In addition to tobacco and alcohol abuse, certain viruses have been associated with squamous cell carcinoma SCC of the head and neck, causing alterations in DNA.
It has been demonstrated that the human papillomavirus HPV squamous papilloma hypopharynx 16, a subtype of the human papillomavirus, is present in the oropharyngeal carcinomas of non-smokers patients inclusive.
HPV-infected cells express some viral proteins encoded by genes called E6 and E7, and can inactivate p53 protein and the retinoblastoma-type protein RBP involved in the regulation of proliferation and cell death.
Materials and method.
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We present an immunohistochemical study conducted to identify significant tumour markers in tonsillar SCC. We present the statistically significant correlations between the presence of immunohistochemical markers and studied local recurrence, lymph node recurrence and risk of a second cancer in the aerodigestive upper tract. The demonstration of HPV in tonsillar tumour tissue requires in situ hybridization or polymerase chain reaction PCR for the evidence of viral genome included into the host cell.
The practical implications of an etiologic role of HPV in head and neck cancer generally and in tonsillar SCC in particular remains in question and is in squamous papilloma hypopharynx with prognosis, treatment and prevention.
În afară de consumul de tutun şi abuzul de alcool, anumite virusuri au fost asociate cu carcinomul cu celule scuamoase CCS al capului şi gâtului, cauzând alterări la nivelul ADN-ului. Este dovedit că virusul papiloma uman HPVtipul 16, este prezent la nivelul carcinoamelor orofaringiene inclusiv în cazul nefumătorilor.
Celulele infectate cu HPV exprimă unele proteine virale codate de genele denumite E6 şi E7 şi pot inactiva proteina p53 şi proteina de tip retinoblastom RBP implicate în reglarea proliferării şi morţii celulare. Materiale şi metodă. Prezentăm un studiu imunohistochimic realizat cu scopul de a identifica markeri tumorali semnificativi în CCS de amigdală.
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Prezentăm corelaţiile semnificative statistic între prezenţa markerilor imunohistochimici şi recurenţa locală, recurenţa nodulilor limfatici şi riscul apariţiei unui al doilea squamous papilloma hypopharynx în tractul aerodigestiv superior.
Punerea în evidenţă a HPV-ului în ţesutul tumoral amigdalian necesită hibridizare in situ şi reacţie de polimerizare în lanţ PCR pentru punerea în evidenţă a genomului viral conţinut în celula-gazdă. Implicaţiile practice ale unui rol etiologic al HPV-ului în cancerele de cap şi gât, în general, şi în CCS de amigdală, în particular, reprezintă un subiect în dezbatere, fiind în relaţie cu prognosticul, tratamentul şi prevenţia acestor tipuri de cancere.
Cuvinte cheie carcinomul cu celule scuamoase de amigdală CCS HPV markeri squamous papilloma hypopharynx Introduction The tonsillar squamous cell carcinoma SCC is becoming a public health problem because of its rising incidence in the last 20 years, in contrast to the decreasing incidence of carcinomas in other subsites of head and neck associated to the reduced prevalence of smoking.
These tumours of oral cavity, oropharynx, larynx, hypopharynx and sinonasal region are linked by common characteristics, including a male predominant appearance in the 5th-6th decade of life, an important etiological link with tobacco, alcohol use or betel nut chewing, and a histopathological resemblance 1.
Data regarding the epidemiology revealed that in Romania the oropharyngeal cancer represents 2. In France, during the last 30 years, the mortality in oral and oropharyngeal cancer increased by three times 1.
As in cervical cancers, the oropharyngeal infection with HPV is a sexually transmitted disease which involves some particularities of sexual behaviour: a large number of vaginal sex partners, oral and anal sex. The recent increasing of OPSCC incidence may reflect the social changes regarding sexual behaviour in the modern world 6.
The anatomical sites preferred by HPV in oropharynx are the tonsils and the tongue, because of the unique presence of transitional mucosa in oropharynx and particular in tonsillar tissue, which presents important histological similarities with the cervical mucosa. Tonsillar epithelium invagination may favour virus capture and promote its access to basal cells the only dividing cells in the epithelium.
The tonsillar tissue could be a reservoir for HPV in the upper aero digestive tract.
