Sexual History and Distinctive Pathological Features in HPV-Related Penile Carcinomas.
Antonio L Cubilla, Alcides Chaux, Ingrid M Rodriguez, Jose E Barreto, George J Netto, Francisco Xavier Bosch, Silvia de Sanjose, Nubia Munoz, Allan Hildesheim. Instituto de Patología e Investigación, Asunción, Paraguay; Johns Hopkins University, Baltimore, MD; Instituto Catalán Oncológico, Barcelona, Spain; CIBER Epidemiologia y Salud Pública, Barcelona, Spain; National Cancer Institute, Bethesda, MD
Background: Two distinct forms of penile squamous cell carcinomas (SCC) have been reported, one that is related to human papillomavirus (HPV) and another that is not. This study was designed to compare epidemiological and pathological characteristics for these two forms of penile SCC.
Design: A questionnaire was administered to 89 prospectively ascertained patients with invasive penile carcinomas at a Penile Cancer Reference Center in Paraguay. Data collected included: patients age, tumor site, residence (urban or rural), socioeconomic status, educational level, smoking, sexual and hygiene habits, and sexually transmitted disease history. Clinico-pathological data abstracted from records included: histological subtype, histological grade, p16INK4a staining status by IHC, presence of adjacent intraepithelial neoplasia (PeIN), presence of lichen sclerosus (LS), and nodal status. HPV was detected in paraffin embedded tumor tissue by PCR (SPF-10 with LIPA-25 genotypification). Categorical variables were compared using the Fisher's exact test. Student's t-test was used to compare continuous data. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using logistic regression. A 2-tailed P<0.05 was required for statistical significance.
Results: HPV was present in 36% of cases. No significant risk factor differences were noted between HPV+ and HPV– patients, with one exception: HPV+ patients reported a higher number of female partners than HPV- patients (OR = 3.8 [95% CI = 3.1–4.6] for 10+ partners vs. <6 partners; p-trend = 0.03). Tumors with warty/ basaloid (WB) morphology, of high grade, and positive for p16INK4a were more likely to be HPV-related (all P-values ≤0.005). Differentiated PeIN and lichen sclerosus were more frequent in HPV– cases while WB PeIN was more frequently found in HPV+ tumors (p-values ≤0.001). Rates of inguinal metastasis were similar in both groups.
Conclusions: HPV positive tumors revealed distinctive pathological features: high grade, WB morphology, p16INK4a positivity and paucity of LS. Epidemiologically, a history of more female sexual partners was observed among HPV+ compared to HPV– patients.
Category: Genitourinary (including renal tumors)
Tuesday, March 1, 2011 1:45 PM
Platform Session: Section A, Tuesday Afternoon