to infect both skin and oral cavity. • > 30 types known to infect the oral mucosa in particular. Oral mucosa Skin (Host of the virus) Epithelium HPV infection Connective tissue Modes of transmission Oral HPV infection HPV • Person-to-person contact • Salivary transfer • Contaminated objects • Breast feeding The virus enters the epithelial and stays inactive in the basal cell until the immunity get lowered by any risk factor Epithelial basal cells HPV is one of the viruses that can cause squamous cell carcinoma Oral HPV infection • HPV is associated with: 1. Benign epithelial lesions Most common types associated with benign Low risk viruses ( types 6, 11, 13, 32) 2. Premalignant epithelial lesions High risk viruses (types 16, 18) 3. Malignant epithelial lesions Important HPV-induced benign oral epithelial lesions Squamous Papilloma • HPV Types: 6 & 11 Most common WCGSTLE • Rarely contagious • Can arise at any age. • No significant gender predilection. Finger projections Neville, 2016 Squamous Papilloma Location: • Soft palate , tongue and lips are the most common sites. • Any oral mucosa surfaces can be affected. Because the epithelial of the oral mucosa Neville, 2016 Courtesy to Dr. Mark Lerman Squamous Papilloma Neville, 2016 Clinical presentation: exophytic nodule with numerous fingerlike surface projections Above the mucosal lining ( Papillary ) Neville, 2016 Squamous Papilloma Neville, 2016 Papillary squamous epithelial proliferation Neville, 2016 Squamous Papilloma White zone around the nucleus It can be in any viral infection Viral inside epithelial cells Koilocytes (virus- altered epithelial cells) Neville, 2016 Neville, 2016 Squamous Papilloma Treatment: • Conservative surgical treatment. • No reported malignant transformation. Neville, 2016 Neville, 2016 Verruca vulgaris • HPV Types: 2 • Contagious (autoinoculation). • Extremely common on the skin. • Rarely develops on oral mucosa. • Common in children. Neville, 2016 Verruca vulgaris Location: • Extremely common on the skin (hands). Neville, 2016 • Rarely develops on oral mucosa(the vermilion border, labial mucosa, or anterior tongue). Courtesy. Jan R. Mekkes. Verruca vulgaris Clinical & histopathological presentation: Neville, 2016 Jan R. Mekkes. Courtesy. Painless papule or nodule with papillary projections Bigger than Neville, 2016 Verruca vulgaris Histopathological presentation: Neville, 2016 Neville, 2016 Verruca vulgaris Keratin The difference between verruca vulgaris and squamous papiloma is keratohyalin granules Neville, 2016 Koilocytes & keratohyalin granules Verruca vulgaris Treatment: • Surgical excision (oral lesions) • Topical salicylic acid, topical lactic acid, or liquid nitrogen cryotherapy (skin lesions). • No reported malignant transformation. Neville, 2016 Neville, 2016 Condyloma Acuminatum Most important thing is the type • HPV Types: 6 & 11. • Diagnosed in teenagers and young adults. • Contagious • Oral lesions most frequently occur on the labial mucosa, lingual frenum & the soft Neville, 2016 palate. Neville, 2016 Condyloma Acuminatum Clinical presentation: Most common thing between all lesion is having fingerlike projections Neville, 2016 Exophytic mass with short, blunted surface projectionsNeville, 2016 Condyloma Acuminatum Treatment: • Oral lesions usually are treated by conservative surgical excision Neville, 2016 Multifocal Epithelial Hyperplasia (Heck Disease) • HPV Types: 13 & 32. • Risk factors: ✓ Familial occurrence suggests genetic predisposition ✓ Lower socioeconomic status & crowded living conditions ✓ Poor hygiene ✓ Malnutrition ✓ HIV infection Neville, 2016 Neville, 2016 Multifocal Epithelial Hyperplasia (Heck Disease) • Predominantly arises in children. • The most common sites of involvement include the labial, buccal, and lingual mucosa. Neville, Neville, 20162016 Neville, 2016 Multifocal Epithelial Hyperplasia (Heck Disease) Clinical presentation: Multifocal = Multiple Neville, 2016 GETLE Neville, 2016 Neville, 2016 Multiple well-demarcated fissured pink, papules and nodules Multifocal Epithelial Hyperplasia (Heck Disease) Histopathological presentation: Neville, 2016 Neville, 2016 Elongated rete ridges “ club shape” Neville, 2016 Specific for this Mitosoid cells lesion Mitosis like cells Neville, 2016 Multifocal Epithelial Hyperplasia (Heck Disease) Treatment: • Spontaneous regression has been reported after months or years. • Conservative surgical excision may be performed for diagnostic or aesthetic purposes or for lesions subject to recurrent trauma • No reported malignant transformation potential. Neville, 2016 Neville, 2016 Verruciform Xanthoma You can add it as differential diagnosis • Clinically presents as exophytic mass with papillary surface projections (similar to squamous papilloma, verruca vulgaris or condyloma acuminatum) • HPV has no definitive pathogenetic role. • Common in adults (40-70 years) • Gingiva and alveolar mucosa are the most common sites. • Treatment: Surgical excision. Clinically mimics benign hpv lesions Neville, 2016 Neville, 2016 Neville, 2016 HPV-induced malignant oral epithelial lesions Verrucous Carcinoma • A low-grade variant of oral squamous cell carcinoma. • Associated with Smokeless tobacco. Main cause • HPV types 6, 11, 16, and 18 were found in a minority of oral verrucous carcinomas “ may play a role or just a coincidental HPV infection” Neville, 2016 Neville, 2016 Neville, 2016 Neville, 2016 HPV- related oropharyngeal Carcinomas • Persistent infection with HPV 16 increases risk. • HPV 16 identified in 90% of HPV+ oropharyngeal cancers. • Limited role in oral cavity cancers (5% of oral SCCAs due to HPV). Most common area for hpv oropharyngeal carcinoma is posterior of the tounge , near to the oropharynx Neville, 2016 Neville, 2016 Neville, 2016 Neville, 2016 HPV- related oropharyngeal Carcinomas Neville, 2016 Neville, 2016 Neville, 2016 Neville, 2016 Lerman MA et al. HPV 16 in a distinct subset of oral epithelial dysplasia. Mod Pathol, 2017 HPV- related oropharyngeal Carcinomas +ve for hpv Neville, 2016 Neville, 2016 Neville, 2016 Neville, 2016 Lerman MA et al. HPV 16 in a distinct subset of oral epithelial dysplasia. Mod Pathol, 2017 HPV- related oropharyngeal Carcinomas • Most important prognostic factor is HPV status • Five year survival ✓HPV+ 54-89% (better prognosis) ✓HPV- 33-65% Neville, 2016 Neville, 2016 Neville, 2016 Neville, 2016 Neville, 2016 Neville, 2016 Neville, 2016 Neville, 2016 Thank you Neville, 2016 [email protected] Neville, 2016 Neville, 2016