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

• Published in: Gynecologic and obstetric investigation Vol. 82; no. 3; p. 307
• Main Authors: Pichon, Maxime, Gaymard, Alexandre, Lebail-Carval, Karine, Frobert, Emilie, Beaufils, Etienne, Chene, Gautier, Tommasino, Massimo, Lina, Bruno, Gaucherand, Pascal, Gautheret-Dejean, Agnès, Bonnafous, Pascale, Gheit, Tarik, Buenerd, Annie, Lamblin, Gery, Mekki, Yahia
• Format: Journal Article
• Language: English
• Published: Switzerland 01.01.2017
• Subjects: 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; Human papillomaviruses; High-grade SIL; Genital cancer; Vaginal intra-epithelial neoplasia; Inherited chromosomally integrated HHV-6A; Low-grade SIL
• ISSN: 1423-002X
• DOI: 10.1159/000470907

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.