07/16/2009 Condyloma Acuminatum and HPV Infection in the Oral Mucosa of Children

Resident: Jason Hencler
Date: 07/16/2009

Article title: Condyloma Acuminatum and HPV Infection in the Oral Mucosa of Children
Author(s): Liu Lai Kui, PhD; He Zhi Xiu, MD; Li Yi Ning, DDS
Journal: Pediatric Dentistry
Volume #25; Number 2; Page 149,153
Year: 2003


Major topic: Condyloma Acuminatum (CA), HPV
Type of Article: Investigative

Main Purpose:
Investigate the clinicopathological features of oral condylomas in children and condylomatous lesions in their mothers and to determine the mode of transmission as well as the genotype of HPV oral condylomas in children


Overview of method of research:
9 cases of oral CA in children were reviewed clinically and histologically. Mothers of each child accepted histological exam of lesions from the oral cavity or anogenital regions. DNA in-situ hybridization (ISH) was performed with HPV 6,11,and 16/18 probes. Two genital CA were used as positive controls and negative controls consisted of normal oral tissues.


Findings:
Age range of the 9 children with oral CA lesions was 1yr 4mo-6yr and 6 out of 9 of the children were female. Most common location was the palate, with only 2 cases in the commissure. After surgical excision of oral CA only 1 recurred. Seven of nine of the mothers had vulva and/or oral CA during pregnancy. Social evaluation confirmed sexual abuse in 1 girl and probable sexual abuse in another girl. ISH demonstrated HPV 16/18 being positive in 5 out of 9 cases, HPV 6 and 11 for just one case, both HPV 6 and HPV 16/18 for another single case, and one case positive for only HPV 6 and one case being positive for only HPV 11.


Key points in the article discussion:
CA has been reported to occur in the oral cavity but most published instances are in adults. In this study 9 instances of oral CA were found in children in which the lesion appeared at around 3yrs. The most common location of oral CA in children was the palate which differed from adults which are most often located on the lower lip and tongue. Past data indicate that the primary means of transmission in adults is sexual contact with a person infected with HPV. Previous published reports of children with anogenital CA have been authored by clinicians who work with child protection services and have concluded that the majority of children whose lesions appeared after infancy have been sexually abused. So sexual abuse must be considered as a mode of transmission when children present with CA. Perinatal transmission of HPV to infants and toddlers is possible and as most experts agree that HPV lesions seen on the body of a child younger than 1 yr can be the result of vertical transmission from an infected mother. Contrastingly, in this study the lesion had appeared around 3 yrs, so vertical transmission is considered to be unlikely. A surprising finding in this study was that HPV type in CA between same mother and child were different, which suggested that vertical transmission of HPV to the child is rare. This study demonstrates that HPV 16/18 is the most common type found in oral CA in children. Other studies report a high incidence of HPV 6 and 11 in oral CA in adults. This may suggest a lower incidence of these viruses in the oral cavity of children with CA. The one case that recurred was associated with HPV 16/18. Childhood CA caused by low risk HPV 6 and HPV 11 may resolve spontaneously, while chronic HPV infection may be correlated with the high risk types HPV 16/18 that are highly associated with mucosal carcinoma in adults. This suggests that a prolonged follow up is necessary for HPV 16/18 infections in children.

Summary of conclusions:
Most incidences of oral CA in children are caused by HPV 16/18. Sexual abuse is the most common mode of transmission. Prenatal transmission of HPV to children is less common. Genotype, lesion location, and mode of transmission of oral CA in children was different from adults.


Assessment of article:
I thought this was a good article that made some valid points, most importantly, that pediatric dentists should consider sexual abuse as a possibility in a child with oral CA. Different results may have been observed in this study if the sample size was larger although this may not be possible because oral CA in children is not extremely prevalent. More study is needed to investigate the differences in HPV type, location, and mode of transmission between children and those seen in the adult population.