Humane Papillomaviren bei Kopf-Hals-Karzinomen

Zusammenfassung

Humane Papillomaviren (HPV) können Kopf-Hals-Karzinome verursachen. Typische Lokalisation HPV-assoziierter Kopf-Hals-Karzinome ist der Oropharynx und hier besonders die Gaumen- und Zungengrundtonsille. Es ist unklar, ob HPV auch an der Karzinomentstehung anderer Kopf-Hals-Lokalisationen beteiligt sind. Für die maligne Transformation sind die Virusproteine E6 und E7 verantwortlich. Neben anderen Wirkungen hemmen sie funktionell p53 und das Retinoblastomprotein. Im Gegensatz zu Kanzerogenen, wie z. B. Tabakrauch, werden die jeweiligen Gene durch das Virus nicht verändert. Der Nachweis an Gewebeschnitten erfolgt entweder direkt durch In-situ-Hybridisierung oder indirekt über den immunhistochemischen Nachweis von p16. Der Nachweis von HPV in einem Tumor beweist nicht deren Kausalität für die Entstehung dieses Tumors. HPV sind in 10–20% auch in normaler Kopf-Hals-Schleimhaut nachweisbar. Unabhängig von der Therapiemodalität haben HPV-assoziierte Kopf-Hals-Karzinome eine bessere Prognose. Der HPV-Nachweis spricht nicht gegen eine chirurgische Therapie.

Abstract

Human papilloma viruses (HPV) may cause head and neck squamous cell carcinomas. HPV associated carcinomas mostly occur in the oropharynx and particularly in the palatine tonsil and base of tongue. Carcinomas at other sites are infrequently caused by HPV. The viral proteins E6 and E7 are crucial for malignant transformation. They functionally interfere with cellular proteins maintaining genomic integrity such as p53 and cell cycle control such as retinoblastoma protein. However, unlike carcinogens such as tobacco smoke, the virus does not disrupt the coding genes. Reliable HPV detection methods in histological specimens include in situ hybridisation of high risk DNA and immunohistochemical detection of p16. HPV positivity does not proof a causal relation between HPV and tumour. High risk HPV are also detectable in 10–20% of normal mucosal specimens. Irrespective of the various modalities available for treatment, HPV associated head and neck cancers have a better prognosis than their carcinogen caused counterparts. HPV positivity does not object to surgical treatment.

Schlüsselwörter

Kopf-Hals-Karzinome - Humane Papillomaviren - Kanzerogenese

Key words

head and neck cancer - human papilloma virus - carcinogenesis

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