Squamous Cell Carcinoma of the Head and Neck in HIV-Positive Patients. A Neoplasm Infrequently Associated with Human Papillomavirus Infection
L Alos, S Moyano, A Diaz, F Garcia, M Caballero, A Cardesa, J Ordi. Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain; Hospital Clinic, Barcelona, Spain
Background: Malignant neoplasms occur at increased frequency in patients with HIV/AIDS, especially those related to human papillomavirus (HPV) infection. We have studied the clinicopathological features of head and neck squamous cell carcinomas (HNSCC) developing in HIV-positive patients, and we have analyzed the possible relationship with HPV infection.
Design: All HIV-infected patients with HNSCC diagnosed at a single institution from 1998 to 2007 were retrospectively evaluated. The clinicopathological features were analyzed and tissues were tested for the presence of HPV genome by highly sensitive PCR. Moreover, immunohistochemical studies for HIV p24, p16 INK4a, p53, Epstein-Barr virus latent membrane protein 1 (LMP-1) and human-herpes virus 8 (HHV-8), and in situ hybridization for mRNA of EBER1/2 gene of the Epstein-Barr virus were performed.
Results: Ten of 4,987 HIV-infected patients seen in this period in the Infectious Disease Department developed HNSCC. The patients median age was 45 (range 36-54), the male to female ratio was 2:1. All patients were heavy smokers. Median duration of HIV infection previous to the diagnosis of the laryngeal tumor was 10.5 years (range 7-18 years) and all patients had been on antiretroviral therapy since the identification of HIV infection. Six neoplasms developed in larynx, two in oropharynx and two in oral cavity. All tumors were keratinizing squamous cell carcinomas poorly differentiated (8 cases) or moderately differentiated (2 cases). The tumors usually presented at a high clinical stage and a half of the patients died of the laryngeal neoplasm after a mean time of 16 months. HPV 16 was detected in only one oropharyngeal carcinoma, whereas the rest of the tumors were negative for HPV, even in two patients with laryngeal carcinoma and coexisting HPV-associated gynecological neoplasm. Stainings for HIV p24, p16INK4a, LMP-1, HHV-8 and EBER were negative in all tumors, and p53 was positive in 6 of 10 cases.
Conclusions: HNSCC developing in HIV-positive patients is infrequently associated with HPV infection. This neoplasm develops in young, heavy smokers and presents at an advanced clinical stage.
Category: Head & Neck
Monday, March 9, 2009 1:00 PM
Poster Session II # 167, Monday Afternoon