Vaginal Neoplasia Induced by an Unusual Papillomavirus Subtype in a Woman with Inherited Chromosomally Integrated Human Herpesvirus Type 6A

Gynecol Obstet Invest. 2017;82(3):307-310. doi: 10.1159/000470907. Epub 2017 Apr 6.

Abstract

We describe here a case of high-grade vaginal squamous lesion in a 54-year-old woman with a papillomaviruses (HPV) genital infection that developed from a cervical low-grade squamous intraepithelial lesion (SIL) to a high-grade SIL (H-SIL) on cytological examination. A colposcopy exam led to the detection of suspect vaginal lesions with granulomatous infiltrations, which were classified as a Vaginal Intra-Epithelial Neoplasia grade 2 after pathologists' analyses. After a laser vaginal surgery and a loop excision of the transformation zone, the analyses of the anatomical pieces using a near-complete HPV screening panel revealed an HPV-4 infection that was not detected before in cervical smears. This HPV-infection is associated with a high human herpesvirus type 6A (HHV-6A) viral load in the same anatomical piece. The presence of an inherited chromosomally integrated HHV-6A (iciHHV-6A) was proved in this patient by real-time polymerase chain reaction on hair follicles and nail. This case suggests reconsidering both the benign nature of low-grade lesions in the female genital tract and the well-known "good" prognosis of low-risk HPV infection, especially when iciHHV-6A is diagnosed. This clinical course insists on the benefits of the multiplex panel use or global sequencing in order to optimize biological testing sensitivity, and so enhance clinical management of infection-induced neoplasia.

Keywords: Genital cancer; High-grade SIL; Human papillomaviruses; Inherited chromosomally integrated HHV-6A; Low-grade SIL; Vaginal intra-epithelial neoplasia.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Viral / blood
  • Cervical Intraepithelial Neoplasia / pathology
  • Cervical Intraepithelial Neoplasia / virology
  • Colposcopy
  • DNA, Viral / analysis
  • Female
  • Gammapapillomavirus
  • Herpesvirus 6, Human* / immunology
  • Humans
  • Middle Aged
  • Papillomaviridae / genetics
  • Papillomavirus Infections / diagnosis
  • Papillomavirus Infections / genetics
  • Papillomavirus Infections / virology
  • Roseolovirus Infections / complications*
  • Roseolovirus Infections / immunology
  • Squamous Intraepithelial Lesions of the Cervix / pathology
  • Squamous Intraepithelial Lesions of the Cervix / virology
  • Uterine Cervical Neoplasms / pathology
  • Vagina / pathology
  • Vaginal Neoplasms / pathology
  • Vaginal Neoplasms / surgery
  • Vaginal Neoplasms / virology*
  • Virus Integration / genetics

Substances

  • Antibodies, Viral
  • DNA, Viral