Original articleDetection of human papillomavirus in esophageal and gastroesophageal junction tumors: A retrospective study by real-time polymerase chain reaction in an instutional experience from Turkey and review of literature
Introduction
Esophageal cancer is a rapidly progressive and poor-prognosis disease with late manifestation [1]. It ranks eighth among all types of cancer with a prevalence rate of 4.2% [2], [4]. The most common tumor type of esophageal cancer is squamous cell carcinoma (SCC) followed by adenocarcinoma [2], [5], [6]. These two tumor types account for the great majority of esophageal cancers, and there are significant epidemiological/etiological differences between them [2], [3], [7]. Whilst SCCs are more prevalent in the eastern countries and developing countries, the incidence of adenocarcinomas, which were less prevalent in the recent years, increases by 5–10% each year particularly in the industrialized western countries [3]. This tumor, which appears at the age of 65 years in average, shows male predominance particularly for adenocarcinomas. Its incidence shows variation among countries, as well as among geographical regions in the same country. Countries where the disease is more prevalent include China, Japan, Korea, India, Singapore, South Africa, Russia, Turkmenistan and Iran. Esophageal cancer, which has low-moderate risk in Turkey, is more prevalent especially in the Eastern Anatolian Region [3], [7], [8]. The etiology of esophageal carcinomas includes tobacco and alcohol consumption, local environmental and nutritional carcinogens, vitamin and mineral deficiencies, achalasia, tylosis, caustic stenosis, celiac disease, Plummer–Vinson syndrome, gastro-esophageal reflux (GER), Barrett's esophagus (BE) and Human Papillomavirus (HPV) [5], [8].
HPV is worldwide one of the most common sexually-transmitted agents in both females and males. The exact incidence and prevalence are not known since it is not a disease of mandatory reporting. It is agreed that HPV infection is an effective factor in the carcinogenesis of cervix uteri, skin, oral cavity, pharynx, larynx, and anogenital system tumor [6], [9], [10]. Although the relation between HPV infection and esophageal cancer has been identified in many regions of the world, the role of HPV infection in the etiology of esophageal cancer is not clear in Turkey, particularly in our region.
The present study aimed to detect the prevalence of HPV-DNA in the esophageal cancers in our region, to determine which types are more prevalent in the patients from whom HPV-DNA was isolated, and to evaluate the relation with clinico-pathological data.
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Patients
Hematoxylin & Eosin stained preparations of a total of 52 cases, of which esophagus and gastric resection materials had been examined between 2000 and 2013 at Kocaeli University Faculty of Medicine, Department of Pathology and 33 had been diagnosed with SCC whereas 19 had been diagnosed with adenocarcinoma, were retrospectively evaluated. Averagely 10 sections in 5-micron thickness were obtained from the selected paraffin blocks and were examined to detect the presence of HPV infection by
Results
Of the 60 cases enrolled in the study, 33 had been diagnosed with SCC and 19 had been diagnosed with adenocarcinoma, whereas remaining eight were the control cases. Of the overall cases with esophageal and gastroesophageal region carcinoma, 19 (36.5%) were female, 33 (63.5%) were male, and the mean age was 61.92 ± 11.72 years (range: 20–78 years); 59.6 ± 13.1 years for the cases with SCCs and 65.95 ± 7.5 years for the cases with adenocarcinomas. The mean tumor size was 4.96 ± 2.38 cm.
With regard to the
Discussion
The relation between HPV infection, which was defined in 1907 as the agent of wart and considered to be an effective factor for tumor carcinogenesis in many organs, and esophageal carcinoma was first identified in 1982 [4], [6], [9], [12], [13]. Today, it is a contradictory opinion although it is generally thought that HPV infection has a role in the etiology of esophageal SCCs [10]. In the literature, the rate of HPV isolation in esophageal cancers changes between 0 and 100%, and this
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