Special Issue “HPV in the Head and Neck Region”

Previously, human papillomaviruses were best known for causing diseases in the genital tract, where high-risk types may cause, e.g., cancer of the cervix uteri, while low risk types could cause condylomas [...]

The Not-So-Good, the Bad and the Ugly: HPV E5, E6 and E7 Oncoproteins in the Orchestration of Carcinogenesis

Infection with HPV starts with the access of the viral particles to basal cells in the epidermis, potentially via microtraumas to the skin. The basal cells are able to keep away these pathogens in normal circumstances through a robust immune response from the host, as HPV infections are, in general, cleared within 2 to 3 weeks. However, the rare instances of persistent infection and/or in cases where the host immune system is compromised are major risk factors for the development of lesions potentially leading to malignancy. Evolutionarily, obligatory pathogens such as HPVs would not be expected to risk exposing the host to lethal cancer, as this would entail challenging their own life cycle, but infection with these viruses is highly correlated with cancer and malignancy—as in cancer of the cervix, which is almost always associated with these viruses. Despite this key associative cause and the availability of very effective vaccines against these viruses, therapeutic interventions against HPV-induced cancers are still a challenge, indicating the need for focused translational research. In this review, we will consider the key roles that the viral proteins play in driving the host cells to carcinogenesis, mainly focusing on events orchestrated by early proteins E5, E6 and E7—the not-so-good, the bad and the ugly—and discuss and summarize the major events that lead to these viruses mechanistically corrupting cellular homeostasis, giving rise to cancer and malignancy.

Squamous Cell Metastasis of Cancer from Cervix to Breast: A Case Report

Squamous cell metastasis from cervical cancer to breast is an extremely rare entity, approximately 29 cases have been documented worldwide since 1947 and it is the second documented case in Ecuador, the incidence is very low, it represents only 1,2 of all malignant neoplasms of the breast, which limits the expertise in the diagnosis and treatment of this metastasis, with the outermost quadrant of the breasts being the most frequent site of presentation. We present the clinical case of a 46-year-old married woman with a history of stage IVB squamous cell cancer of the cervix, who received chemotherapy, a Paclitaxel/Carboplatin regimen for 6 cycles. There was no good response and we had radiotherapy and brachytherapy treatment. The second line of chemotherapy with monodroga Gemcitab is proposed, the scheme is completed for 8 cycles. There is no favorable response, so a second-line chemotherapy treatment with Ifosfomide is proposed. The same metastases are present in the breast as after imaging and pathology examinations, it is concluded that the patient presents cervical Ca squamous cell metastases (cancer) from the cervix, 6 months after the diagnosis of the deceased patient. Metastasis to the breast from a neoplasm of other organs is very rare, the incidence of which is very low and the prognosis is gloomy. Keywords: metastasis, squamous cells, cancer of the cervix. RESUMEN La metástasis de células escamosas de cáncer de cérvix a mama es una entidad extremadamente rara, se ha documentado a nivel mundial aproximadamente 29 casos desde 1947 y es el segundo caso documentado en el Ecuador, la incidencia es muy baja, representa tan solo el 1,2 de todas las neoplasias malignas de la mama, lo que limita la experticia en el diagnóstico y tratamiento de esta metástasis, siendo el sitio más frecuente de presentación el cuadrante superior externo de las mamas. Se presenta el caso clínico de una paciente de 46 años, casada, con antecedentes de cáncer de cérvix de células escamosas en estadio IVB por lo que recibió tratamiento de quimioterapia, esquema Paclitaxel/Carboplatino por 6 ciclos. No hubo buena respuesta y recibió tratamiento de radioterapia y braquiterapia. Se propone segunda línea de quimioterapia con monodroga Gemcitab, se completa el esquema por 8 ciclos. No existió respuesta favorable por lo que se propone tratamiento de segunda línea de quimioterapia con Ifosfomida. Presenta metástasis en mama la misma que posterior a exámenes de imagen y patología se concluye que la paciente presenta metástasis de células escamosas de Ca (cáncer) de Cérvix a mama, 6 meses posterior al diagnóstico la paciente fallece. La metástasis en la mama de una neoplasia de otros órganos es muy raro cuya incidencia es muy baja y de pronóstico sombrío. Palabras claves: metástasis, células escamosas, cáncer de cérvix.

Chlamydia trachomatis. Co-factor or factor in cancer of the cervix?

The objective of this article was to review and to analyze the possible role that Chlamydia trachomatis has as a co-factor in the origin and development of cervical cancer. For that purpose, the Latin-American and international bibliography was reviewed using the Pub-Med, Google Scholar, Springer, the Cochrane Library, Embase, Scielo, Imbiomed-L, Redalyc and Latindex databases. The searches included the key words: Chlamydia trachomatis, epidemiology of Chlamydia trachomatis, epidemiology of cervical cancer, Chlamydia trachomatis and infection, Chlamydia trachomatis and inflammation mechanisms, cervical cancer and co-factors, sexually transmitted infections and cervical cancer, cancer and inflammation mechanisms, carcinogenesis, inflammation mechanisms. Publications from 1970 to June 2020 were reviewed and analyzed. This review article analyzes the possible mechanisms that Chlamydia trachomatis could play in the carcinogenesis of the cervical cancer as a co-factor with the human papilloma virus or as an independent factor.

