AIDS INFORMATION NEWSLETTER Michael Howe, MSLS, Editor AIDS Information Center VA Medical Center, San Francisco (415) 221-4810 ext 3305 June 28, 1996 Opportunistic Infections (Part XXVII) Squamous Cell Carcinomas - Review Articles AU - Kuffer R TI - Papillomavirus Infections and Precancerous Lesions in the Oral Cavity AB - The incidence of oral squamous cell carcinoma (OSC) shows great geographic variation, from 2.5 in southern England to 25/100,000 in certain parts of India, where it represents a major public health problem. Precancerous lesions of the oral cavity and the role of human papillomavirus (HPV) infection in these lesions are reviewed under the following headings: the need for more accurate terminology for 'leukoplakia;' low or high malignant potential of oral precancerous lesions; carcinogenic factors in oral malignancy; oral HPV-associated lesions (focal epithelial hyperplasia [FEH], oral papillomas, oral condyloma acuminatum, oral lesions resembling flat condyloma and vulvar Bowenoid papulosis, oral verrucous carcinoma, oral florid papillomatosis, oral hairy leukoplakia, OSC, and oral lichen planus); and whether HPVs cause oral premalignant and malignant lesions. The precancerous lesions of the oral mucosa, which may have a low or a high malignant potential, are characteristically flat or papillomatous exophytic lesions. Flat lesions may be either white patches ('leukoplakia') or (especially when malignant potential is high) red plaques ('erythroplakia') or more often white and red 'mosaic' pattern lesions ('speckled leukoplakia'). The word leukoplakia, which includes in a purely clinical sense different benign entities as well as dysplasias and even superficial carcinoma, should be replaced by adequate terms. A new classification of oral intraepithelial neoplasia (OIN) derived from the one currently in use for uterine cervix lesions is proposed: OIN 1 for mild dysplasia, OIN 2 for moderate dysplasia, and OIN 3 for severe dysplasia and intraepithelial carcinoma. Recent research has shown that either flat or papillomatous precancerous oral lesions are associated with HPV genotypes 2, 6, 11, 16, and 18. Types 16 and 11 are detected with a particular frequency in oral squamous cell carcinomas, dysplasias, and potential precursor keratosis. HPV types 13 and 32 are specific for FEH, a constantly benign lesion, and type 7 has been found in HIV-infected patients. HPV infection may cooperate with other classical carcinogenic factors (tobacco, alcohol, decayed teeth, and cicatricial atrophy) in oral carcinogenesis. (58 Refs) SO - Serono Symp Publ Raven; 78:365-77 1990. AU - Langford A ; Langer R ; Lobeck H ; Stolpmann HJ ; Pohle HD ; Reichart P ; Bier J TI - Human immunodeficiency virus-associated squamous cell carcinomas of the head and neck presenting as oral and primary intraosseous squamous cell carcinomas. AB - Six cases of squamous cell carcinoma arising in the head and neck of patients infected with the human immunodeficiency virus are described. This article reports the first two cases of primary intraosseous squamous cell carcinoma associated with infection with human immunodeficiency virus. Clinical presentation, results of imaging studies, histologic characteristics, therapies applied, and the clinical follow-up are described in detail for each of the six cases. These data are evaluated through a review of the current literature. SO - Quintessence Int. 1995 Sep;26(9):635-54. AU - Lovejoy NC ; Anastasi JK TI - Squamous cell cervical lesions in women with and without AIDS. Biochemical risk factors, prevention, and policy. AB - Worldwide, squamous cell cervical cancer and intraepithelial lesions (SIL) are a major source of morbidity and mortality. Compared to women in general, women with human immunodeficiency syndromes (HIV) are at higher risk of developing SIL. With the HIV epidemic escalating among women, prevalence, morbidity, and mortality related to SIL are likely to increase unless adequate prevention and detection programs are mounted. Consequently, this article provides background information for the design of such programs, focusing on selected biochemical risk factors and natural history of SIL in women infected with HIV (HIV+) and women in general (HIV-). Current screening policies are described, and implications for nursing research and policy are discussed. SO - Cancer Nurs. 1994 Aug;17(4):294-307. AU - Maiman M TI - Cervical neoplasia in women with HIV infection. AB - HIV infections in women now account for 40% of all HIV infections worldwide, and the majority of new infections are due to heterosexual transmission. In the United States, 12% of AIDS cases occur in women and in certain high prevalence areas such as Brooklyn, New York, 25% of cases are in women. Both squamous cell neoplasia of the cervix and HIV infection are, in part, sexually transmitted diseases, with oncogenic types of human papillomavirus infection the implicated viral carcinogen associated with cervical cancer. Therefore, an association between cervical cancer and AIDS can be anticipated on the basis of common sexual behavioral risk factors. The author summarizes what we know about the diagnosis and management of women with these problems. SO - Oncology (Huntingt). 