Prevalence of human papillomavirus types 16 and 18 in squamous‐cell carcinoma of the penis: A retrospective analysis of primary and metastatic lesions by differential polymerase chain reaction

Human papillomaviruses (HPV), particularly types 16 and 18, may be carcinogenic effectors in a variety of human lower‐genital‐tract malignancies. Using the highly sensitive technique of differential polymerase chain reaction (D‐PCR) with amplimers from the E6 open reading frames of HPV types 16 and 18, a retrospective analysis of a 20‐year institutional experience with squamous‐cell carcinoma of the penis (SCCP) was performed to determine the prevalence of these HPV types in this malignancy. Paraffin‐embedded surgical specimens of primary (N = 27), locally recurrent (N = 5), and metastatic deposits (N = 26) from 29 patients with invasive SCCP were analyzed, as well as primary (N = 3) and recurrent (N = 2) specimens from 2 patients with penile carcinoma in situ (CIS) (Bowen's disease). Nine of the 29 (31%) patients had invasive SCCP containing HPV 16 or 18 DNA, with HPV 16 found in 8 (28%) and HPV 18 in I (3%); no patient had both. In 7 patients in which only tissue from metastatic sites was available, 2 had HPV 16 detected in 2 separate metastatic sites each. Specimens from both primary and metastatic sites were available in an additional 6 patients, and HPV 16 was defected in specimens from 3 of these 6 patients. HPV was detected in comparable copy number at both sites in each patient, indicating that HPV DNA may be a stable component within cancer cells during disease progression. Of patients with CIS only, I of 2 was positive for HPV 16, and upon multifocal recurrence, showed persistence of the virus at 2 separate sites. Southern blotting was performed to confirm the presence of type‐specific HPV DNA and showed complete concordance with D‐PCR, but discordant hybridization intensities for HPV 18 were noted between the control and positive patient specimens; sequence analysis of the patient specimen revealed 4 point mutations in the HPV‐18 target segment. Comparison of the HPV‐positive (both HPV 16 and HPV 18) and HPV‐negative groups revealed no statistical differences between groups in patient age or ethnic origin, tumor histologic grade, or incidence of nodal involvement. Kaplan‐Meier analysis of both overall and cause‐specific survival likewise was not different between groups. These data, particularly the presence of HPV in metastatic deposits, provide strong evidence for an etiologic role of HPV type 16 (and possibly 18) in a substantial sub‐set of patients from the southeastern United States who developed SCCP.