title: Evidence that human papillomavirus causes inverted papilloma is sparse.
abstract: BACKGROUND
  Controversy exists regarding the pathogenesis of inverted papilloma as it relates to the involvement of human papillomavirus (HPV). The purpose of this report is to describe the prevalence of HPV in nondysplastic, "early inverted papilloma" and to summarize HPV detection rates in the general population and in other HPV related neoplasia.
  
  
  METHODS
  This case series report characterizes consecutive inverted papilloma patients from January 2005 to August 2012 with regard to smoking history, dysplasia, and HPV detection rates. Presence or absence of low/high risk HPV was determined by standardized in situ hybridization DNA probes. Medline literature review was performed to determine the prevalence of HPV in inverted papilloma without moderate or severe dysplasia.
  
  
  RESULTS
  Thirty-six consecutive patients were identified with an average age of 63.6 (range, 40-84) years; gender: 23 men, 13 women. More than half (55%) were active or former smokers (14% active and 41% former). High/low risk HPV was present in 1 in 36 (2.7%) patients and 1 in 36 (2.7%) had mild dysplasia. In the literature review: (1) HPV was detected in 16.4% of inverted papilloma without dysplasia; (2) oral cavity HPV detection was 4.2% to 11.4% in the normal population; and (3) HPV was normally detected in 85% to 95% of HPV-related neoplasia.
  
  
  CONCLUSIONS
  Given histological features of inverted papilloma and comparatively low detection rates of HPV in inverted papilloma without dysplasia (2.7%), as well as the summary of the world literature, HPV is not related to the initial pathogenesis of inverted papilloma or inverted papilloma's tendency to persist or recur. It is postulated that since inverted papilloma is more an inflammatory polyp, it is susceptible to secondary HPV infection because of its metaplasia. Tobacco and other causes of respiratory epithelium remodeling are more plausible explanations for the initial tissue transformation to inverted papilloma.
authors.affiliation: Department of Otolaryngology, Division of Rhinology and Skull Base Surgery, University of Florida, Gainesville, FL.
authors.forename: Jeb M
authors.initials: JM
authors.lastname: Justice
authors.forename: Kern M
authors.initials: KM
authors.lastname: Davis
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Saenz
authors.forename: Donald C
authors.initials: DC
authors.lastname: Lanza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052685:Alphapapillomavirus / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018308:Papilloma, Inverted / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D015995:Prevalence; D012307:Risk Factors; D014481:United States
keywords: HPV; Schneiderian; dysplasia; everted papilloma; human papillomavirus; inverted papilloma; metaplasia; papilloma; squamous cell carcinoma; tobacco smoke