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Intranasal Condyloma Acuminatum with Malignant Transformation
Accepted Manuscript Intranasal Condyloma Acuminatum With Malignant Transformation Tengchin Wang, MD, Chieh Jen Wu, MD PII:
S0002-9343(17)30594-6
DOI:
10.1016/j.amjmed.2017.05.016
Reference:
AJM 14119
To appear in:
The American Journal of Medicine
Received Date: 28 April 2017 Revised Date:
4 May 2017
Accepted Date: 4 May 2017
Please cite this article as: Wang T, Wu CJ, Intranasal Condyloma Acuminatum With Malignant Transformation, The American Journal of Medicine (2017), doi: 10.1016/j.amjmed.2017.05.016. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Intranasal Condyloma Acuminatum With Malignant Transformation Tengchin Wang MD1, Chieh Jen Wu MD2 1.Department of otolaryngology, Tainan municipal hospital , Tainan City, Taiwan 2.Department of pathology, Tainan municipal hospital , Tainan City, Taiwan
RI PT
*Corresponding author: Tengchin Wang, Department of otolaryngology, Tainan municipal hospital, No.670, Chongde Rd., East Dist., Tainan City 701, Taiwan E-mail: [email protected] Telephone Number：+886-6-2609926
SC
Funding: None
M AN U
Conflict of interests: All authors declare no conflict of interests whatsoever
Dr T.C Wang took responsibility for the integrity of the contetnt of the paper. Dr C.J Wu offered pathological picture and performed the final review of the paper.
AC C
EP
TE D
Running head: intranasal condyloma acuminatum
ACCEPTED MANUSCRIPT A 48-year-old man with a growing mass in the right naris and epistaxis for 6 months visited our department in August 2016. He had a history of diabetes mellitus
RI PT
and psoriasis. We observed a cauliflower-like lesion in the right nasal vestibule (Fig. 1A), extending to the septum and nasal floor. Nasopharyngoscopy revealed that the nasopharynx, oropharynx, hypopharynx, and larynx, were free of lesions. The
SC
pathological diagnosis was condyloma acuminatum. HC2 high-risk human
M AN U
papillomavirus DNA testing (Hybrid Capture® II) of the specimen indicated negative results for high-risk human papillomavirus infection. The patient acknowledged that he had previously experienced penile condyloma acuminatum, which was cured. In the microscopic examination, low magnification revealed a papillary (villous)
TE D
architecture with hyperkeratosis (Fig. 1B), whereas high magnification epithelium revealed vacuolization (koilocytosis), which was characteristic of human
EP
papillomavirus infection (Fig. 1C). Focal invasive squamous cell carcinoma was
AC C
noted (Fig. 1D). Invasive growth was manifested by the interruption of the basement membrane and growth of tumor islands in the subepithelial stroma. Because adequate safe margins were not achieved, re-excision or adjuvant radiotherapy was recommended. However, the patient was lost to follow-up for 3 months, and he then returned to receive radiotherapy for local recurrence. The most common pathogens for condyloma acuminatum are human
ACCEPTED MANUSCRIPT papillomavirus types 6 and 11 and rarely types 16 and 18. Subtypes 6 and 11 are “low-risk human papillomavirus” that cause condyloma acuminatum on or around the
and 68 are associated with malignant transformation.1
RI PT
genitals, anus, mouth, or throat. Subtypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59,
The classical histopathological features of condyloma acuminatum include broad
SC
reticulated acanthosis, hyperkeratosis, and koilocytosis, which is the histological gold
M AN U
standard for diagnosis.2
According to the literature, most condyloma acuminatum malignant transformations occur in the anogenital regions, and up to 90% cases are associated with human papillomavirus types 16 and 18.3 Another condyloma
TE D
acuminatum-associated low-grade malignancy is termed “giant condyloma acuminatum” and occurs in the anogenital region. This disease is thought to be
EP
verrucous carcinoma and is highly related to human papillomavirus types 6 and 11.
AC C
Abscess formation and fistulas are common in this condition.4 Immunosuppression, coexisting human immunodeficiency virus infection, irritant
effects of anal sex, and unhygienic conditions play a role in malignant transformation. As observed in the present case, diabetes mellitus can lead to an immunocompromised state, and psoriasis involves the dysregulation of T cell function.4 Both conditions may contribute to malignant transformation. The patient
ACCEPTED MANUSCRIPT did not consent to being tested for human immunodeficiency virus. The most reliable treatment method is radical excision in the anogenital area.
