                   AIDS INFORMATION NEWSLETTER
                   Michael Howe, MSLS, Editor
                     AIDS Information Center
                VA Medical Center, San Francisco
                     (415) 221-4810 ext 3305
                          June 28, 1996

              Opportunistic Infections (Part XXVII)
           Squamous Cell Carcinomas - Review Articles


AU  - Kuffer R
TI  - Papillomavirus Infections and Precancerous Lesions in the
Oral Cavity
AB  - The incidence of oral squamous cell carcinoma (OSC) shows
great geographic variation, from 2.5 in southern England to
25/100,000 in certain parts of India, where it represents a major
public health problem. Precancerous lesions of the oral cavity and
the role of human papillomavirus (HPV) infection in these lesions
are reviewed under the following headings: the need for more
accurate terminology for 'leukoplakia;' low or high malignant
potential of oral precancerous lesions; carcinogenic factors in
oral malignancy; oral HPV-associated lesions (focal epithelial
hyperplasia [FEH], oral papillomas, oral condyloma acuminatum, oral
lesions resembling flat condyloma and vulvar Bowenoid papulosis,
oral verrucous carcinoma, oral florid papillomatosis, oral hairy
leukoplakia, OSC, and oral lichen planus); and whether HPVs cause
oral premalignant and malignant lesions. The precancerous lesions
of the oral mucosa, which may have a low or a high malignant
potential, are characteristically flat or papillomatous exophytic
lesions. Flat lesions may be either white patches ('leukoplakia')
or (especially when malignant potential is high) red plaques
('erythroplakia') or more often white and red 'mosaic' pattern
lesions ('speckled leukoplakia'). The word leukoplakia, which
includes in a purely clinical sense different benign entities as
well as dysplasias and even superficial carcinoma, should be
replaced by adequate terms. A new classification of oral
intraepithelial neoplasia (OIN) derived from the one currently in
use for uterine cervix lesions is proposed: OIN 1 for mild
dysplasia, OIN 2 for moderate dysplasia, and OIN 3 for severe
dysplasia and intraepithelial carcinoma. Recent research has shown
that either flat or papillomatous precancerous oral lesions are
associated with HPV genotypes 2, 6, 11, 16, and 18. Types 16 and
11 are detected with a particular frequency in oral squamous cell
carcinomas, dysplasias, and potential precursor keratosis. HPV
types 13 and 32 are specific for FEH, a constantly benign lesion,
and type 7 has been found in HIV-infected patients. HPV infection
may cooperate with other classical carcinogenic factors (tobacco,
alcohol, decayed teeth, and cicatricial atrophy) in oral
carcinogenesis. (58 Refs) 
SO  - Serono Symp Publ Raven; 78:365-77 1990.

AU  - Langford A ; Langer R ; Lobeck H ; Stolpmann HJ ; Pohle HD
; Reichart P ; Bier J
TI  - Human immunodeficiency virus-associated squamous cell
carcinomas of the head and neck presenting as oral and primary
intraosseous squamous cell carcinomas.
AB  - Six cases of squamous cell carcinoma arising in the head and
neck of patients infected with the human immunodeficiency virus are
described. This article reports the first two cases of primary
intraosseous squamous cell carcinoma associated with infection with 
human immunodeficiency virus. Clinical presentation, results of
imaging studies, histologic characteristics, therapies applied, and
the clinical follow-up are described in detail for each of the six
cases. These data are evaluated through a review of the current
literature.
SO  - Quintessence Int. 1995 Sep;26(9):635-54.

