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Case Report/Case Series |

Effect of Quadrivalent Human Papillomavirus Vaccination on Oral Squamous Cell Papillomas

Nika Cyrus, MD1; Adam B. Blechman, MD2; Matthew Leboeuf, MD3; Elizaveta A. Belyaeva, MD4; Maurits N. C. de Koning, PhD5; Koen D. Quint, MD, PhD5,6; John J. Stern, MD7
[+] Author Affiliations
1Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
2Department of Dermatology, University of Virginia Health System, Charlottesville
3Department of Dermatology, University of Pennsylvania Health System, Philadelphia
4Department of Pathology, Pennsylvania Hospital, Philadelphia
5DDL Diagnostic Laboratory BV, Rijswijk, the Netherlands
6Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
7Division of Infectious Diseases, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia
JAMA Dermatol. 2015;151(12):1359-1363. doi:10.1001/jamadermatol.2015.2805.
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ABSTRACT

Importance  Cutaneous verruca vulgaris lesions (warts) and oral squamous cell papillomas are common lesions caused by human papillomavirus (HPV). Multiple reports have described cases of wart resolution following quadrivalent HPV vaccination. We report the case of a patient with chronic oral papillomas with resolution after quadrivalent HPV vaccination and perform a review of the literature.

Observations  An immunocompetent man in his 60s presented with chronic verrucous papules on the lips, tongue, and buccal mucosa refractory to multiple excisions. Biopsy showed squamous cell papilloma, and DNA sequencing revealed HPV-32. He received the quadrivalent HPV vaccine resulting in clearance of all lesions after 3 months. We found 8 reported cases of disseminated, recurrent warts with resolution after quadrivalent HPV vaccination. Improvement was seen within 4 weeks of vaccination, and resolution after 3 to 8 months.

Conclusions and Relevance  We report the case of recurrent oral papillomas caused by HPV-32 with complete resolution after quadrivalent HPV vaccination and reviewed reports of resolution of recalcitrant and disseminated warts after vaccination. Production of cross-protective immunoglobulins and cytotoxic T cells is a possible mechanism. There remains a critical need for randomized clinical trials to assess efficacy of quadrivalent HPV vaccination for treatment of oral squamous papillomas and cutaneous verruca vulgaris.

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Figure 1.
Clinical Views of Lesions on Left Buccal Mucosa and Tongue Before and After Quadrivalent HPV Vaccination

HPV indicates human papillomavirus. A, Verrucous oral squamous cell papilloma papules, coalescing in some areas, on the left buccal mucosa before quadrivalent HPV vaccination. B, Complete resolution of lesions on the left buccal mucosa after vaccination.

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Figure 2.
Histopathologic Findings of Excisional Biopsy Specimens From Oral Squamous Cell Papillomas on the Left Buccal Mucosa (Hematoxylin-Eosin)

A, Moderately keratinized exophytic epithelial fronds supported on connective tissue, consistent with mucosal squamous cell papilloma (original magnification ×100). B, Dark nuclei with perinuclear haloes representing koilocytes are human papillomavirus (HPV)-infected cells; infiltrating lymphocytes and neutrophils are also seen (original magnification ×200). C, Three discrete areas of cells (outlined areas; original magnification not reported) were excised from the slide by laser-capture microdissection (LCM) and analyzed for HPV type as described in the HPV Typing subsection, with results summarized herein.

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