title: Vaginal Neoplasia Induced by an Unusual Papillomavirus Subtype in a Woman with Inherited Chromosomally Integrated Human Herpesvirus Type 6A.
abstract: We describe here a case of high-grade vaginal squamous lesion in a 54-year-old woman with a papillomaviruses (HPV) genital infection that developed from a cervical low-grade squamous intraepithelial lesion (SIL) to a high-grade SIL (H-SIL) on cytological examination. A colposcopy exam led to the detection of suspect vaginal lesions with granulomatous infiltrations, which were classified as a Vaginal Intra-Epithelial Neoplasia grade 2 after pathologists' analyses. After a laser vaginal surgery and a loop excision of the transformation zone, the analyses of the anatomical pieces using a near-complete HPV screening panel revealed an HPV-4 infection that was not detected before in cervical smears. This HPV-infection is associated with a high human herpesvirus type 6A (HHV-6A) viral load in the same anatomical piece. The presence of an inherited chromosomally integrated HHV-6A (iciHHV-6A) was proved in this patient by real-time polymerase chain reaction on hair follicles and nail. This case suggests reconsidering both the benign nature of low-grade lesions in the female genital tract and the well-known "good" prognosis of low-risk HPV infection, especially when iciHHV-6A is diagnosed. This clinical course insists on the benefits of the multiplex panel use or global sequencing in order to optimize biological testing sensitivity, and so enhance clinical management of infection-induced neoplasia.
authors.affiliation: Laboratoire de Virologie, Institut des Agents Infectieux, CBN, Groupement Hospitalier Nord, Lyon, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Pichon
authors.forename: Alexandre
authors.initials: A
authors.lastname: Gaymard
authors.forename: Karine
authors.initials: K
authors.lastname: Lebail-Carval
authors.forename: Emilie
authors.initials: E
authors.lastname: Frobert
authors.forename: Etienne
authors.initials: E
authors.lastname: Beaufils
authors.forename: Gautier
authors.initials: G
authors.lastname: Chene
authors.forename: Massimo
authors.initials: M
authors.lastname: Tommasino
authors.forename: Bruno
authors.initials: B
authors.lastname: Lina
authors.forename: Pascal
authors.initials: P
authors.lastname: Gaucherand
authors.forename: Agnès
authors.initials: A
authors.lastname: Gautheret-Dejean
authors.forename: Pascale
authors.initials: P
authors.lastname: Bonnafous
authors.forename: Tarik
authors.initials: T
authors.lastname: Gheit
authors.forename: Annie
authors.initials: A
authors.lastname: Buenerd
authors.forename: Gery
authors.initials: G
authors.lastname: Lamblin
authors.forename: Yahia
authors.initials: Y
authors.lastname: Mekki
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D003127:Colposcopy; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D052689:Gammapapillomavirus; D015654:Herpesvirus 6, Human / Q000276:immunology; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000235:genetics / Q000821:virology; D019349:Roseolovirus Infections / Q000150:complications* / Q000276:immunology; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000473:pathology / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000473:pathology; D014621:Vagina / Q000473:pathology; D014625:Vaginal Neoplasms / Q000473:pathology / Q000601:surgery / Q000821:virology*; D016662:Virus Integration / Q000235:genetics; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000821:virology
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral
keywords: Genital cancer; High-grade SIL; Human papillomaviruses; Inherited chromosomally integrated HHV-6A; Low-grade SIL; Vaginal intra-epithelial neoplasia