Transitional cell and uncommon urothelial carcinoma of renal pelvis/ureter and bladder: low incidence of human papilloma virus.
BACKGROUND
Recently, it has been proposed that human papilloma virus (HPV) infection may play a role in the carcinogenesis of bladder urothelial malignancy. However, there is still controversy about the prevalence of HPV in such malignancies. With similar techniques of in situ hybridization (ISH) or polymerase chain reaction (PCR), either high or rare frequency have been detected. To evaluate the prevalence of HPV in the urothelial malignancies based on presentations here, 118 cases of urothelial malignancies were analysed, including those of the renal pelvis and ureter which have rarely been reported before.


METHODS
Non-isotopic ISH technique was used to detect HPV on paraffin sections, including 51 bladder transitional cell carcinoma (TCC), 48 renal pelvic/ureter TCC, 5 bladder adenocarcinoma, 3 bladder small cell carcinoma, 2 bladder undifferentiated carcinoma, 1 multiple synchronous pelvic and ureteric squamous cell carcinoma (SCC) and 8 bladder SCC. An FITC-labelled probe of wide spectrum HPV was used for screening, and probes of HPV 6/11, 16, 18, 31, 33 were used for typing.


RESULTS
By the technique of ISH, wide spectrum HPV was detected in only three of the eight cases of bladder SCC. Of the three positive cases, two were subsequently shown to be uterine cervical SCC with bladder invasion. Therefore, HPV was positive in only one case of primary bladder SCC, occurring in a patient with systemic lupus erythematosus under steroid and cyclophosphamide therapy. Further subtyping was negative for HPV 6/11, 16, 18, 31, and 33. The result indicated that the positive staining by wide spectrum probe was caused by types 30, 35, 45, 51, and/or 52. HPV was not detected in any of the 51 bladder TCC, 48 renal pelvic/ ureter TCC, 5 bladder adenocarcinoma, 3 bladder small cell carcinoma, and 2 bladder undifferentiated carcinoma.


CONCLUSIONS
The results are in agreement with the majority of recent reports which suggest that HPV is unlikely to be involved in the etiology of urothelial malignancies; however, it seems probable that immunosuppressed patients are at greater risk for HPV-associated bladder SCC.
Wang
J S
JS
Department of Pathology, Veterans General Hospital-Kaohsiung, Taiwan, R.O.C.
Tseng
H H
HH
Lin
S L
SL
Hsieh
S P
SP
D000230:Adenocarcinoma / Q000821:virology; D000328:Adult; D018288:Carcinoma, Small Cell / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000821:virology; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000821:virology*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D017403:In Situ Hybridization; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology*; D015995:Prevalence; D012306:Risk; D014412:Tumor Virus Infections / Q000453:epidemiology*; D014571:Urologic Neoplasms / Q000453:epidemiology / Q000821:virology*