RI PT
Radiotherapy can be applied either alone or with chemotherapy in cases of recurrence or unresectable lesions. However, no current data regarding the malignant
transformation of condyloma acuminatum in the nasal area are available, and the
SC
epidemiology and treatment protocols are unclear.
M AN U
In conclusion, condyloma acuminatum rarely presents in the nasal cavity, and the associated malignant transformation has not yet been reported in the literature. Immunocompromised states may be a contributor to this process, and more intensive surveillance is required if frequent recurrence is observed. Due to the limited number
EP
Acknowledgements
TE D
of cases, a comprehensive consensus for treatment should be obtained in the future.
AC C
We acknowledge Wallace Academic Editing for editing this manuscript.
ACCEPTED MANUSCRIPT
1.
RI PT
Reference Silverberg MJ, Thorsen P, Lindeberg H, Ahdieh-Grant L, Shah KV. Clinical course of recurrent respiratory papillomatosis in Danish children. Arch
Tindle RW. Immune evasion in human papillomavirus-associated cervical cancer
M AN U
2.
SC
Otolaryngol Head Neck Surg 2004;130:711–716.
Nature Reviews Cancer 2, 2002 Jan;59-64 3.
Zur Hausett H. Genital papillomavirus infections. Prog Med Virol 1985;32:15-21.
4.
Bertram P, Treutner KH, Rubben A, et al. Invasive squamouscell carcinoma in
TE D
giant anorectal condyloma (Buscke- Loewenstein tumor). Langenbecks Arch
AC C
EP
Chir 1995; 380: 115- 118.
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
Figure 1. (A) Cauliflower-like lesion growing in the right nasal vestibule and
TE D
occluding the naris; (B) papillary architecture with hyperkeratosis of the overlying squamous epithelium; (C) koilocytosis, which is characteristics of active viral
EP
replication; and (D) invasive carcinoma beyond the basement membrane (black
AC C
arrow), consisting of irregular nests of hyperchromatic cells showing squamous differentiation and focal mitotic figures (black asterisks).
S0002-9343(17)30594-6
DOI:
10.1016/j.amjmed.2017.05.016
Reference:
AJM 14119
To appear in:
The American Journal of Medicine
Received Date: 28 April 2017 Revised Date:
4 May 2017
Accepted Date: 4 May 2017
Please cite this article as: Wang T, Wu CJ, Intranasal Condyloma Acuminatum With Malignant Transformation, The American Journal of Medicine (2017), doi: 10.1016/j.amjmed.2017.05.016. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Intranasal Condyloma Acuminatum With Malignant Transformation Tengchin Wang MD1, Chieh Jen Wu MD2 1.Department of otolaryngology, Tainan municipal hospital , Tainan City, Taiwan 2.Department of pathology, Tainan municipal hospital , Tainan City, Taiwan
RI PT
*Corresponding author: Tengchin Wang, Department of otolaryngology, Tainan municipal hospital, No.670, Chongde Rd., East Dist., Tainan City 701, Taiwan E-mail: [email protected] Telephone Number：+886-6-2609926
SC
Funding: None
M AN U
Conflict of interests: All authors declare no conflict of interests whatsoever
Dr T.C Wang took responsibility for the integrity of the contetnt of the paper. Dr C.J Wu offered pathological picture and performed the final review of the paper.