AU  - Lovejoy NC ; Anastasi JK
TI  - Squamous cell cervical lesions in women with and without
AIDS. Biochemical risk factors, prevention, and policy.
AB  - Worldwide, squamous cell cervical cancer and intraepithelial
lesions (SIL) are a major source of morbidity and mortality.
Compared to women in general, women with human immunodeficiency
syndromes (HIV) are at higher risk of developing SIL. With the HIV
epidemic escalating among women, prevalence, morbidity, and
mortality related to SIL are likely to increase unless adequate
prevention and detection programs are mounted. Consequently, this
article provides background information for the design of such
programs, focusing on selected biochemical risk factors and natural
history of SIL in women infected with HIV (HIV+) and women in
general (HIV-). Current screening policies are described, and
implications for nursing research and policy are discussed.
SO  - Cancer Nurs. 1994 Aug;17(4):294-307.

AU  - Maiman M
TI  - Cervical neoplasia in women with HIV infection.
AB  - HIV infections in women now account for 40% of all HIV
infections worldwide, and the majority of new infections are due
to heterosexual transmission. In the United States, 12% of AIDS
cases occur in women and in certain high prevalence areas such as
Brooklyn, New York, 25% of cases are in women. Both squamous cell
neoplasia of the cervix and HIV infection are, in part, sexually
transmitted diseases, with oncogenic types of human papillomavirus
infection the implicated viral carcinogen associated with cervical
cancer. Therefore, an association between cervical cancer and AIDS
can be anticipated on the basis of common sexual behavioral risk
factors. The author summarizes what we know about the diagnosis and
management of women with these problems.
SO  - Oncology (Huntingt). 1994 Aug;8(8):83-9; discussion 89, 93-4.

AU  - Mandelblatt J
TI  - Squamous cell cancer of the cervix, immune senescence and
HPV: is cervical cancer an age-related neoplasm?
AB  - Relationships between cancer and aging will assume greater
scientific importance over the coming decades as the number and
proportion of elderly increase. Contrary to popular belief,
cervical cancer remains an important disease into old age. This
paper will briefly review what is known about immune senescence,
cervical cancer and immune function, and the relationship between
human papilloma virus and immunity, to support the hypothesis that
these factors may contribute to the continued occurrence of
invasive cervical cancer in the elderly.
SO  - Adv Exp Med Biol. 1993;330:13-26.

AU  - McLucas B ; McGill J
TI  - Pure cutting current for loop excision of squamous
intraepithelial lesions.
AB  - Clear margins are critical to the identification of complete
excision of premalignant lesions on the cervix. Large loop excision
of the transformation zone aids the pathologic evaluation of the
excised specimen while it causes minimal thermal damage. Prior
studies of loop excision were performed with a cutting current
blended with a coagulating waveform to aid hemostasis. Blended
current has higher voltage, which may cause tissue to stick to the
electrode and produce thermal damage to the cervix. In this series,
pure cutting current was used to excise the cervical transformation
zone in 20 patients. The depth of thermal damage was studied in 6
patients; the average endocervical zone of damage was 0.47 mm and
that of the exocervical zone, 0.43 mm. The base of the cervix could
be examined with the colposcope for the presence of glands. None
of our procedures was complicated by intraoperative or delayed
bleeding. The preoperative injection of a vasoconstrictor into the
cervical stroma is thought to aid the surgery by its hemostatic
properties.
SO  - J Reprod Med. 1994 May;39(5):373-6.

