Squamous cell papilloma of the conjunctiva due to human papillomavirus (HPV): presentation of two cases and review of literature

Abstract

PurposeWe describe two patients with squamous cell papilloma of the conjunctiva due to human papilloma virus (HPV) and review the literature.Patients and methodsTwo patients with conjunctival tumors were examined and treated in the University Eye Clinic and diagnosed in the University Pathology Department, University Hospital of Ioannina, Greece. The first patient was a 48-year-old man presenting with an extended papillomatous lesion in bulbar conjunctiva covering part of the cornea of his right eye. The second patient was a 24-year-old man presenting with a polypoidal papillomatous lesion on the caruncle of his right eye. The two lesions were removed surgically, cryotherapy was applied to the adjacent conjunctiva, and topical mitomycin-C was used. The amniotic membrane was used to restore the conjunctival defect in the first patient. The two removed lesions were sent to the Pathology Department for histopathological examination. Immunohistochemistry, DNA in situ hybridization, and polymerase chain reaction (PCR) analysis were performed.ResultsIn the first patient, histopathology showed the presence of a benign squamous papilloma with koilocytosis. DNA in situ hybridization with broad-spectrum probes showed that this patient was positive for HPV DNA. In the second patient, histopathology showed the presence of a squamous papilloma with mild dysplasia and koilocytosis. Immunohistochemical analysis was positive for HPV protein and p16 protein. DNA in situ hybridization with broad-spectrum probes showed that the patient was positive for HPV DNA. PCR analysis showed the presence of HPV 6. According to morphological and molecular findings, both patients were diagnosed with squamous cell papilloma due to HPV.ConclusionHPV can infect the ocular surface. According to clinical results, the ophthalmologist in cooperation with the pathologist can recommend appropriate laboratory examinations to confirm the diagnosis and successfully treat conjunctival papillomas.

Conjunctival Papilloma

“…10 High-risk types cause uterine cervical cancer and a significant proportion of carcinomas in other sites, including the vulva, vagina, penis, anus, larynx, and tonsils. 11,12 Low-risk types cause genital warts (condyloma acuminata), low-grade intraepithelial lesions of the uterine cervix, and, rarely, recurrent respiratory papillomatosis. 10,11 Conjunctival papillomas are associated most commonly with low-risk types 6 and 11 (especially in children) and rarely with high-risk types 16,18, and 33 (especially in adults).…”

“…11,12 Low-risk types cause genital warts (condyloma acuminata), low-grade intraepithelial lesions of the uterine cervix, and, rarely, recurrent respiratory papillomatosis. 10,11 Conjunctival papillomas are associated most commonly with low-risk types 6 and 11 (especially in children) and rarely with high-risk types 16,18, and 33 (especially in adults). [6][7][8][9]13 Conjunctival papilloma in infants whose mother had documented genital HPV infection has led to the speculation that the virus could be inoculated into the newborn's conjunctiva during vaginal birth.…”

Identification and Characterization of Two Novel Viruses in Ocular Infections in Reindeer

“…Overall, it is thus unlikely that RtPV2-like viruses are involved in causing the observed disease signs. They might be involved in causing conjunctival papillomas [19,20], but in spite of the fact that skin papillomas are reported in reindeer from time to time, not much knowledge exists on papillomatosis in reindeer as a disease, or the virus(es) causing them. The impact of papillomavirus infections on reindeer in general and the specific role of RtPV2 thus has to be further addressed.…”

Clinical manifestations and burden of HPV infection – prevention and therapeutic possibilities

“…A study has documented hand carriage of HPV types in patients with genital warts 26 . Conjunctival papillomas have also been reported in infants due to vertical transmission, when the conjunctiva of the newborn is contaminated by the affected genital tract 27 .…”