Human Papillomavirus Type 1-Associated Squamous Cell Carcinoma in a Heart Transplant Recipient

Abstract

The occurrence of squamous cell carcinomas in organ transplant recipients with warts represents a good model to study viral carcinogenesis. Most of the cases were reported in renal transplant recipients. We present the case of a heart transplant recipient in whom multiple common warts, preepitheliomatous keratoses, and squamous cell carcinomas developed. The warts began 4 years after the transplantation and the first carcinoma occurred 2 years after the warts, all the lesions being on sun-exposed areas. Histologic signs of human papillomavirus infection were seen in all premalignant and malignant lesions. Furthermore, human papillomavirus type 1 DNA was detected by in situ molecular hybridization within one of the carcinomas. Human papillomaviruses, along with other carcinogenic factors, play an important role in the development of carcinomas, and benign types could be implicated. Further studies are required to evaluate the frequency of cutaneous malignant neoplasms in heart transplant recipients as compared with renal transplant recipients.

Transformation of Common Warts into Squamous Cell Carcinoma on Sun-Exposed Areas in an Immunosuppressed Patient

“…HPV-1, -2, -4, -6, -11) classically associ ated with warts or condylomas, in a variety of skin carcino mas including basal cell carcinomas, well-differentiated SCC and verrucous carcinomas [8][9][10][11][12], Generally, in these lesions, the HPV DNA are free and in the unintegrated state, suggesting a causal relationship between wart virus infection and development of malignancy [13], Orth [14] has also reported that, in contrast to genital cancers, HPV-5 and HPV-8 genomes in cancers from pa tients with epidermodysplasia verruciformis were free, monomeric or oligomeric molecules.…”

Transformation of Common Warts into Squamous Cell Carcinoma on Sun-Exposed Areas in an Immunosuppressed Patient

“…HPV-1, -2, -4, -6, -11) classically associ ated with warts or condylomas, in a variety of skin carcino mas including basal cell carcinomas, well-differentiated SCC and verrucous carcinomas [8][9][10][11][12], Generally, in these lesions, the HPV DNA are free and in the unintegrated state, suggesting a causal relationship between wart virus infection and development of malignancy [13], Orth [14] has also reported that, in contrast to genital cancers, HPV-5 and HPV-8 genomes in cancers from pa tients with epidermodysplasia verruciformis were free, monomeric or oligomeric molecules.…”

Prevalence of human papillomavirus DNA in cutaneous neoplasms from renal allograft recipients supports a possible viral role in tumour promotion

“…By contrast, investigation of the relationship between HPV and cutaneous cancers in RARs has been inconclusive with regard to both prevalence and type of HPV DNA detected. This may be the result of differences in sample size studied or differences in sensitivity and specificity of the detection (Lutzner et al, 1980(Lutzner et al, , 1983Rudlinger et al, 1986;Jablonska et al, 1987;Van der Leest, 1987;Blessing et al, 1989;Euvrard et al, 1991). An additional factor in some studies may be the inclusion of a large proportion of patients who seem to be at exceptionally high risk of developing multiple and widespread premalignant and malignant cutaneous lesions with increased HPV DNA content .…”

Renal allograft recipients with high susceptibility to cutaneous malignancy have an increased prevalence of human papillomavirus DNA in skin tumours and a greater risk of anogenital malignancy

“…In situ hybridization, Southern hybridization and PCR techniques detected HPV DNA in 37-54% SCCs from RARs, including anogenital, cutaneous and EV types of HPV (Muller et al, 1989;Eliezri et al, 1990;Euvrard et al, 1991; Soler et al, 1992;Stark et al, 1994a). Uncharacterized HPV types have been found in benign and malignant skin tumours using either degenerate PCR primers (Shamanin et al, 1994), multiple complementary sets of consensus PCR primers (Tieben et al, 1994) or nested PCR assays (Berkhout et al, 1995).…”

Transformation of Common Warts into Squamous Cell Carcinoma on Sun-Exposed Areas in an Immunosuppressed Patient

