The association of human papillomavirus (HPV) with juvenile laryngeal papillomatosis has been well documented. We report two cases of juvenile laryngeal papillomatosis and correlated these cases with presence of HPV, p53 and c-erbB-2 proteins. The first case was a one-year-old male patient and the second a six-year-old female patient. Formalin-fixed paraffin-embedded biopsy specimens were tested for the presence of HPV genome by the technique of in situ hybridisation using wide spectrum and type specific biotinylated probes while the immunohistochemical expression of p53 (D07, 1:50) and c-erbB-2 (DAKO A0485, 1:300) proteins were evaluated with commercially available antibodies. Histologically the tumours in both cases showed papillary configuration of squamous papilloma. The first case detected HPV type 6, HPV type 11 and p53 protein expression while the second case showed only HPV type 6. Both cases of HPV showed positive signals confined to the nuclei in the superficial squamous epithelium. The first case showed p53 positivity seen from the basal region up to one third of the epithelium of laryngeal papillomas and the subsequent recent repeat biopsy showed the positivity of p53 had extended throughout the upper layers of the epithelium. Expression of c-erbB-2 protein was not detected in both cases. These findings were similar as in other studies where follow-up of the cases was recommended since they tend to recur.
Detection of Human Papillomavirus, p53 and c-erbB-2 Protein Expression in Juvenile Laryngeal Papillomatosis: A Report of 2 Cases
Abstrak
Perkaitan antara papilomavirus manusia (HPV) dengan papilomatosis larinks telah lama didokumentasi. Kami melaporkan dua kes papilomatosis larinks dan mengkorelasi kes-kes ini dengan kehadiran HPV, protein-protein p53 dan c-erbB-2. Kes yang pertama ialah seorang pesakit lelaki berumur satu tahun dan kes yang kedua, seorang pesakit perempuan berumur enam tahun. Spesimen biopsi yang berfiksasi formalin dan terbenam-parafin telah diuji secara teknik in situ hibridisasi untuk kehadiran genom HPV. Teknik ini menggunakan prob-prob berbiotin yang spektrumnya luas dan jenis spesifik. Manakala ekspresi imunohistokimia pada protein-protein p53 (DO7, 1:50) dan c-erbB-2 (DAKO A0485, 1:300) dievaluasi dengan antibodi yang terdapat secara komersial. Secara histologi, tumor pada kedua-dua kes ini menunjukkan bentuk papilari pada papiloma skuamus. Kes pertama mengesan HPV jenis 6, HPV jenis 11 dan ekspresi protein p53 manakala kes kedua hanya mempunyai HPV jenis 6. Kedua-dua kes HPV menunjukkan tanda positif terhad di nukleus pada epitelium skuamus superfisial. Kes yang pertama menunjukkan kepositifan p53 yang kelihatan di bahagian basal hingga satu per tiga epitelium papiloma larinks dan biopsi susulan yang terkini menunjukkan kepositifan p53 telah melanjut ke lapisan atasan epithelium. Ekspresi protein c-erbB-2 tidak dikesan pada kedua-dua kes ini. Penemuan ini adalah sama dengan kajian lain di mana pemantauan susulan klinikal pada kes-kes ini disyorkan kerana ia kecenderungan berulang.
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Related Images
 image1.jpg "FIGURE 1: Histological section of laryngeal papillommatosis (Case 1) (Haematoxylin & eosin, a, x20). Cells containing HPV 6 DNA by in situ hybridisation, indicated by the dark-stained nuclei of the superficial cells (b, x40 & c, x400)")
 image2.jpg "FIGURE 2: Layngeal papillomatosis. Histological section from Case 1 showing nuclear staining for p53 protein in the cells within the basal layer, and a few positive cells in the upper epithelial cells. (Immunoperoxidase, a, x 40; b, x400)")
 image3.jpg "FIGURE 3: Laryngeal papillomatosis. Histological section from Case 1 showing nearly diffuse nuclear staining of p53 protein throughout the epithelial thickness (Immunoperoxidase stain, x20)")
