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Dermatology Board Prep > DERM (11) Infections, Infestations, and Bites > Human Papillomaviruses > Flashcards

Human Papillomaviruses Flashcards

1
Q

What HPV subtypes are most common in palmar/plantar warts?

A

HPV-1, HPV-2, HPV-4, HPV-27, HPV-57

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2
Q

What are the high-risk HPV subtypes?

A

HPV 16,18,31,33,45

16/18 are the big ones

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3
Q

What type of virus is HPV?

A

Double-stranded DNA virus

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4
Q

What are the major structural proteins of the HPV virus?

A

L1 = Major structural protein

L2= Minor structural protein

these are important for binding/entering epithelial cells

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5
Q

What layer of keratinocytes must HPV infect to proliferate?

A

The basal layer keratinocytes

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6
Q

What HPV proteins are responsible for DNA replication and keratinocyte immortalization?

A

Early proteins (E1-E7)= DNA replication + keratinocytes immortalization

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7
Q

What HPV proteins are responsible for virion formation?

A

Late protein (L1-L2): expressed in superficial epidermis and encode structural proteins required for virion formation

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8
Q

Which HPV proteins decrease host immune response and how do they do it?

A

E6 + E7 decrease host immune response (e.g., TLR9 and IL-8)

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9
Q

What HPV proteins are oncoproteins and how are they oncogenic?

A

E6+E7 in high-risk mucosal subtypes are oncoproteins

E6= ubiquitin-mediated p53 destruction –> decreased apoptosis/ increased replication/increased mutations

E7 binds Rb–> loss of inhibition of E2F transcription factor and increased expression of genes important for DNA replication

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10
Q

What levels of the skin have higher levels of L1 and L2 proteins and where can the complete virus be observed?

A

More superficial layers have higher L1 and L2 levels

  • Complete virus is observed in the granular layer and above
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11
Q

What genus of HPV leads to most mucosal and cutaneous HPV?

A

Alpha genus

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12
Q

What cutaneous disease is the beta genus of HPV involved in?

A

Epidermodysplasia verruciformis

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13
Q

The clinical description of common warts (i.e. verruca vulgaris)?

A

Hyperkeratotic papules w/ pinpoint black dots (thrombosed capillaries? some discussion of this)

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14
Q

Most common locations for verruca vulgaris?

A

Fingers, dorsal hands/elbows/knees

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15
Q

What strains of HPV typically lead to verruca vulgaris?

A

HPV-1,2,4,27,57

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16
Q

What disease can HPV-57 be associated with?

A

10 nail dystrophy

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17
Q

What histologic findings are seen in verruca vulgaris?

A
  • “Church spire” papillomatosis + hyperkeratosis
  • Acanthosis (with elongated rete ridges)
  • Hypergranulosis
  • Koilocytosis (granular layer)
  • Increased dermal vessels
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18
Q

What does it mean for a wart to be “myrmecial”?

A

The anthill-like appearance that some plantar warts get

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19
Q

What strains of HPV are associated with plantar/palmar warts?

A

HPV-1, 2, 4, 27, 57

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20
Q

What different features do plantar warts have as compared to verruca vulgaris?

A

Eosinophilic inclusion bodies and “ant hill” piles of keratohylain

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21
Q

What HPV species are associated with flat warts (verruca plana)?

A

HPV-3, 10, 28, 41

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22
Q

The clinical description of verruca plana?

A

Light pink/brown, soft/smooth, slightly raised, occ. Linear flat-topped papules on dorsal hands/face

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23
Q

Who commonly gets verruca plana?

A

These are more common in children; adult women>>adult men. People who shave their legs (koebnerization)

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24
Q

What difference can be seen on histology for verruca plana as compared to another verruca?

A

Less papillomatosis, mild

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25
Q

What are Butcher’s warts?

A

Extensive verruca occurring on the hands in meat/fish handlers

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26
Q

What is the clinical of Butcher’s warts?

A

Extensive verrucous papules or cauliflower-like lesions on the hands

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27
Q

What HPV subtypes are involved in butcher’s warts?

A

HPV-7, 2

28
Q

What HPV subtype is associated with ridged warts?

A

HPV-60

29
Q

Where is the pigmented form of ridged wart more common?

A

Japan

30
Q

What is epidermodysplasia verruciformis?

A

Genetic disorder, Generalized polymorphic papules (generally flat wart-like appearance), on the dorsal hands, neck, face, and extremities, but also scaly pink macules or hypopigmented guttate macules/patches, and seborrheic keratosis like lesions on forehead/neck/trunk

31
Q

What genes are mutated in epidermodysplasia verrcuiformis?

A

TMC6 (EVER1) and TMC8 (EVER2)

32
Q

What HPV-subtypes are associated with epidermodysplasia verruciformis?

A

Genus beta HPV

-HPV-3, 5, 8, 9, 12, 14, 15, 17, 19, 25, 36, 38

33
Q

What HPV subtypes are particularly important in epidermodysplasia verruciformis?

A

HPV type 5 and 8 because these can cause AK’s and SCC in pts w/ risk factors (>30 y/o, sun-exposed areas)

->30 will develop SCC

34
Q

What group of patients is at risk of getting sporadic epidermodysplasia verruciformis-like lesions without a gene mutation?

A

Immunosuppressed patients

35
Q

What is the histology of epidermodysplasia verruciformis?

A

Flat wart-like architecture + cell w/ perinuclear halos and blue-gray granular cytoplasm

36
Q

What is WHIM syndrome?