AU  - Metcalf AM ; Dean T
TI  - Risk of dysplasia in anal condyloma.
AB  - BACKGROUND. Recent studies suggest an alarming incidence of
dysplasia in homosexuals with anal condyloma. The purpose of our
study was to determine the incidence of dysplasia in anal condyloma
in our male patients and to determine risk factors for premalignant
or malignant change. METHODS. Between 1986 and 1994, 103 male
patients were referred to our colorectal clinic for evaluation of
anal condyloma. Ninety-one patients had biopsy for pathology and
form the basis of this report. All charts were reviewed and results
analyzed using the chi-squared test with the Yates correction
factor. RESULTS. Mean patient age was 31 +/- 11 years (range, 13 
to 78 years) and mean duration of disease was 20 +/- 26 months
(range, 2 to 120 months). There were 59 heterosexuals and 32
homosexuals/bisexuals. Two heterosexuals (3%) had invasive squamous
cell carcinoma and four (6%) had dysplasia. One homosexual/bisexual
(3%) had squamous cell carcinoma in situ and nine (28%) had
dysplasia (p < 0.05). Statistical analysis revealed that HIV
seropositive status and disease location above the dentate line
also predicted increased risk of dysplasia, whereas duration of
disease, previous topical therapy, substance abuse, and other
sexually transmitted diseases were not significant risk factors.
CONCLUSIONS. Homosexual orientation, disease above the dentate line
and HIV seropositivity increase the risk of dysplasia in perianal
condyloma. The incidence of dysplasia in perianal condyloma is
significant enough to warrant consideration of biopsy in all
patients.
SO  - Surgery. 1995 Oct;118(4):724-6.

AU  - Monsonego J
TI  - Human Papillomavirus (HPV), Co-Factors and Carcinogenesis of
the Uterine Cervix
AB  - Recently, a distinct increase has been seen in the incidence
of viral anogenital condylomatous lesions in men and women. The
epidemiological profile of cancer of the uterine cervix (including
intraepithelial cancer) has changed, with an overall decrease in
incidence in the past 30 yr, which has occurred mainly in women
over 50 yr old, while a progressive increase has been observed in
women from 20-40 yr old. Koilocytosis, pathognomonic of HPV
infection, is seen in cervical intraepithelial neoplasia (CIN) and
in successive stages leading to invasive cancer. HPV and cofactors
in cervical carcinogenesis are reviewed, including factors related
to local exposure to the virus (columnar ectopy and recurring
cervicitis and cervico-vaginitis); factors involved in CIN and
invasive epidermoid cancers of the uterine cervix (oral
contraception, tobacco use, immunodepression, diseases associated
with disorders of immunity, seropositivity for HIV, pregnancy, age
at first intercourse, diet, associated sexually transmitted
diseases, and viral lesions in the male partner); and oncogenes.
Numerous biological, epidemiological, and evolutionary arguments
support the view that the association between HPVs 16-18 and
possibly others with condylomatous lesions and CIN is insufficient,
by itself, to confer tumor characteristics on infected tissues. The
host and the cofactors that characterize it also are probable 
determinants in carcinogenesis. It is not impossible that, in
certain circumstances, HPV or cofactors may induce activation of 
certain oncogenes, the transcription of which may be augmented in 
certain precursors of cancer of the cervix and amplified in the
tumor processes. Certain cofactors may favor viral replication and
integration into the host genome, or may induce the liberation of
transforming factors. In practical terms, the determination of
markers of carcinogenesis that are more specific than HPV should
permit better selection of patients for treatment. The
determination of activated oncogenes, overexpressed or mutated, in
the precursor lesions of cancer of the cervix very probably will
constitute a valid marker for the evolution of disease. (108 Refs) 
SO  - Serono Symp Publ Raven; 78:31-48 1990.

AU  - Peters K ; Vejlsgaard GL
TI  - Basal cell and squamous cell carcinoma and Kaposi's sarcoma.
AB  - The mortality rate of nonmelanoma skin cancer is higher than
generally considered. An actual nonmelanoma skin cancer is a risk
factor not only for other skin cancers but also for cancers in
other organs. The recurrence rate can, according to the method of
calculation, yield surprisingly diverging results. Statistical
mapping of subclinical tumor growth in basal cell carcinoma
supplies the margins for tumor-free excision. An even better but
more expensive tool for therapy planning is tumor imaging with
magnetic resonance imaging. Psoralen plus ultraviolet light of the
A wavelength-treated patients run a dose-dependent risk of
developing squamous cell carcinoma of the skin but also cancers in
other organs. Human papilloma virus-16 seems not to be associated
with squamous cell carcinoma of the skin except for the anogenital 
region and possibly the finger. The finding of retroviruslike
particles in endemic non-acquired immunodeficiency syndrome
Kaposi's sarcoma strongly suggests that a virus other than human
immunodeficiency virus may play a role in the pathogenesis of this
disease.
SO  - Curr Opin Oncol. 1992 Apr;4(2):380-5.