Medico-social factors associated with late presentation in women with cancer of the cervix in Northern Nigeria

Cancer of the cervix is the commonest gynecological cancer and the leading cause of cancer mortality among women in Africa.Certain social behaviors have been associated with an increased risk of high-risk Human Papillomavirus (HPV) infection, which is responsible for virtually all cases of Invasive Cervical Cancer (ICC). Retrospective review of the medico-social and histo-pathologic patterns of cases of cancer of the cervix at the Gynecology Oncology Unit, Aminu Kano Teaching Hospital, Kano between January 2006 to December 2010 was conducted. The socio-demographic, medical and histological data of each patient were extracted and analyzed. A total of 91 cases of cancer of the cervix were identified. The mean age of the respondents was 48 years (SD±10.2years), mean parity was 7 (SD±3.2) and mean age at first marriage was 15.2 years (SD±1.9years). Most of the patients had being married more than once in their lifetime. Majority of the women were unemployed and over half had no formal education. The commonest presenting complaint and complication respectively was vaginal bleeding (72.5%) and anaemia (45.1%). Most of the patient had advanced stages of the disease (86.8%). Only 18 out of the 91 had undergone HIV testing, with 28% testing positive to the virus. The commonest histologic type of cervical cancer (85.7%) was Squamous Cell Carcinoma (SCC). There were statistically significant associations between advanced disease and age, parity and number of lifetime marriages. Patients with cancer of the cervix seen at our institution are within the reproductive age group. They are mostly grandmultiparous, have no formal education and have more than one life time marriages. They usually present with late stage disease and of SCC histologically.

TO STUDY THE PATTERN OF VARIOUS CERVICAL LESION

Background: Cancer of the cervix is an increasing health problem and an important cause of mortality in women worldwide. The incidence of cervical cancer arises worldwide. Methods: A retrospective study was conducted in the Department of Pathology, JLN Medical College & Hospital Ajmer. Results: A total of 100 smears were analyzed. Out of which 96.00% smears were satisfactory for evaluation. Out of 96.00% satisfactory smears, 30.00% shows normal smear and 52.00% shows benign cellular changes and 4.00% shows epithelial cells abnormality. 5.00% smears shows Bacterial vaginosis. 45.00% were inflammatory smears. Conclusion: We concluded that cervical cytology by Pap smear is a simple, safe and effective test to detect premalignant and malignant lesions of cervix at an early stage, and thus help the clinicians in early and more efficient management of the patients. Keywords: Pap smear, Cervix, Cytology.

Сlinical and morphological case of cervical cancer due to HIV-associated infection

Cervical cancer ranks second in the structure of mortality of malignant tumors of the female reproductive system. Of particular interest is cervical cancer in patients with HIV infection, which develops more rapidly than in HIV-negative women. In this regard, the purpose of our study was to analyze the clinical and morphological case of the development of cervical cancer with HIV infection and to describe the features of metastasis in a young patient.Materials and methods. A postmortem examination was carried out, the material of the accompanying documentation (case history, outpatient card) was studied, a histological examination of the material was carried out (staining with hematoxylin and eosin, immunohistochemical examination for CK5/14, p16, p63).Research results. In a young patient (41 years old), HIV-infected, the cervix is revealed with destructive changes, ulceration, with signs of infiltrative growth, with the growth of the tumor structure into the surrounding tissues. Squamous cell non-keratinizing cancer of the cervix of a moderate degree of differentiation was histologically exposed. In the analyzes — CD4+ lymphocytes 18 cells/ml. The peculiarity and rarity of the presented clinical and morphological case is that against the background of the aggressive course of cervical cancer, there is an absence of characteristic metastases, there is a pronounced infiltrating growth and germination of atypical cells into the surrounding tissues, with the development of severe complications.

Cervical Cancer in a Tertiary Hospital in South-South, Nigeria: A 5-Year Review

Background: Cervical cancer is the most common gynaecological cancer in developing countries. The World Health Organisation estimated that there were about 570,000 new cases of cancer of the cervix in 2018 and about 311,000 women died of the disease. Objective: To determine the prevalence and characteristics of patients with cervical cancer at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria. Materials and Methods: This was a descriptive study which involved all the patients with histologically confirmed cervical cancer managed at the gynaecological unit of the hospital from 1st January, 2016 to 31st December, 2020. Information was extracted from the gynaecological records and entered into a predesigned proforma. All available data were retrospectively analysed with SPSS version 23.0, and results were presented in tables and frequencies. Results: There were 31 cases of cervical cancers out of the 2,478 gynaecological cases seen. The prevalence of cervical cancer was 1.25%. About one-third of the women were in the sixth decade of life (32.3%). About half of the women were diagnosed at Stage 2 of the disease (51.6%) and squamous cell carcinoma accounted for 80.6% of the cancers. Radiotherapy was the most used treatment option (64.5%). About one-quarter died (25.8%). Conclusion: Most of the patients in this study presented in the advanced stages of the disease, with death of about one-quarter of them. Prevention and early presentation to the hospital are key in the prevention of poor quality of life and deaths. All hands must be on deck to tackle this disease.