Mastication of verruca vulgaris associated with esophageal papilloma: HPV-45 sequences detected in oral and cutaneous tissues☆,☆☆,★

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Abstract

Human papillomaviruses (HPVs) are double-stranded, circular, epitheliotropic DNA viruses of which nearly 70 types have been identified. Specific HPV types exhibit a predilection to infect certain sites; however, occurrence is not unique or restricted to these sites. HPV typing may also be helpful in determining the oncogenic potential of HPV lesions. The most common HPV types, 6 and 11, are associated with benign mucosal lesions, whereas types 18, 16, 31, and 33 are thought to confer a high rate of malignant transformation. We describe a patient with both palmar verrucae and esophageal papillomatosis that proved to be HPV type 45 by polymerase chain reaction. HPV 45 has a high homology to HPV 18 and is a member of the relatively new "high-risk" mucosal HPV family in terms of cervical oncogenic potential. To our knowledge, HPV 45 has never been reported in cutaneous warts or esophageal lesions.(J Am Acad Dermatol 1997;36:853-7.)

Section snippets

CASE REPORT

A 60-year-old woman had odynophagia, dysphagia to solids, morning nausea, and epigastric burning for 1 year. Multiple warts were present on her distal fingertips. She disclosed intermittent biting of the warts and daily oral-digital contact while adjusting her dental prosthesis.

Initial radiographic examination of the upper gastrointestinal tract revealed only a benign congenital midesophageal narrowing (Schatzki's ring), a narrow esophagogastric junction, and a moderately long hiatal hernia.

METHODS

HPV typing was performed on DNA extracted from the tissue specimens by direct sequencing of consensus primer-generated polymerase chain reaction (PCR) fragments as described previously. 1 Consensus degenerate oligonucleotide primer sets (MY09, MY11) designed for the HPV L1 region 2 were obtained from Perkin Elmer Cetus (Norwalk, Connecticut). Consensus nondegenerate primer sets specific to the E1 region (GP1, GP2) 3 were synthesized by Biosynthesis Inc. (Denton, Texas). PCRs were carried out

RESULTS

On the basis of the highest scores derived from sequence alignments, HPV-45 DNA sequences were detected with 100% identity in both the digital and esophageal lesions. Direct sequencing and comparison of the L1 region to HPV-45 DNA also yielded sequences with 100% identity in both lesions. The nonisotopic in situ hybridization confirmed the presence of the HPV infection. In the digital verruca the in situ hybridization signals showed the type 1 form. The stained nuclear material can be

DISCUSSION

HPVs are double-stranded, circular, epitheliotropic DNA viruses 6, 7, 8 containing a genome of 8000 base pairs in length. 6, 8 Nearly 70 types of HPV have been identified. 8 Specific HPV types have preferential areas of infection, 9 but HPV types are not unique or restricted to that site. Although HPV 6 and 11 are the most common HPV types associated with benign oral and laryngeal papillary lesions, 9, 10, 11, 12, 13, 14 our patient exhibited an HPV 18–like (HPV 45) virus type from a

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    ☆

    This article is made possible through an educational grant from the Dermatological Division, Ortho Pharmaceutical Corporation.

    ☆☆

    Reprint requests: Stephen K. Tyring, MD, PhD, University of Texas Medical Branch, Department of Dermatology, Galveston, TX 77555-0783.

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    Copyright © 1997 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.