title: Human papillomavirus is not an etiologic agent of urothelial inverted papillomas.
abstract: Inverted papilloma of the urinary bladder is rare, accounting for <1% of all bladder neoplasms. Although there is general consensus that inverted papilloma is benign in nature, little is known about its pathogenesis. Some have suggested that human papillomavirus (HPV) plays an etiologic role in the development of this neoplasm. These claims have not been adequately substantiated, and there is controversy as to the role of HPV in other urinary bladder neoplasms as well. To further investigate a possible etiologic role of HPV in urothelial neoplasia, we evaluated 27 inverted papillomas of the urinary bladder for the presence of HPV. Both immunohistochemical and in situ hybridization (ISH) studies for HPV and immunohistochemical analysis for p16, a surrogate marker for HPV infection, were used to assess HPV infection status. In the urinary bladder inverted papillomas of these 27 patients (age range, 35 to 78 y; M:F ratio, 11:1), no HPV was detected by HPV immunohistochemistry or by ISH. Immunoreactivity to p16 was detected in 11/27 (41%) of the cases. Expression of p16 is seen inconsistently within these neoplasms and does not correlate with the presence of HPV antigens or genes by immunohistochemistry or ISH, respectively. Therefore, p16 is not a reliable surrogate marker for HPV infection in urothelial inverted papilloma. Our findings indicate the absence of HPV in urothelial inverted papillomas. HPV testing should not be used as a diagnostic adjunct for inverted papilloma cases.
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Riley E
authors.initials: RE
authors.lastname: Alexander
authors.forename: Darrell D
authors.initials: DD
authors.lastname: Davidson
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez-Beltran
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montironi
authors.forename: Gregory T
authors.initials: GT
authors.lastname: MacLennan
authors.forename: Eva
authors.initials: E
authors.lastname: Compérat
authors.forename: Muhammad T
authors.initials: MT
authors.lastname: Idrees
authors.forename: Robert E
authors.initials: RE
authors.lastname: Emerson
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000956:Antigens, Viral / Q000032:analysis; D001706:Biopsy; D019941:Cyclin-Dependent Kinase Inhibitor p16; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000032:analysis; D018308:Papilloma, Inverted / Q000737:chemistry / Q000473:pathology / Q000821:virology*; D027383:Papillomaviridae / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000150:complications / Q000378:metabolism / Q000821:virology*; D011237:Predictive Value of Tests; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000737:chemistry / Q000473:pathology / Q000821:virology*; D019459:Urothelium / Q000737:chemistry / Q000473:pathology / Q000821:virology*
chemical_list: D000956:Antigens, Viral; C000614131:CDKN2A protein, human; D019941:Cyclin-Dependent Kinase Inhibitor p16; D004279:DNA, Viral; D009363:Neoplasm Proteins