We had two premises squamous papilloma hypopharynx our study on tonsillar cancers. The second consists in the fact that mutagens such as tobacco, alcohol and HPV viral oncogenes E6 and E7 induce dysfunctions of two major mechanisms of cellular cycle, which involves the p53 and RBP tumoral suppressor genes 2.
Materials and method We made an immunohistochemical retrospective study between andaiming to identify any correlations between squamous papilloma hypopharynx markers and the evolution and prognosis in tonsillar SCC. Materials We studied 52 cases of patients diagnosed with tonsillar SCC. We had a first group Group I with 25 cases, where the positive diagnose was made by biopsy and these patients had radiotherapy as first curative method of treatment.
We had a second group Group II with 27 cases, squamous papilloma hypopharynx the positive diagnose was made on surgical specimens and these patients had surgery as the first curative method of treatment. The two groups were similar regarding age and gender distribution. The dilutions and markers specifications are revealed in Table 1. We also studied lymphocyte populations CD4, CD8, and populations of dendritic cells in tumour tissue. Table 1.
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Squamous papilloma hypopharynx dilutions and markers specifications For the immunohistochemical identification of tumoral antigens we used the three-stadial indirect method Avidine-Biotine-Peroxidase ABPafter Hsu and colab. Results The gender repartition of cases was: 47 male cases and 5 female cases. The squamous papilloma hypopharynx repartition of cases was: two cases between years old, 14 cases between years old, 21 cases between years old, 10 cases squamous papilloma hypopharynx years old, and five cases between years old.
The correlation coefficient between the two sets of data, corresponding to Group I and Group II, was 0. In both groups, we had 48 smoker patients, representing The patients who were both smokers and alcohol consumers represented We studied the tumoral markers on 52 cases of squamous cell carcinoma.
Thirty-eight cases were well differentiated carcinoma and 14 cases were medium differentiated carcinoma. We present the results, that we considered immunohistochemically valid and statistically significant Table 2. Table 2. The distribution of tumoral markers in specimens of SCC studied We realised a correlation between the presence of the tumoral marker of a certain type positive pancreatic cancer types slowly positive results and the post-therapeutic evolution — local recurrence, nodal relapse, the occurrence of second cancers in upper aerodigestive upper ways and distance metastases.
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We have had patients who had more than one recurrence in the same time. Our purpose was to identify the correlations between markers of evolution and prognosis in tonsillar SCC. Our results indicate p53 protein and RBP protein as tumoral markers of unfavourable prognosis for post-therapeutic evolution in tonsillar SCC.
For TGFa, we can make a correlation between its level in tumoral tissue and the risk of loco-regional relapse. For the HPV identification in tumoral tissue, we used the identification of capsid p16 protein, so we cannot can hpv vaccination prevent cervical cancer definitive conclusions referring at the presence or absence of HPV in the tumoral tissue for patients with tonsillar SCC.
But we realised a correlation between the presence of HPV and the type of post-therapeutic evolution Figures Figure 1. The presence of RBP protein 48 positive and slowly positive cases was associated with local recurrence in 29 cases The presence of TGF protein 41 positive and slowly positive cases was associated with local recurrence in 18 cases The presence of HPV capsid protein 14 positive cases was associated with local recurrence in nine cases Figure 6. Tumoral markers in evolution squamous papilloma hypopharynx tonsillar SCC result of our retrospective study From our data, we can certify as prognostic factors in tonsillar SCC: T stage, N stage, performing or not an elective type of clinical negative neck N0, type of neck dissection, the total dose of radiotherapy.
We cannot make statistical significant conclusions referring to the HPV presence in tumoral tissue in tonsillar SCC and long-term prognosis. Demonstrating the squamous papilloma hypopharynx of HPV in tonsillar tumoral tissue imposes hybridisation in situ or polymerase chain reaction PCR. Discussion Slaughter et al.
They explained the greater risk for multiple primary cancers 8. Tobacco and alcohol abuse increase the risk for a squamous papilloma hypopharynx cancer development in patients with oropharyngeal SCC. Tobacco and alcohol abuse are associated with mutations of the p53 protein in patients with OFSCC, being important factors in the molecular progression through carcinogenesis 9.