AU  - Schweitzer VG
TI  - Photodynamic therapy for treatment of head and neck cancer.
AB  - Since 1975, photodynamic therapy has reportedly been
effective in a variety of head and neck malignancies that failed 
traditional (conventional) therapy, including surgery, cryotherapy,
chemotherapy, hyperthermia, and radiation therapy. Photodynamic
therapy consists of the intravenous administration of
(di)hematoporphyrin ether, a chemosensitizing drug selectively
retained by neoplastic and reticuloendothelial tissues which, when
exposed to a 630-nm argon laser, catalyzes a photochemical reaction
to release free oxygen radicals, the cytotoxic agents responsible
for cell death and tumor necrosis. Preliminary investigations have
assessed the efficacy of photodynamic therapy in treatment of: (1)
superficial condemned mucosa or field cancerization of the oral
cavity and (2) stage III and IV head and neck carcinomas that had
unsuccessful conventional therapy. Complete and/or partial
remissions were obtained in 11 of 12 patients (16 treatments) with
a variety of carcinomas of the nasopharynx, palate and uvula,
retromolar trigone, temporal bone, cervical esophagus, and
AIDS-related Kaposi's sarcoma of the oral cavity.
SO  - Otolaryngol Head Neck Surg. 1990 Mar;102(3):225-32.

AU  - Som PM
TI  - Detection of metastasis in cervical lymph nodes: CT and MR
criteria and differential diagnosis.
AB  - Radiologists are frequently asked to evaluate cervical lymph
nodes with CT or MR imaging to determine if metastases are present,
how extensive the metastases are, and if they have spread from
lymph nodes to critical adjacent structures such as the carotid
artery and skull base. Accurate information of this type is
essential if the most appropriate treatment is to be selected. The
purpose of this report is to review the diagnostic criteria that
are currently used with CT and MR imaging to diagnose metastases
in cervical nodes by evaluating nodal size, shape, grouping, and
necrosis and extranodal tumor spread. In addition, emphasis is
laced on details that should be included in the CT and MR report,
such as the location of the nodes, the presence of nodal
calcification, and the presence of associated diseases such as
parotid cysts that may suggest a specific diagnosis like HIV
infection. Because optimal treatment planning depends on the
combined information gleaned from the clinical evaluation and the
imaging studies, it is essential that there be a close dialogue
between clinicians and radiologists.
SO  - AJR Am J Roentgenol. 1992 May;158(5):961-9.

AU  - Weber BP ; Fierlbeck G ; Kempf HG
TI  - Multiple metachronous skin squamous cell carcinomas and
epidermodysplasia verruciformis in the head region: a human
papilloma virus-associated disease.
AB  - Data from a young adult man with epidermodysplasia
verruciformis (EV) and multiple metachronous spinaliomas in the
head and neck region are presented. Diagnosis of this rare, human
papilloma virus (HPV)-associated disease was based on: (1) Typical
skin lesions, including viral warts, verruca plana-type lesions and
pityriasis versicilor; (2) typical histological features, including
foamy giant keratinocytes; (3) evidence of HPV 5, 8 and 20 in
pityriasis versicilor-like lesions; (4) a cellular immunodeficiency
due to a relative T-helper-cell deficit. No specific treatment of
EV is known, so that therapy concentrates on early removal of
spinaliomas and treatment of intercurrent infections. Since EV
patients have numerous benign skin lesions and frequently develop
metastatic and non-metastatic carcinomas, molecular changes of HPV
during carcinogenesis can be studied.
SO  - Eur Arch Otorhinolaryngol. 1994;251(6):342-6.

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