1994 Aug;8(8):83-9; discussion 89, 93-4. AU - Mandelblatt J TI - Squamous cell cancer of the cervix, immune senescence and HPV: is cervical cancer an age-related neoplasm? AB - Relationships between cancer and aging will assume greater scientific importance over the coming decades as the number and proportion of elderly increase. Contrary to popular belief, cervical cancer remains an important disease into old age. This paper will briefly review what is known about immune senescence, cervical cancer and immune function, and the relationship between human papilloma virus and immunity, to support the hypothesis that these factors may contribute to the continued occurrence of invasive cervical cancer in the elderly. SO - Adv Exp Med Biol. 1993;330:13-26. AU - McLucas B ; McGill J TI - Pure cutting current for loop excision of squamous intraepithelial lesions. AB - Clear margins are critical to the identification of complete excision of premalignant lesions on the cervix. Large loop excision of the transformation zone aids the pathologic evaluation of the excised specimen while it causes minimal thermal damage. Prior studies of loop excision were performed with a cutting current blended with a coagulating waveform to aid hemostasis. Blended current has higher voltage, which may cause tissue to stick to the electrode and produce thermal damage to the cervix. In this series, pure cutting current was used to excise the cervical transformation zone in 20 patients. The depth of thermal damage was studied in 6 patients; the average endocervical zone of damage was 0.47 mm and that of the exocervical zone, 0.43 mm. The base of the cervix could be examined with the colposcope for the presence of glands. None of our procedures was complicated by intraoperative or delayed bleeding. The preoperative injection of a vasoconstrictor into the cervical stroma is thought to aid the surgery by its hemostatic properties. SO - J Reprod Med. 1994 May;39(5):373-6. AU - Metcalf AM ; Dean T TI - Risk of dysplasia in anal condyloma. AB - BACKGROUND. Recent studies suggest an alarming incidence of dysplasia in homosexuals with anal condyloma. The purpose of our study was to determine the incidence of dysplasia in anal condyloma in our male patients and to determine risk factors for premalignant or malignant change. METHODS. Between 1986 and 1994, 103 male patients were referred to our colorectal clinic for evaluation of anal condyloma. Ninety-one patients had biopsy for pathology and form the basis of this report. All charts were reviewed and results analyzed using the chi-squared test with the Yates correction factor. RESULTS. Mean patient age was 31 +/- 11 years (range, 13 to 78 years) and mean duration of disease was 20 +/- 26 months (range, 2 to 120 months). There were 59 heterosexuals and 32 homosexuals/bisexuals. Two heterosexuals (3%) had invasive squamous cell carcinoma and four (6%) had dysplasia. One homosexual/bisexual (3%) had squamous cell carcinoma in situ and nine (28%) had dysplasia (p < 0.05). Statistical analysis revealed that HIV seropositive status and disease location above the dentate line also predicted increased risk of dysplasia, whereas duration of disease, previous topical therapy, substance abuse, and other sexually transmitted diseases were not significant risk factors. CONCLUSIONS. Homosexual orientation, disease above the dentate line and HIV seropositivity increase the risk of dysplasia in perianal condyloma. The incidence of dysplasia in perianal condyloma is significant enough to warrant consideration of biopsy in all patients. SO - Surgery. 1995 Oct;118(4):724-6. AU - Monsonego J TI - Human Papillomavirus (HPV), Co-Factors and Carcinogenesis of the Uterine Cervix AB - Recently, a distinct increase has been seen in the incidence of viral anogenital condylomatous lesions in men and women. The epidemiological profile of cancer of the uterine cervix (including intraepithelial cancer) has changed, with an overall decrease in incidence in the past 30 yr, which has occurred mainly in women over 50 yr old, while a progressive increase has been observed in women from 20-40 yr old. Koilocytosis, pathognomonic of HPV infection, is seen in cervical intraepithelial neoplasia (CIN) and in successive stages leading to invasive cancer. HPV and cofactors in cervical carcinogenesis are reviewed, including factors related to local exposure to the virus (columnar ectopy and recurring cervicitis and cervico-vaginitis); factors involved in CIN and invasive epidermoid cancers of the uterine cervix (oral contraception, tobacco use, immunodepression, diseases associated with disorders of immunity, seropositivity for HIV, pregnancy, age at first intercourse, diet, associated sexually transmitted diseases, and viral lesions in the male partner); and oncogenes. Numerous biological, epidemiological, and evolutionary arguments support the view that the association between HPVs 16-18 and possibly others with condylomatous lesions and CIN is insufficient, by itself, to confer tumor characteristics on infected tissues. The host and the cofactors that characterize it also are probable determinants in carcinogenesis. It is not impossible that, in certain circumstances, HPV or cofactors may induce activation of certain oncogenes, the transcription of which may be augmented in certain precursors of cancer of the cervix and amplified in the tumor processes. Certain cofactors may favor viral replication and