A

AD

Warts

Hypogammaglobulinemia

Infections

Myelokathexis (neutropenia (2 /2 to myelokathexis*)

Retention of mature neutrophils in the bone marrow

37
Q

What is the gene mutation in WHIM syndrome?

A

Primary immunodeficiency 2/2 CXCR4 mutation

38
Q

What is WILD syndrome?

A

Warts

Immunodeficiency (cellular)

Lymphoma (primary)

Dysplasia (multifocal anogenital)

39
Q

Treatments for verruca?

A
  • Destructive: cryotherapy, ED+C, scissors/shave removal, laser (PDL or CO2)/PDT, cantharidin, and salicylic acid preparations
  • Immunomodulatory/antiviral: (SADE/DPCP) and intralesional immunotherapy [e.g., Candida]
  • 5-FU: (topically w/ salicylic acid usually or intralesional)

Intralesional: 5-FU, Bleomycin or cidofovir gel

40
Q

What is acondyloma cuminata?

A

Genital warts, most common STD

  • Occurs on genitals/perineum/peri-anal/groin/mons/vagina/urethra/anal canal
  • Smooth, sessile, raised, skin-colored to brown lobulated papules
41
Q

What HPV subtypes cause genital warts (condyloma cuminata)?

A

HPV-6, 11, 16, 18 and 31, HPV-33, 45

42
Q

What are the high-risk subtypes of HPV?

A

HPV-16, 18, 31, 33, 45

HIGH YIELD QUESTION

43
Q

What are the risk factors for HPV lesion progression to cancer?

A

HPV type (16 and 18, 31, 33-35)

Location of infection

Cigarette smoking

Uncircumcised status

Immunosuppressed status

44
Q

What component of the HPV virus do the vaccines have in them?

A

Contain L1 major capsid protein: self-assembled into virus-like particles–> allows for development of immunity w/o any harm b/c they do not contain DNA virus

45
Q

What are the 3 types of HPV vaccines?

A

Three types:

Quadrivalent (Gardasil; HPV-6, 11, 16, 18)

Bivalent (Cervarix; HPV 16,18)

9 valent (HPV 6, 11, 16, 18, 31, 33, 45, 52, 58)

46
Q

What is bowenoid papulosis?

A
  • Multiple brown papules/ smooth plaques
  • Located on genitals/perineum/perianal
  • High grade squamous intraepithelial lesions (HSIL) or SCCIS
47
Q

How high of a risk is bowenoid papulosis for progression to SCC?

A
  • High grade squamous intraepithelial lesions (HSIL) or SCCIS
  • Progression to invasive SCC if very rare; a/w high-risk HPV types
48
Q

What is erythroplasia of Queyrat?

A
  • Red smooth plaque
  • On glabrous penis/vulva
  • HSIL or SCIS
49
Q

What is the risk of progression to Eryhtroplasia of Queyrat?

A

Increased risk of progression to invasive SCC; has high risk HPV types (HPV-16 commonly)

50
Q

What type of HPV does Erythroplasia of Queryrat and bowenoid papulosis often have?

A

Contain high-risk HPV types, mostly HPV-16

51
Q

What is the Buschke-Lowenstein tumor?

A
  • Arises on genitals
  • Cauliflower like tumors that infiltrate deeply on external genitals and perianally
52
Q

What four HPV-related cancers are in the verrucous carcinomas group?

A
  1. Buschke-Lowenstein (HPV 6, 11)
  2. Oral florid papillomatosis (HPV-6, 11; RFs: smoking radiation, inflammation)
  3. Epithelioma cuniculatum (HPV-2, 11, 16)
  4. Papillomatis cutis carcinoides
53
Q

Histology of Buschke-Lowenstein tumor?

A

Papillomatous acanthotic epidermis w/ bulbous (“pushing”) downward extending rete ridges; no cellular atypia/ basement membrane penetration

54
Q

What is the treatment for Buschke-Lowenstein tumor and what is the recurrence rate?

A
  • Treatment: excision w/ clear margins
  • Recurrences: frequent, has high morbidity
55
Q

What patients are at higher risk of oral warts?

A

HIV + patients

56
Q

Most common HPV subtypes in oral warts?

A

HPV types 6, 11

In HIV patients there may be unusual strains like 7, 71, 72, 73

57
Q

What is Heck’s disease?

A

Focal epithelial hyperplasia

  • Multiple flat wart-like papules on gingival/buccal/labial mucosa in children

common in South America

58
Q

What are the most common HPV subtypes in Heck’s disease?

A

HPV-13, 32

59
Q

What is recurrent respiratory papillomatosis?

A

Papillomas of the airway

  • # 1 benign tumor of the larynx
  • Presents with hoarseness + stridor + respiratory distress
60
Q

Risk factors for recurrent respiratory papillomatosis in children and adults?

A
  • Childhood: 2/2 to vertical transmission
  • Adulthood: 2/2 genital to oral contact
61
Q

HPV subtypes associated with recurrent respiratory papillomatosis?

A

HPV-6 , 11

62
Q

Can recurrent respiratory papillomatosis progress to SCC?

A

Can progress to SCC, especially in smokers

63
Q

What is oral florid papillomatosis?

A

Large exophytic verrucous tumor of oral cavity

64
Q

What HPV subtypes are a/w oral florid papillomatosis?

A

HPV-6, 11

65
Q

What percentage of warts are expected to resolve w/o treatment in 2 and 3 years?

A

Approximately 66% of warts will self-resolve by 2 years and 75% by 3 years

DERM (11) Infections, Infestations, and Bites (13 decks)

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