“…HPV-1, -2, -4, -6, -11) classically associ ated with warts or condylomas, in a variety of skin carcino mas including basal cell carcinomas, well-differentiated SCC and verrucous carcinomas [8][9][10][11][12], Generally, in these lesions, the HPV DNA are free and in the unintegrated state, suggesting a causal relationship between wart virus infection and development of malignancy [13], Orth [14] has also reported that, in contrast to genital cancers, HPV-5 and HPV-8 genomes in cancers from pa tients with epidermodysplasia verruciformis were free, monomeric or oligomeric molecules.…”

Prevalence of human papillomavirus DNA in cutaneous neoplasms from renal allograft recipients supports a possible viral role in tumour promotion

“…By contrast, investigation of the relationship between HPV and cutaneous cancers in RARs has been inconclusive with regard to both prevalence and type of HPV DNA detected. This may be the result of differences in sample size studied or differences in sensitivity and specificity of the detection (Lutzner et al, 1980(Lutzner et al, , 1983Rudlinger et al, 1986;Jablonska et al, 1987;Van der Leest, 1987;Blessing et al, 1989;Euvrard et al, 1991). An additional factor in some studies may be the inclusion of a large proportion of patients who seem to be at exceptionally high risk of developing multiple and widespread premalignant and malignant cutaneous lesions with increased HPV DNA content .…”

Renal allograft recipients with high susceptibility to cutaneous malignancy have an increased prevalence of human papillomavirus DNA in skin tumours and a greater risk of anogenital malignancy

“…In situ hybridization, Southern hybridization and PCR techniques detected HPV DNA in 37-54% SCCs from RARs, including anogenital, cutaneous and EV types of HPV (Muller et al, 1989;Eliezri et al, 1990;Euvrard et al, 1991; Soler et al, 1992;Stark et al, 1994a). Uncharacterized HPV types have been found in benign and malignant skin tumours using either degenerate PCR primers (Shamanin et al, 1994), multiple complementary sets of consensus PCR primers (Tieben et al, 1994) or nested PCR assays (Berkhout et al, 1995).…”

Transformation of Common Warts into Squamous Cell Carcinoma on Sun-Exposed Areas in an Immunosuppressed Patient

“…HPV-1, -2, -4, -6, -11) classically associ ated with warts or condylomas, in a variety of skin carcino mas including basal cell carcinomas, well-differentiated SCC and verrucous carcinomas [8][9][10][11][12], Generally, in these lesions, the HPV DNA are free and in the unintegrated state, suggesting a causal relationship between wart virus infection and development of malignancy [13], Orth [14] has also reported that, in contrast to genital cancers, HPV-5 and HPV-8 genomes in cancers from pa tients with epidermodysplasia verruciformis were free, monomeric or oligomeric molecules.…”

Prevalence of human papillomavirus DNA in cutaneous neoplasms from renal allograft recipients supports a possible viral role in tumour promotion

“…By contrast, investigation of the relationship between HPV and cutaneous cancers in RARs has been inconclusive with regard to both prevalence and type of HPV DNA detected. This may be the result of differences in sample size studied or differences in sensitivity and specificity of the detection (Lutzner et al, 1980(Lutzner et al, , 1983Rudlinger et al, 1986;Jablonska et al, 1987;Van der Leest, 1987;Blessing et al, 1989;Euvrard et al, 1991). An additional factor in some studies may be the inclusion of a large proportion of patients who seem to be at exceptionally high risk of developing multiple and widespread premalignant and malignant cutaneous lesions with increased HPV DNA content .…”

Renal allograft recipients with high susceptibility to cutaneous malignancy have an increased prevalence of human papillomavirus DNA in skin tumours and a greater risk of anogenital malignancy

“…In situ hybridization, Southern hybridization and PCR techniques detected HPV DNA in 37-54% SCCs from RARs, including anogenital, cutaneous and EV types of HPV (Muller et al, 1989;Eliezri et al, 1990;Euvrard et al, 1991; Soler et al, 1992;Stark et al, 1994a). Uncharacterized HPV types have been found in benign and malignant skin tumours using either degenerate PCR primers (Shamanin et al, 1994), multiple complementary sets of consensus PCR primers (Tieben et al, 1994) or nested PCR assays (Berkhout et al, 1995).…”