AC C
EP
TE D
Running head: intranasal condyloma acuminatum
ACCEPTED MANUSCRIPT A 48-year-old man with a growing mass in the right naris and epistaxis for 6 months visited our department in August 2016. He had a history of diabetes mellitus
RI PT
and psoriasis. We observed a cauliflower-like lesion in the right nasal vestibule (Fig. 1A), extending to the septum and nasal floor. Nasopharyngoscopy revealed that the nasopharynx, oropharynx, hypopharynx, and larynx, were free of lesions. The
SC
pathological diagnosis was condyloma acuminatum. HC2 high-risk human
M AN U
papillomavirus DNA testing (Hybrid Capture® II) of the specimen indicated negative results for high-risk human papillomavirus infection. The patient acknowledged that he had previously experienced penile condyloma acuminatum, which was cured. In the microscopic examination, low magnification revealed a papillary (villous)
TE D
architecture with hyperkeratosis (Fig. 1B), whereas high magnification epithelium revealed vacuolization (koilocytosis), which was characteristic of human
EP
papillomavirus infection (Fig. 1C). Focal invasive squamous cell carcinoma was
AC C
noted (Fig. 1D). Invasive growth was manifested by the interruption of the basement membrane and growth of tumor islands in the subepithelial stroma. Because adequate safe margins were not achieved, re-excision or adjuvant radiotherapy was recommended. However, the patient was lost to follow-up for 3 months, and he then returned to receive radiotherapy for local recurrence. The most common pathogens for condyloma acuminatum are human
ACCEPTED MANUSCRIPT papillomavirus types 6 and 11 and rarely types 16 and 18. Subtypes 6 and 11 are “low-risk human papillomavirus” that cause condyloma acuminatum on or around the
and 68 are associated with malignant transformation.1
RI PT
genitals, anus, mouth, or throat. Subtypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59,
The classical histopathological features of condyloma acuminatum include broad
SC
reticulated acanthosis, hyperkeratosis, and koilocytosis, which is the histological gold
M AN U
standard for diagnosis.2
According to the literature, most condyloma acuminatum malignant transformations occur in the anogenital regions, and up to 90% cases are associated with human papillomavirus types 16 and 18.3 Another condyloma
TE D
acuminatum-associated low-grade malignancy is termed “giant condyloma acuminatum” and occurs in the anogenital region. This disease is thought to be
EP
verrucous carcinoma and is highly related to human papillomavirus types 6 and 11.
AC C
Abscess formation and fistulas are common in this condition.4 Immunosuppression, coexisting human immunodeficiency virus infection, irritant
effects of anal sex, and unhygienic conditions play a role in malignant transformation. As observed in the present case, diabetes mellitus can lead to an immunocompromised state, and psoriasis involves the dysregulation of T cell function.4 Both conditions may contribute to malignant transformation. The patient
ACCEPTED MANUSCRIPT did not consent to being tested for human immunodeficiency virus. The most reliable treatment method is radical excision in the anogenital area.
RI PT
Radiotherapy can be applied either alone or with chemotherapy in cases of recurrence or unresectable lesions. However, no current data regarding the malignant
transformation of condyloma acuminatum in the nasal area are available, and the
SC
epidemiology and treatment protocols are unclear.
M AN U
In conclusion, condyloma acuminatum rarely presents in the nasal cavity, and the associated malignant transformation has not yet been reported in the literature. Immunocompromised states may be a contributor to this process, and more intensive surveillance is required if frequent recurrence is observed. Due to the limited number
EP
Acknowledgements
TE D
of cases, a comprehensive consensus for treatment should be obtained in the future.
AC C
We acknowledge Wallace Academic Editing for editing this manuscript.
ACCEPTED MANUSCRIPT
1.
RI PT
Reference Silverberg MJ, Thorsen P, Lindeberg H, Ahdieh-Grant L, Shah KV. Clinical course of recurrent respiratory papillomatosis in Danish children. Arch
Tindle RW. Immune evasion in human papillomavirus-associated cervical cancer
M AN U
2.
SC
Otolaryngol Head Neck Surg 2004;130:711–716.
Nature Reviews Cancer 2, 2002 Jan;59-64 3.
Zur Hausett H. Genital papillomavirus infections. Prog Med Virol 1985;32:15-21.
4.
Bertram P, Treutner KH, Rubben A, et al. Invasive squamouscell carcinoma in
TE D
giant anorectal condyloma (Buscke- Loewenstein tumor). Langenbecks Arch
AC C
EP
Chir 1995; 380: 115- 118.
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
Figure 1. (A) Cauliflower-like lesion growing in the right nasal vestibule and
TE D
occluding the naris; (B) papillary architecture with hyperkeratosis of the overlying squamous epithelium; (C) koilocytosis, which is characteristics of active viral
EP
replication; and (D) invasive carcinoma beyond the basement membrane (black
AC C
arrow), consisting of irregular nests of hyperchromatic cells showing squamous differentiation and focal mitotic figures (black asterisks).