HPV associated dysplasia of the oral cavity

by Jason Wasserman MD PhD FRCPC
May 13, 2024


HPV associated dysplasia of the oral cavity is a precancerous condition in which the squamous cells that cover the inside of the oral cavity begin to show abnormal growth due to infection with the human papillomavirus (HPV). If not treated effectively, this condition can progress to a type of cancer called squamous cell carcinoma.

What causes HPV associated dysplasia of the oral cavity?

The primary cause of HPV associated dysplasia is infection with certain types of HPV, particularly HPV 16 and 18, which are also associated with other cancers like cervical and oropharyngeal cancer. HPV infects the squamous cells of the oral cavity and induces changes that can lead to dysplasia.

What parts of the oral cavity are commonly involved?

HPV associated dysplasia can affect any part of the oral cavity, although the tongue and floor of the mouth are most commonly affected.

Oral cavity

What are the symptoms of HPV associated dysplasia of the oral cavity?

The condition may not present noticeable symptoms in the early stages, but possible signs can include pain, difficulty swallowing, unexplained lumps, or changes in the appearance of the oral mucosa. Lesions may appear slightly raised, white, or red in color.

How is this diagnosis made?

The diagnosis of HPV associated dysplasia is typically made through a biopsy of the affected tissue. This sample is examined under a microscope to assess the presence and degree of dysplasia. Additionally, the presence of HPV RNA or DNA may be confirmed through molecular testing tests such as in situ hybridization (ISH) or polymerase chain reaction (PCR).

Microscopic features

Microscopically, HPV associated dysplasia is characterized by abnormalities in the squamous cells, pleomorphism (variation and cell size and shape), increased nuclear-to-cytoplasmic ratio, hyperchromatic nuclei, and possibly increased mitotic activity. The architectural organization of epithelium may also be disrupted.

Grading of HPV associated dysplasia

Unlike HPV-independent dysplasia, HPV associated dysplasia of the oral cavity is not graded because grade has not been shown to accurately correlate with the risk of developing cancer.

p16 testing in HPV associated squamous dysplasia

p16 is a protein that is commonly overexpressed in cells affected by HPV. Pathologists test for p16 as a biomarker for HPV associated dysplasia and cancers because its presence strongly correlates with HPV infection. Overexpression of p16 in the cells of a biopsy is used to support the diagnosis of HPV-related pathology. The test for p16 can be particularly useful as it helps differentiate HPV-associated lesions from other conditions that are not related to HPV.

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