integration into the host genome, or may induce the liberation of transforming factors. In practical terms, the determination of markers of carcinogenesis that are more specific than HPV should permit better selection of patients for treatment. The determination of activated oncogenes, overexpressed or mutated, in the precursor lesions of cancer of the cervix very probably will constitute a valid marker for the evolution of disease. (108 Refs) SO - Serono Symp Publ Raven; 78:31-48 1990. AU - Peters K ; Vejlsgaard GL TI - Basal cell and squamous cell carcinoma and Kaposi's sarcoma. AB - The mortality rate of nonmelanoma skin cancer is higher than generally considered. An actual nonmelanoma skin cancer is a risk factor not only for other skin cancers but also for cancers in other organs. The recurrence rate can, according to the method of calculation, yield surprisingly diverging results. Statistical mapping of subclinical tumor growth in basal cell carcinoma supplies the margins for tumor-free excision. An even better but more expensive tool for therapy planning is tumor imaging with magnetic resonance imaging. Psoralen plus ultraviolet light of the A wavelength-treated patients run a dose-dependent risk of developing squamous cell carcinoma of the skin but also cancers in other organs. Human papilloma virus-16 seems not to be associated with squamous cell carcinoma of the skin except for the anogenital region and possibly the finger. The finding of retroviruslike particles in endemic non-acquired immunodeficiency syndrome Kaposi's sarcoma strongly suggests that a virus other than human immunodeficiency virus may play a role in the pathogenesis of this disease. SO - Curr Opin Oncol. 1992 Apr;4(2):380-5. AU - Schweitzer VG TI - Photodynamic therapy for treatment of head and neck cancer. AB - Since 1975, photodynamic therapy has reportedly been effective in a variety of head and neck malignancies that failed traditional (conventional) therapy, including surgery, cryotherapy, chemotherapy, hyperthermia, and radiation therapy. Photodynamic therapy consists of the intravenous administration of (di)hematoporphyrin ether, a chemosensitizing drug selectively retained by neoplastic and reticuloendothelial tissues which, when exposed to a 630-nm argon laser, catalyzes a photochemical reaction to release free oxygen radicals, the cytotoxic agents responsible for cell death and tumor necrosis. Preliminary investigations have assessed the efficacy of photodynamic therapy in treatment of: (1) superficial condemned mucosa or field cancerization of the oral cavity and (2) stage III and IV head and neck carcinomas that had unsuccessful conventional therapy. Complete and/or partial remissions were obtained in 11 of 12 patients (16 treatments) with a variety of carcinomas of the nasopharynx, palate and uvula, retromolar trigone, temporal bone, cervical esophagus, and AIDS-related Kaposi's sarcoma of the oral cavity. SO - Otolaryngol Head Neck Surg. 1990 Mar;102(3):225-32. AU - Som PM TI - Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AB - Radiologists are frequently asked to evaluate cervical lymph nodes with CT or MR imaging to determine if metastases are present, how extensive the metastases are, and if they have spread from lymph nodes to critical adjacent structures such as the carotid artery and skull base. Accurate information of this type is essential if the most appropriate treatment is to be selected. The purpose of this report is to review the diagnostic criteria that are currently used with CT and MR imaging to diagnose metastases in cervical nodes by evaluating nodal size, shape, grouping, and necrosis and extranodal tumor spread. In addition, emphasis is laced on details that should be included in the CT and MR report, such as the location of the nodes, the presence of nodal calcification, and the presence of associated diseases such as parotid cysts that may suggest a specific diagnosis like HIV infection. Because optimal treatment planning depends on the combined information gleaned from the clinical evaluation and the imaging studies, it is essential that there be a close dialogue between clinicians and radiologists. SO - AJR Am J Roentgenol. 1992 May;158(5):961-9. AU - Weber BP ; Fierlbeck G ; Kempf HG TI - Multiple metachronous skin squamous cell carcinomas and epidermodysplasia verruciformis in the head region: a human papilloma virus-associated disease. AB - Data from a young adult man with epidermodysplasia verruciformis (EV) and multiple metachronous spinaliomas in the head and neck region are presented. Diagnosis of this rare, human papilloma virus (HPV)-associated disease was based on: (1) Typical skin lesions, including viral warts, verruca plana-type lesions and pityriasis versicilor; (2) typical histological features, including foamy giant keratinocytes; (3) evidence of HPV 5, 8 and 20 in pityriasis versicilor-like lesions; (4) a cellular immunodeficiency due to a relative T-helper-cell deficit. No specific treatment of EV is known, so that therapy concentrates on early removal of spinaliomas and treatment of intercurrent infections. Since EV patients have numerous benign skin lesions and frequently develop metastatic and non-metastatic carcinomas, molecular changes of HPV during carcinogenesis can be studied. SO - Eur Arch Otorhinolaryngol. 1994;251(6):342-6.