Many clinical studies searched for the p53 protein mutations on surgical specimens from patients with OFSCC. The patients with surgical positive edges for p53 protein mutations have a higher risk of local relapse P53 protein mutations are involved in the loco-regional failure at OFSCC tonsillar with curative radiotherapy The HPV 16 DNA was identified only in tratament oxiuri zentel tumour cells and in their metastases in similar manner with cervical cancer 3.
The presence of HPV 16 genome was revealed squamous papilloma hypopharynx polymerase chain reaction PCR or the method of hybridisation in situ, which certified the presence of viral genome included in host cell genome It is necessary to make a study on HPV tonsillar infection in non-smokers and non-alcoholic consumers. Squamous papilloma hypopharynx method for HPV identification was immunohistochemistry for p16 protein, which is a specific capsid protein of HPV 16 type, so we cannot certify the presence of HPV genome in all specimens studied.
We were in the situation of the unavailability of the in situ hybridization kits or polymerase chain reaction for HPV 16 type during the study. We have to mention the high cost for identifying viral markers.
Clinical stadialization represents the primary guide to choose the therapeutic modality, but it is a limited guide.
We expected the genetic analysis to be the method of future, meaning squamous papilloma hypopharynx identification of markers for prevention, therapy and good prognosis. Recent studies showed an inverse correlation between the presence of HPV and p53 protein mutations. The HPV-positive tumors have genetic alterations associated with a better answer to chemotherapy and with an improved squamous papilloma hypopharynx. The immune response of the patient is better, because of the immune stimulation realised by viral antigens.
The younger age with less comorbidities may contribute to a better prognosis Prophylactic squamous papilloma hypopharynx is not efficient in already diagnosed infections and in malignant lesions, so it is necessary to study the efficiency of therapeutic HPV vaccination in the treatment of HPV-associated cancer 1.
We found in literature premises for the therapeutic vaccination in HPV-induced cancers, where this type of vaccine induced a cytolytic immune response in cells which express it 5. It is necessary to study the carriage squamous papilloma hypopharynx HPV in apparently normal tonsillar tissue, to have screening programmes exophytic papillomatous to select the patients at risk for OFSCC Conclusions The prognosis in tonsillar SCC is mediocre, due to local recurrence, nodal relapse, the occurrence of second cancers in upper aerodigestive upper ways 17 and to distance metastases.
From our data, we can certify as prognostic factors in tonsillar SCC: T stage, N stage, performing or not an elective type of clinic negative neck N0, type of neck squamous papilloma hypopharynx and total dose of radiotherapy. We cannot draw significant conclusions referring to the HPV presence in tumoral tissue in tonsillar SCC and regarding the prognosis signification of the HPV presence in the tumoral tissue.
The presence of HPV 16 can be considered a positive prognostic factor for disease-free survival and for healing, but the use as a predictive marker has not yet been proven.
The best treatment against cancer is prevention, especially in malignancies where the main pathogen agent is known, and we are talking here about smoking, alcohol consume and a safe sexual behaviour. Ethical approval: All authors hereby declare that all experiments have been examined and approved by the appropriate ethics committee and have therefore been performed in squamous papilloma hypopharynx with the ethical standards laid down in the Declaration of Helsinki.
She has done an accurate immunohistochemical examination of paraffin-embedded specimens. Conflict of interests: The authors declare no conflict of interests.
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European Journal of Cancer Prevention. Successful therapeutic lentiviral vector defective integrase vaccination with human papillomavirus E7 protein Expressing nononcogenic. Squamous papilloma hypopharynx J Cancer. Frequent p53 mutations in head and neck cancer. Cancer Res. Quantification of surgival margin shrinkage in the oral cavity.
Head and Neck. Journal of National Cancer Institute. Human papillomavirus and DNA ploidy in tonsillar squamous papilloma hypopharynx — correlation to prognosis.
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Anticancer Researches. Altered antigen expression predicts outcome in squamous cell carcinoma of the head and neck. Human papillomavirus positivity predicts favourable outcome for squamous carcinoma of the tonsil. International Journal of Cancer. Detection of human squamous papilloma hypopharynx type 16 squamous papilloma hypopharynx carcinoma of the palatine tonsil. Journal of Clinical Pathology. Second neoplasm in patients with head and neck cancer.