Ackerman's tumour of buccal mucosa in a leprosy patient.

Leprosy (Hansen's disease) is a chronic granulomatous disease caused by Mycobacterium leprae (Hansen's bacillus). Oral manifestations occur in 20-60% of cases, usually in lepromatous leprosy, and are well documented. They may involve both the oral hard and soft tissues. Incidence of verrucous carcinoma/Ackerman's tumour developing in anogenital region and plantar surfaces of feet in lepromatous leprosy has been sufficiently documented in the literature. However, association of oral verrucous carcinoma with lepromatous leprosy has not been established. We report for the first time a case of verrucous carcinoma of the buccal mucosa occurring in a leprotic patient, with brief review of literature on orofacial manifestations of leprosy.

Mycological and histological associations of Candida in oral mucosal lesions.

The present study aimed to assess the presence and level of colonization of Candida in patients with oral mucosal lesions, to determine the presence or absence of candidal hyphae in biopsy specimens and to correlate the degree of epithelial dysplasia with the number of colony-forming units of Candida. We performed a prospective study including 50 patients diagnosed as having oral potentially malignant and malignant disorders. These patients had lesions such as leukoplakia, lichen planus, lichenoid reaction, verrucous carcinoma and oral squamous cell carcinoma. An oral swish with 10 mL of normal saline was performed, and this was collected in a sterile plastic container. Candidal colony-forming units were assessed in the specimen. This was followed by a biopsy of the lesion, which was sent for histopathologic examination for dysplasia and severity, and to assess the presence or absence of candidal hyphae. The results of the present study revealed a correlation between higher Candida colonization and increasing severity of dysplasia. An effort was made to correlate Candida by histologic and mycologic means with epithelial dysplasia. If such a correlation is strongly established, then the importance of antimycotic therapy can be emphasized to avoid deterioration.

Detection of Herpes Simplex Virus and candida infection with special emphasis on their possible role in human Squamous Cell Carcinoma and its variants.

Sixty seven cases of human oral S.C.C. with its intra oral variances were investigated microbiologically, histopathologically, histochemically and immunologically. Yeasts were isolated from 85% of examined cases. "Candifast test" showed that Candida albicans was the commonest form of the detected fungi, followed by C. parapsilosis and C. tropicalis, while the least in frequency was the Torulopsis glabrata. Yeasts were more detected in females, elders and tobacco smokers. Two cases of well differentiated S.C.C. were surprisingly detected, and for the first time in literature, associated with a specific granulomatous reaction and showed positively impregnated fungi. While negative reactions for fungi were noticed in all lymphoepitheliomas, almost all the verrucous carcinoma were positive. Viral inclusion bodies were demonstrated for the first time by MT. This method was rapid, economic and could be used as a pilot study before applying the more specific monoclonal antibody techniques or in-situ hybridization methods. Comparing the results of HSV hybridization with that of candida infection we found that both could be detected in some cases. The results indicate that viral and fungal factors may be synergetic in the development of oral carcinomas.

Buschke-Loewenstein tumour infiltrating pelvic organs.

We report a 42-year-old HIV-negative patient with a 12-year history of exceptionally extensive genital warts and coexisting verrucous carcinoma of the anogenital region (Buschke-Loewenstein tumour). Masses of both tumour and viral papillomas infiltrated the external genitalia, perineum and buttocks, pelvic diaphragm and parts of the lesser pelvis, as well as the urethra, prostate and parts of the urinary bladder, necessitating repeated surgical intervention and plastic reconstruction. Adjuvant interferon-alpha therapy was given without any lasting effects. Human papillomavirus type 6 was detected by DNA in situ hybridization and Southern blot analysis.

HPV detection and p53 alteration in squamous cell verrucous malignancies of the lower genital tract.

We examined five cases of verrucous carcinoma (VC) and two cases of giant condyloma of Buschke-Löwenstein (GCBL) associated with invasive squamous cell carcinoma (ISCC), by immunocytochemistry and molecular techniques. Neither human papillomavirus (HPV) footprints nor p53-altered expression and/or mutation were observed among the cases of VC. By contrast, both cases of GCBL with ISCC turned out to be HPV 6 or 11 positive, showed overexpression of p53 and, one of the two, a mutation in the nucleotide sequence of this tumor suppressor gene. The results point out that VC and GCBL with ISCC, in spite of some morphologic similarities, are two distinct entities, the former being unrelated to both HPV and p53 inactivation and the latter related to both. Regarding p53, immunocytochemical and molecular data on GCBL with ISCC suggest a role of mutant p53 in the progression of malignancy into invasion.

Detection of human papillomavirus DNA in oral verrucous carcinoma by polymerase chain reaction.

Archival tissue biopsies of 17 cases of oral verrucous carcinoma were tested for human papillomaviruses by polymerase chain reaction followed by DNA slot-blot hybridization. Sections of the biopsies were also tested by in situ DNA hybridization with biotin-labeled probes for human papillomavirus types 6/11, 6/18, and 31/33/35. Using polymerase chain reaction, human papillomavirus DNA was detected in seven of 17 cases (41%). Slot-blot hybridization of the amplification products identified human papillomavirus type 6 in two cases, type 11 in four cases, and both types 6 and 11 in one case of oral verrucous carcinoma. In situ hybridization confirmed the presence of human papillomavirus type 6/11 DNA in tumor cell nuclei for each of the cases which tested positive by polymerase chain reaction and was negative in the remaining 10 cases. We conclude that human papillomavirus types 6 and 11 are frequently present in cases of oral verrucous carcinoma.

A case of verrucous carcinoma associated with human papillomavirus type 16 DNA.

We report here a case of verrucous carcinoma which occurred on the penis of a 75-year-old male. The nodule was first noted six months earlier and was whitish, cauliflower-like, and 17 x 19 mm in size. The histopathological examination revealed hypertrophic epidermal proliferation with pale staining keratinocytes, extending into the deep dermis. Partial penectomy and inguinal lymph node dissection were done. No lymph node metastasis was recognized. DNA was isolated from the frozen tumor tissue and examined for the presence of human papillomavirus (HPV) 16, 18, and 33 DNA by the polymerase chain reaction (PCR), using common and specific primers. A 140 base pair (bp) band was amplified and finally determined to be the HPV16 sequence by dot-blot hybridization.

HPV DNA in intraepithelial neoplasia and carcinoma of the vulva and penis.

Surgical specimens of 15 patients with early and 12 patients with advanced squamous cell carcinoma of the vulva and the penis were examined for the presence of human papillomavirus (HPV) type 6, 11, 16, and 18 DNA by Southern blotting (SB) and polymerase chain reaction (PCR) analysis. By SB, HPV type 16 DNA was detected in all early carcinomas and 2 of 12 cases of advanced squamous cell carcinoma (ISCC) of the vulva and penis. PCR revealed HPV DNA in four additional cases of vulvar and penile ISCC negative by SB. Three cases contained HPV16 and one HPV18. Two cases of vulvar and penile Buschke-Löwenstein (BL) tumor with malignancy and one case of vulvar verrucous carcinoma were also examined by both techniques. While BL tumors were associated with DNA of HPV6 or 11, no HPV association was found for verrucous carcinoma. Our results confirm that the detection rate of HPV DNA in early vulvar and penile carcinomas is much higher than in invasive carcinomas. In addition, we have shown that in the lower genital tract, 50% of cases of ISCC are HPV16 correlated. The absence of HPV DNA (types 6, 11, 16, and 18) in the remaining 50% of cases of ISCC thus suggests that vulvar and penile ISCC may have more than one pathogenetic pathway.